Kangaroo Care and Kangaroo Zak

What is Kangaroo Care (KC)?

Kangaroo Care , Skin-To-Skin Contact, and Kangaroo Mother Care are terms that relate to the holding of a diaper clad infant bare-chest to bare-chest, ventral-surface to ventral-surface by the mother, father, or others(Source: USIKC).

The benefits of skin to skin contact in premature and term babies and the parents have been a topic of many research projects.

This method consists of skin to skin contact between the adult and baby, even from the time of birth (from the delivery room or intensive, intermediate o basic care) as soon as possible, the food based on breastfeeding and the early discharge from the hospital. For safer, more comfortable, and longer sessions, use the Kangaroo Zak.

It is well known that while the attention of high –tech medical care is essential, babies have to endure the stress conditions from which they were protected in the womb: noise, light, painful procedures and sleep and wakefulness cycles. All these noxious stimuli affect the development of the neurological system, which is still immature, unable to adequately respond to all this and become attacks that can leave short, medium and long term consequences.

Birth Kangaroo Care Position: During the first hour of life of a healthy baby, when the baby is placed in birth KC position: strictly vertical between the breasts of the mother, and the eye level of the child is at the level of the mother's nipples to reduce the length of the "natural journey" to the first latch and breastfeed.

Kangaroo Position in postpartum and beyond: Infant is placed between the mother's bare breast, strictly vertical and in a prone position, with legs and arms flexed, head in midline and lateral position to allow maximum skin-to-skin exposure. The top of the baby's head is placed a couple of inches lower than the mother's neck. Once the infant is properly positioned, lift the Kangaroo Zak covering the baby up to the level of the learlobe. Make sure the baby's face is uncovered and the nose unobstructed. Baby only wears diaper (no higher than the belly button) and a hat. Socks may be worn if the room is too cold.

The Kangaroo Zak is the one and only ergonomic device especifically designed to avoid accidental falls during Kangaroo Care, and to hold the position and the weight of the baby. It minimizes disruptions, provides proper containment and support leaving the parent's handsfree for resting safely or for other activities.

Parents should hold as long as they can, no less than one hour which is the length of one full sleep cycle. Many sessions a day if necessary and with minimal interruptions, as recommended by The American Academy of Pediatrics, The Academy of Breast Feeding Medicine, UNICEF, the World Health Organization, the Neonatal Resuscitation Program, and the United States Institute of Kangaroo Care.

"Best Practice is Kangaroo Care as soon as possible, for as long as possible, and as uninterrupted as possible"
(Nyqvist et al., 2010, May Acta Paediatrica) Top ^

Kangaroo Care and Kangaroo Zak

Benefits

Benefits for the parents include:

• Enhanced attachment and bonding (Tessier et al., 1998)
• Resilience and feelings of confidence, competence, and satisfaction regarding baby care (Tessier et al., 1998; Conde Agudelo, Diaz Rossello, & Belizan, 2003; Kirsten, Bergman, & Hann, 2001)
• Increased milk volume, doubled rates of successful breastfeeding and increased duration of breastfeeding (Mohrbacher & Stock, 2003)
• Physiologically her breasts respond to her infant's thermal needs (Ludington-Hoe et al., 2006)
• Profoundly beneficial for adoptive parents with critically ill preterm infant (Parker L, Anderson GC. , 2002)

Benefits for the babies include:

• Kangaroo Care reduces neonatal mortality (Conde-Agudelo et al, 2011)
• Less incidence and severity of infection (Charpak N, Ruiz-Pelaez JG, Figuero de Calume Z, Charpak Y., 1997)
• Accelerated autonomic and neurobehavioral development (Feldman R, Eidelman, 2003)
• Promotes self-regulation in premature infants: sleep wake cyclicity, arousal modulation, and sustained exploration (Feldman R, Weller A, Sirota L, Eidelman A., 2002)
  
• Consistently high and stable oxygen saturation levels, lower airway resistance, fewer apnea episodes, and an increased percentage of quiet sleep (Ludington- Hoe, Ferreira, & Goldstein, 1998)
  cambiar el link de "kangaroo mother care" de los teasers a su pagina respectiva sobre el canguro (medicos a medicos y padres a la seccion de padres) a la seccion de medicos Kangaroo Care, por favor ponle las fotos del brochure que ajustes estas haciendo al website?
• Stable temperature within normal thermal zone, heart rate, and respiratory rate (Ludington-Hoe et al., 2010)
  
• Reduced crying associated with painful procedures (Kostandy R, Ludington-Hoe SM, 2008)
  
• Breast milk is readily available and accessible, and strengthens the infant's immune system
  
• The maternal contact causes a calming effect with decreased stress and rapid quiescence (McCain, Ludington-Hoe, Swinth, & Hadeed, 2005; Charpak et el., 2005)
  
• Reduced physiological and behavioral pain responses (Ludington-Hoe, Hosseini, & Torowicz, 2005)
  
• Increased weight gain (Charpak, Ruiz-Pelaez, & Figueroa, 2005)
  
• Enhanced attachment and bonding (Tessier et al., 1998)
  
• Positive effects on infant's cognitive development (Feldman, Eidelman, Sirota, & Weller, 2002)
  
• Less nosocomial infection, severe illness, or lower respiratory tract disease (Conde-Argudelo, et. al., 2003)
  
• Restful sleep (Ludington-Hoe et al., 2006)
  
• Earlier hospital discharge (London et al., 2006)
  
• Possible reduced risk of sudden infant death syndrome (SIDS) (see www.infactcanada.ca)
  
• Normalized infant growth of premature infants (Charpak, Ruiz-Pelaez, & Figueroa, 2005)
  
• May be a good intervention for colic (Ellett, Bleah, & Parris, 2002)
  
• Possible positive effects in motor development of infants (Penalva & Schwartzman, 2006)
  
• The critical stimuli to which the baby is exposed during KC are:
  Vestibular: the chest movement of the breathing of the parent, and walking if allowed
  Tactile: the skin and natural warmth of the parent on the bottom (chest), on the sides (breast of mother), and the back (Kangaroo Zak™)
  Olfactory: the scent of the parent and the maternal breast milk.
  Auditory: by the voices and heartbeat of the parent

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Kangaroo Care and Kangaroo Zak

Kangaroo Care Sessions

To maximize the effectiveness of the Kangaroo Care sessions, parents and caregivers must have some basic knowledge.

Who can be kangarooed: If the baby is in condition to be moved or lifted to be weighed, s/he can be transfered to Kangaroo Care.

Time of holding: No less than one hour per session, and there is no maximum time - the more the better. Since a complete sleep cycle is one hour, it is NOT recommended that the babies are held on kangaroo if the parent cannot hold for at least that long (especially for small preemies as it may cause reverse effects). The stress of the transfer only is outweighed if the baby is held for at least one sleep cycle.

Rule of thumb: preemies are "Kangarooed" for 6 months and full-term babies within one minute from birth until the first feeding and as much as possible for 3 months.

Instructional Video about Skin-to-Skin Contact from the Institute of Neonatology, Belgrade, Serbia, (English subtitles) They use the Kangaroo Zak and the Zakys as the standard of developmental care and to facilitate maturation.

What parents should know before they hold their babies in KC:

 

• Kangaroo Care (KC), Skin-To-Skin Contact (SSC), Kangaroo Mother Care (KMC) are all terms that relate to the holding of a diaper clad infant bare-chest to bare-chest, ventral-surface to ventral-surface by the mother, father, or other caregiver. (Source: USIKC)
  
• Learn the benefits of Kangaroo Care and to distinguish signs of stability of the baby (to request a kangaroo session) and warning signs of instability (to stop the kangaroo session.)
  
• Learn the how to wear the Kangaroo Zak for standing and sitting transfer.
  
• Learn that the Kangaroo Zak can be opened just enough to allow the baby to sniff and explore the mother's breasts, for breastfeeding/pumping, and numerous medical interventions while holding.
  
• Know that they may do the transfer alone, but ONLY after the training and approval of a medical professional.
  
• Learn basic monitor readings, and know what and when to communicate with the staff.
  
• Wear the Kangaroo Zak without anything underneath (bra, shirt, etc.) and with the zippers to the side.  Over it, wear comfortable clothing that easily opens in the front or a hospital gown.
  
• Remove jewelry that might come in contact with the baby.
  
• Refrain from using powder, lotion or perfume on the chest before doing skin to skin care. The baby needs to feel the parent's natural scent.
  
• Be free of any lesions or skin breakdown on the chest.
  
• Take care of their own personal needs (food, fluids, restroom, etc.)
  
• Bring a camera and ask the medical staff to take pictures and/or movies.  After all, it is an important time for them.
  
• With the Kangaroo Zak parents kangaroo for long periods of time, so plan accordingly. Parents are encouraged to sleep (as the baby will help the parent relax and take an effective nap), read (for them or to their children), rest, work or do a craft or scrapbook, write a journal, bring a computer/tablet/phone and watch a movie (don't forget the headphones.) This is also a great time to read the manuals, books, and other resources provided by the hospital.

While kangarooing, you may place The Zaky behind the neck to scent it and warm it naturally. Leave it with the baby when the skin-to-skin session ends to continue to provide developmentally supportive care.

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Kangaroo Care and Kangaroo Zak

Sitting/Standing Transfer with the Kangaroo Zak

When the kangaroo position is applied correctly, it generates better results in the development of the premature infants compared with infants who have not received kangaroo care. 

Kangaroo Zak™ sets limits and contention to babies in kangaroo position ensuring and adequate and continuous skin to skin contact, minimizing the transfer time to/from the chest of the parent, thus decreasing stress and loss of temperature.

With the Kangaroo Zak, the baby always comes first: The baby is properly positioned on the chest of the parent, and only then is when the KC position is secured with the Kangaroo Zak. Moreover, the position of the baby can always be checked by looking at the contour of the baby's body on the fabric, or just by raising the fabric to look at the baby, or by slightly opening the zipper of the Kangaroo Zak. Avoid products where the baby must be "stuffed" down a shirt because if the proper positioning of the baby can be ultimately achieved, it requires more time and handling of the baby (thus more time for the baby to self-regulate and tolerate the transfer).

Instructions for effective transferring:

• For sitting transfer:

 

• The parent wraps the Kangaroo Zak (KZ) around the naked torso and closes it with the zipper to the side (not to touch the baby.
• Either lower the KZ or partially/fully open the zipper and place the baby as described in the KC literature.
• Then lift (or close the zipper of) the Kangaroo Zak so that the baby is comfortably contained. The KZ should be not too loose (needs to provide containment) and not too tight (needs to leave space for breathing).
• Parents may sit upright or recline.
• To return the baby to the bed/issolette, reverse the procedure.  
• Note: Parents may do it alone after proper training and approval by the NICU staff.

• For standing transfer:

• The Kangaroo Zak is placed open flat under the baby and the standing parent leans over to lift the baby from underneath the KZ minimizing transfer time to the chest.
• The nurse wraps the KZ around the naked torso of the parent and closes the zipper.
• Then the parent has the hands free to sit down comfortably.
• To return the baby to the bed/issolette, reverse the procedure.  
  

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