1. Skin to skin care (Kangaroo care) Rachel Musoke Department of Paediatrics & child Health University of Nairobi UON/KNH MNCH Symposium 7 th February 2014 1Rachel Musoke

2. MBFHI Step 4: initiate breastfeeding within an hour of birth (BFHI 2009) Interpretation: Cut the cord 1 minute after baby is delivered Dry the baby and place baby skin to skin and cover Assist mother to initiate breastfeeding unless there is a justifiable reason not to do so (Behaviour change is needed here) 2Rachel Musoke

3. If you were a preterm what would you choose? Skin to skin care Mother provides: Warmth (adjusted according to the need) Auditory (heart beat & voice) Sensory (touch & silent communication) Sense of belonging Incubator care Incubator provides: Warmth (not always at appropriate level) Auditory (a constant hum ) Sensation only when taking temp & change of diaper) Despair of being abandoned 3Rachel Musoke

4. The need for care 33-37 weeks gestation: warmth; and feeding; prevention of infection 2 28-32 weeks gestation: warmth; feeding; and some respiratory support e.g. O 2 administration or CPAP; prevention of infection <28 weeks gestation: warmth, feeding, intensive respiratory support, prevention of infection (All babies need stimulation) 4Rachel Musoke

5. Structural brain differences at age equivalent to term Very preterm Born 26w GA Image at 40w GA (14 weeks ex utero) Full term Born 40w GA Image at birth: 40w GA Rueckert’s 2003-06 5Rachel Musoke " Adapted from C Schneider's slides, Ahmedabad, India, Oct 2012".

6. Differences in white mater (less myelinated fibers)  Ex. : thinner corpus callosum (link between hemispheres)  This induces lesser installation of interhemispheric dialogue and in turn lesser installation of intrahemispheric specialties and function (insufficient pruning = non maturation of corpus callosum) 6Rachel Musoke

7. What does skin-to-skin do? The greatest disease burden of being born preterm is developmental disabilities that persist for life (Were KNH study) However it has been shown that: Stimulation through KC accelerates autonomic and neurobehavioural maturation Even at 15yr the non KC group showed incomplete myelination (Schneider et al 2012) 7Rachel Musoke

8. What is full KC care? Kangaroo position Exclusive or near exclusive breastfeeding Adequate follow up 8Rachel Musoke

9. Summary of what KC does Cardiorespiratory stabilisation Improves thermoregulation Provides analgesia Reduces maternal stress Promotes early discharge Improves bonding Promotes neurodevelopment 9Rachel Musoke

10. Near term/borderline preterm Most of these are 2000g or more Do not get the benefit of admission to NBU They have problems with thermoregulation & feeding Many are discharged before ensuring ability to feed Often readmitted Watch out for them 10Rachel Musoke

11. Kangaroo care at KNH NBU Introduced 2000 Challenge: Can only do intermittent care for lack of space for full 24hr care But even intermittent care is beneficial (supported by one local and other studies elsewhere) 11Rachel Musoke

12. How do we improve? Start in the delivery room All babies irrespective of size need the skin-to skin care Strengthen KC in NBU by making sure it is done timely – i.e. As soon as the baby stabilises. Initiate breastfeeding early with the hope of establishing the outpatient component of KC 12Rachel Musoke

13. It is doable if we change our mindset and sharpen our skills. No baby is too small for skin-to-skin care. 13Rachel Musoke