Kangaroo Care.

Simply put, kangaroo care is placing a baby, skin-to-skin, on her parent's chest. Studies of the effects of kangaroo care suggest it promotes higher and more stable temperatures, more stable oxygen saturations, decreased oxygen consumption, more frequent quiet sleep, less apnea and few incidences of infection. (1) Infants on vasopressors or who are otherwise unable to tolerate any stimulation may not be good candidates for kangaroo care, however, many very small and young preemies can benefit from it, and certainly more stable NICU patients as well. A micropremie's course may be full of ups and downs; this is not reason to defer kangaroo care. Take advantage of 'good' days by providing this developmentally supportive opportunity for the parents to parent and the baby to benefit. Educate parents to their baby's developmental needs prior to kangaroo care.

Transitioning a vented baby to kangaroo care will require the assistance of your peers (nurses and/or respiratory therapists). The parent should be ready and sitting with a top that opens easily to the front. A recliner is great if one is available. If not, have a foot stool handy for the parent's feet. Offer restroom facilities prior to starting as it is advisable to leave the baby for at least an hour if not two for them to benefit. Check temperature and change diaper first. If a blood gas is going be due, do it first. If feeding, gavage during kangaroo care, not before. Consider the need for a dose of prn sedation or pain medication. Check that everything will reach the parent before beginning the transfer including IV pumps, ventilation circuits and monitor cables. While the baby is slowly lifted and transfered, chest-to-chest and skin-to-skin, to the parent, another staff member should monitor lines to make sure they aren't caught on something or pulled, and a third person is in charge of ensuring the ETT is stabilized during the transfer. Tape the ETT to the parent or the chair to keep it stable and cover baby and parent with a blanket. Similar care should be taken when the baby is transferred back to bed.

Keep the room particularly quiet and dim the lights during kangaroo care; alert uninvolved staff so that they can be respectful of the baby's need for low stim, and the parent's need for privacy. If possible, offer some privacy by pulling curtains or putting up a screen. Check temperatures and suction as needed. When the baby is back to bed, avoid unnecessary caregiving to allow the baby a time out to transition back from kangaroo care.

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Preemie Massage.

For stable babies research has shown preemie massage to to have numerous effects including: increased weight gain, shorter hospital stay, and improved orientation, habituation and motor scores. (1) The studies suggest that weight gain benefits occured when massage therapy was started between 900 and 1500 grams, not later. Because of the improved orientation and socialization of the infant parent-baby interactions may also improve providing longer term benefits. The preemie massage studied consisted of three 5-minute phases done prior to feeds. The first and last phases consisted of stroking with warm hands. The palms were used and each stroke lasted about 5 seconds using moderate pressure. One region was stroked for about 1 minute (twelve strokes) before the next region was stroked. The regions were:

• top of head to neck and back to head
• neck across shoulders and back to neck
• upper back to waist and back to upper back
• hips to feet and back to hips of both legs
• shoulders to hands of both arms

The middle phase consisted of passive flexion and extension while the baby is supine. Six different movements were used on each limb for about 10 seconds ending with both legs done together.

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