900 Side-lying Kangaroo care: all the benefits whilst still maintaining midline head positioning

Aims

Extremely premature infants are at higher risk for intracranial ischaemic and haemorrhagic injuries, which often occur in the first 72 hours after birth.¹ Intraventricular haemorrhages (IVHs) are associated with increased risk of death and adverse neurodevelopmental outcomes.² There are various postnatal strategies aimed to reduce IVH risk, including midline head positioning. Maintaining a midline (neutral) position is thought to avoid jugular venous obstruction, reduce ipsilateral venous congestion, thus potentially lower the risk for IVH.³ For extremely preterm babies, Kangaroo Care (skin-to-skin), offers a wide range of benefits including decreased mortality, an improvement in physiological parameters, pain-relief, and improved long-term developmental outcomes.⁴ It also empowers parents to play a role in their baby's care; improves bonding and increases breast-milk supply. The traditional method of carrying out Kangaroo care involves the baby's body being placed on a parent's chest with their head turned to one side; therefore is not kept in the midline as recommended for IVH early prevention care. Our objective was to find a method that allows the positives of Kangaroo care while reducing the risk of IVH by keeping the baby's head in the midline position.

Methods

We implemented a method of carrying out Kangaroo Care in side-lying position in the early management of extreme preterm babies, which ensures the baby's head is kept in the midline during skin-to-skin. As part of IVH prevention bundles, nurses and medical staff were educated on how to perform side-lying kangaroo care with clinically stable extreme preterm babies in the first 72 hours of their life. Education was incorporated into the unit's simulation training and photos were displayed showing the correct positioning (figures 1 and 2).

Results

Feedback from staff and parents who had been involved in side-lying kangaroo care has been very positive. It is felt that the practice is aligned with the Family Integrated Care and developmental care cultures, whilst being clinically safe. Parents reported early Kangaroo care aided bonding and enhanced their breast-milk production.

Conclusion

Kangaroo Care in extreme preterm babies in the first 72 hours of life can be carried out safely using the side-lying technique. This allows babies and parents to experience the benefits of Kangaroo Care, whilst still maintaining the principles of IVH prevention with regards to midline positioning of the head. Staff education can ensure that side-lying Kangaroo Care can be carried out safely. Figures 1 & 2: Manikin baby is nursed side-lying to allow the head to remain in midline position during Kangaroo Care as part of unit teaching aid.

References

Gross M, Engel C, Trotter A. Evaluating the effect of a neonatal care bundle for the prevention of intraventricular hemorrhage in preterm infants. Children 2021;8:257. Mukerji A, Shah V, Shah P. Periventricular/Intraventricular hemorrhage and neurodevelopmental outcomes: a meta-analysis. Pediatrics 2015;136(6):1132–1143. Ryan M, et al. Neuroprotection from acute brain injury in preterm infants. Paediatric Child Health 2019;24(4):276-282. Campbell-Yeo, et al. Understanding kangaroo care and its benefits to preterm infants. Paediatric Health Med Ther 2015;6:15-32.