Kangaroo Care: Why Does It Work?
by Holly Richardson
© 1997 Midwifery Today, Inc. All rights reserved.
[Editor's note: This article first appeared in Midwifery Today Issue 44, Winter 1997.]
By the early 1980s, the mortality rate for premature infants in Bogota, Colombia
was 70 percent. The babies were dying of infections and respiratory problems as well
as lack of attention paid to them by a bonded parent. "Kangaroo care" for these infants
evolved out of necessity. Mothers of premature infants were given their babies to
hold twenty-four hours a day-they slept with them and tucked them under their clothing
as if in a kangaroo's pouch. If a baby needed oxygen, it was administered under an
oxygen hood placed on the mother's chest.
Doctors who conducted a concurrent study of the kangaroo care noticed
a precipitous drop in neonatal mortality. Babies were not only surviving,
they were thriving. Currently in Bogota, babies who are born as early
as ten weeks before their due date are going home within twenty-four hours!
The criteria for these babies is that they be alive, able to breathe on
their own, are pink and able to suck. However, their weight is followed
closely, and they can be gavage-fed if necessary.
Dr. Susan Ludington is one of the people who have been most instrumental
in bringing kangaroo care to the United States. She has been intimately
involved in many research projects, and her work is having a powerful,
positive impact on premature babies and their families. In the United
States, the few hospitals that regularly use kangaroo care protocols have
mothers or fathers "wear" their babies for two to three hours per day,
skin-to-skin. The baby is naked except for a diaper, and something must
cover his or her back—either the parent's clothing or a receiving blanket
folded in fourths. The baby is in a mostly upright position against the
The benefits of kangaroo care are numerous: The baby has a stable heart
rate (no bradycardia), more regular breathing (a 75 percent decrease in
apneic episodes), improved oxygen saturation levels, no cold stress, longer
periods of sleep, more rapid weight gain, more rapid brain development,
reduction of "purposeless" activity, decreased crying, longer periods
of alertness, more successful breastfeeding episodes, and earlier hospital
discharge. Benefits to the parents include "closure" over having a baby
in NICU; feeling close to their babies (earlier bonding); having confidence
that they can care for their baby, even better than hospital staff; gaining
confidence that their baby is well cared for; and feeling in control—not
to mention significantly decreased cost!
Why does kangaroo care work? Why are Dr. Ludington and others seeing such phenomenal
results with babies in kangaroo care? What is happening to the baby and the mother
during this time?
One of the first things to happen is that maintenance of the baby's
body temperature begins to depend on the mother, requiring the baby to
use fewer calories to stay warm. Mothers naturally modulate the warmth
of their breasts to keep their infants at the optimal temperature where
babies sleep best, have the best oxygen saturation levels, the least caloric
expenditure, and so forth. Maternal breast temperature can rise rapidly,
then fall off as baby is warmed. As the baby starts to cool, the breasts
heat up again—as much as 2 degrees C in two minutes!
Being next to morn also helps the baby regulate his or her respiratory
and heart rates. Babies experience significantly less bradycardia and
often, none at all. The respiratory rate of kangarooed infants becomes
more stable. The depth of each breath becomes more even, and apnea decreases
four-fold and often disappears altogether. If apneic episodes do occur,
the length of each episode decreases. In my own experience with a baby
in NICU for bradycardia and apnea, I found that both problems disappeared
completely when I was home kangarooing my baby.
During kangaroo care, a premature baby's overall growth rate increases.
This is in part due to the baby's ability to sleep, thus conserving energy
and putting caloric expenditure toward growth. According to Dr. Ludington,
during the last six weeks of pregnancy, babies sleep twenty to twenty-two
hours per day. In a typical NICU, however, they spend less than two hours
total in deep, quiet sleep. Most of that comes in ten or twenty second
snatches. With kangaroo care, the infant typically snuggles into the breast
and is deeply asleep within just a few minutes. These babies gain weight
faster than their non-kangarooed counterparts, and it is interesting to
note that they usually do not lose any of their birthweight.
Researchers have gained significant insight into what happens to an
infant's brain during kangaroo care. Any baby's heart rate and respiratory
rates can be plotted as a sort of artistic drawing. Because premature
infants lack the ability to coordinate their breathing and heart rates,
the rates "plot out" as chaotic. This means with increased demand on the
cardiovascular system, as with crying or fussing, the system does not
respond with a related increase in cardiac output. In other words, the
baby's respiratory rate may increase while crying, but the heart rate
does not. As premies mature, these rates become synchronized, or "coupled,"
resulting in an orderly drawing when the rates are plotted together. The
drawing no longer looks random.
In infants in kangaroo care, researchers found that coupling takes place
after only ten minutes. This hardly seemed possible because it equaled
four weeks of brain development in the "normal" premie. As researchers
studied brain wave patterns of infants in kangaroo care, they found two
significant things. First, there was a doubling of alpha waves—the brain
wave pattern associated with contentment and bliss. Second, they found
that "delta brushes" were occurring. Delta brushes happen only when new
synapses are being formed. So holding the infant skin-to-skin allows his
or her brain to continue its work of developing neural synapses.
Imagine the implications if all infants "at risk" were kangarooed. Dr.
Ludington sums up kangaroo care very aptly by saying "Separation is not
Helping our clients understand their options, including risks, benefits and alternatives,
is a very important part of being "with woman." Knowing enough about kangaroo care
to help them make informed decisions is another important tool for the caregiver's
birth bag. All infants benefit from skin-to-skin contact, breastfeeding, shared sleep
and so forth, but some babies very seriously need kangaroo care. They include premature
infants, infants with low muscle tone or disabilities, high-needs infants, those
with intrauterine growth retardation or those who have a hard time gaining weight.
Midwives would do well to learn the basics of kangaroo care, and where to turn for
further information. Adding Dr. Ludington's book Kangaroo Care to one's library is
a good first step. Being supportive of parents and giving encouragement and positive
reinforcement is also very helpful. Remember that in some instances, kangaroo care
has meant the difference between life and death.
- Ludington-Hoe, S.M. and Golant, S.K. (1993).
Kangaroo Care: The Best You Can Do for Your Premature Infant.
New York: Bantam Books.
- Ludington, S.M. (1997).
Conference presentation, with mention of research in progress.
- Ludington, S.M.
Kangaroo Care Bibliography.
Current to March 1997.
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