KANGAROO MOTHER CARE (KMC)

Kangaroo mother care (KMC) is a method of care of preterm or low birth weight
(LBW) infants by placing them in skin to skin (STS) contact with mother or other caregiver
in order to ensure optimum growth and development of the infant. It is an alternative
substitute for incubators in the treatment of LBW, with several advantages including: an
effective way to meet the most basic needs of infants: the baby's skin to the mother's skin,
where the mother's body will become the thermoregulator for the baby, babies get warmth
(avoiding babies from hypothermia) (Primadi et al., 2010). There are 4 components of KMC
by the World Health Organization: Early, continuous, and prolonged skin-to-skin contact
(SSC) between the newborn and mother, exclusive breastfeeding, early discharge from the
health facility, and close follow-up at home.
Ray and Martinez in Bogota, Columbia in 1979, introduce kangaroo mother care
(KMC) as an alternative way of LBW treatment in the midst of high LBW rates and limited
health facilities. KMC should be encouraged as soon as possible after birth because it
improves bonding between mother and baby and reduces maternal stress. Some studies have
shown that mothers prefer skin-to-skin contact to conventional incubator care since it
increases their confidence, self-esteem, and feeling of fulfillment (Boundy et al., 2016).
When compared with conventional care, KMC is associated with decreased mortality among
newborns who survive to receive it, particularly among LBW infants. Additionally, infants
receiving KMC have improved vital signs, greater head circumference growth, and lower
pain scores (Bernie, 2013).
This method imitates kangaroo marsupial animals whose babies are born are very
premature, and after birth is stored in the mother's abdominal sac to prevent cold and get food
in the form of breast milk (Perinasia, 2012). Position baby in KMS is to place the baby in an
upright position on his mother's chest, between the two breasts of the mother, naked. Babies
are left naked wearing only diapers, socks and hats so that the baby's skin and mother's skin is
as wide as possible. The baby's position is secured with a long cloth or other fastener. The
baby's head is turned to the right or left side, with a slightly upward position (extension). The
end of the binder just below the baby's ears (Primadi et al.,2010).
 Figure 1 Kangaroo Mother Care (KMC) position

There are two types of KMC, continuous and intermittent. Continous KMC is defined as
the practice of skin-to-skin care continuously throughout the day without breaking the contact
between mother and baby. Baby should be in the condition stable and able to have
spontanous and adequte breathing. While intermittent KMC is the practice of skin-to-skin
care alternated with the use of either a radiant warmer or an incubator care for the baby
(Boundy et al, 2016). Infants with severe disease or conditions require intensive and
specialized care in the neonatology ward may even suitable for this method (Bernie, 2013).
Close follow up is a fundamental pre-requisite of KMC practice. Baby is followed
once or twice a week till 37-40 weeks of gestation or till the baby reaches 2.5 to 3 kg of
weight. Thereafter, a follow up once in 2-4 weeks may be enough till 3 months of post-
conception age. Later the baby should be seen at an interval of 1-2 months during first year of
life. The baby should gain adequate weight (15- 20 gm/kg/day up to 40 weeks of post-
conception age and 10 gm/kg/ day subsequently). More frequent visits should be made if the
baby is not growing well or his condition demands (Boundy et al., 2016).
In this case, patient performed KMC by her father, alalternately with her grandmother
or grandfather. The patient’s mother still in the ICU because of the complication after give
birth the patient.

FOLLOW-UP PREPARATION AND CARE-WORK PROCEDURE IN HOME

In general, the criteria for returning preterm and LBW are as follows (Suradi et al.,
2012):
1. The baby is clinically good and stable, no tightness and apnea episodes, stable body
temperature (36.5 - 37.5C) outside the incubator
2. Babies can breastfeed satisfactorily
3. Weight shows a rising tendency (minimum 1800 grams) with an average weight gain up
to 15-30 grams/kg/day
4. Baby can maintain the body temperature in an open crib
5. Mother or family able to care for her baby well, including the implementation of
kangaroo method
If guided by the above, this baby can’t be discharged because it is still in the process
of weaning incubator treatment and the bodyweight is stil less than 1800 grams. But there are
some things that need to be emphasized to parents as preparation are (Suradi et al., 2012):
1. Maintain normal temperature
Infants less than months need to be kept warm and can maintain normal temperature,
which can be done by: (1) Babies should remain dressed (complete with caps) and
blankets at all times and immediately change clothes / diapers when wet; (2)Treatment in
a warm room, not close to windows or air conditioners; (3) Infant care or KMC
continuously and should be done until the baby's weight reaches 2500 grams or the age
of the baby gestation approaching 40 weeks or until the baby is less comfortable with
KMC (Lawn et al., 2010).
2. Immunization plan.
Infants less than 2500 grams of birth weight are given immunization based on
chronological age with the number of full doses same as term infants. Except Hepatitis B
which should given befora discharge or when chronological age ≥ 1 months old, follow up
immunization need to start at 2 months of age.
3. The feeding problems
Infants still has poor coordinate. Mothers should be reassured that the more
breastfeeding the breast milk production will increase and breast milk is the best nutrition
for the baby.
4. Maintain cleanliness and prevention of infection.
Less-than-term babies are particularly susceptible to infections so the emphasis should
be on the care of these patients include maternal cleanliness for the baby, infant body
hygiene, encouraged to breastfeed their babies directly and not to use bottles, but when
using bottles, the cleanliness of the milk bottles should be maintained.
5. Neurodevelopmental problems
Preterm infant is at greater risk of cognitive impairment and long-term development.
The most important thing is encouragement and motivation to parents to monitor the
baby's growth and development regularly. Babies need to be measured in their head
 circumference and body length each week, then plotted on a premature baby's growth
curve until the baby's gestation reaches 40 weeks. When the baby is well enough for the
age of correction, the WHO growth curve for 2006 is based on the age of the correction.
Early intervention of developmental disorders that begin to occur can be said to improve
cognitive output and motor development in the future (Orton et al., 2009).
6. Social support to the family.
The infant's parents are a family of low-middle socio-economic groups and are
already registered as national health insurance members, so they should be able to provide
for infant needs such as the need for infant support, immunization, regular monitoring of
infant growth and other funds if the baby is sick and needs treatment. These infants still
require a series of evaluation so parents need to know the importance of health insurance
for these infants so that all diagnostic plans in infants can be accomplished without
increasing the burden on the elderly.

PROGNOSIS
In general, patients have a good prognosis because in monitoring for 7 days there
were no abnormalities in the eyes and ears. The condition of the patient shows the
development toward the healing so it is concluded the patient's prognosis is as follows:
 Ad vitam: ad bonam.
 Ad sanam: ad bonam.
 Ad fungsionam: ad bonam

REFERENCES
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Kedokteran Universitas Indonesia. Jakarta.
Boundy EO, Dastjerdi R, Spiegelman D, Fawzi, WW, Missmer SA, et al. 2016. Kangaroo mother care
and neonatal outcomes: a meta-analysis. Pediatrics.137(1):2-18.
Lawn JE, Mwansa KJ, Horta BL, Barros, FC, Cousens S. 2010. Kangaroo mother care to prevent
neonatal deaths due to preterm birth complications. Int. J. Epidemiol. 39(1) : 144-154.
Orton J, Spittle A, Doyle L, Anderson P, Boyd R. 2009. Do early intervention programmes improve
cognitive and motor outcomes for preterm infants after discharge? A systematic review’,
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