Objective: Dr. Gene Cranston Anderson and her team collected the data to be used for this secondary analysis in her current study “Self-Regulatory Preterm Infant Care: Adaptation Postbirth.” The question posed in this secondary analysis is: What are the effects of KC on breastfeeding status in mothers of preterm (32-36 weeks gestational age) infants? The hypothesis is that mother-infant dyads who experience KC, compared to the control infants that receive standard care, will have a higher breastfeeding status, and will breastfeed for a longer amount of time, than the control dyads.
Design: Randomized controlled trial with minimization. Secondary analysis.
Population/Sample/Setting/Years: The original study was conducted at University Hospitals of Cleveland in Cleveland, Ohio, and Kadlec Medical Center in Richmond, Washington. The sample for the secondary analysis consisted of 30 mother-infant dyads in the control group and 36 dyads in the intervention group. Inclusion criteria for mothers included: English speaking, 16 years or older, expected to have a singleton birth, healthy enough to provide KC, and willing to stay at the hospital for five days after delivery if assigned to the intervention group. Mothers were excluded if they had eclampsia, an uncontrolled seizure disorder, severe depression, mental illness refractory to treatment, maternal disease requiring transport to an intensive care unit post-delivery, or were known drug abusers during pregnancy. Inclusion criteria for infants included: 1300-3000 grams at birth, 32-36 weeks gestational age, five minute Apgars of >6, and healthy enough to participate in the KC intervention. Infants were excluded if they had a condition that could prevent KC post-birth or if they were diagnosed with a major cardiac anomaly.
Concepts being studied: KC (or skin-to-skin care) is a nursing intervention that has been generally accepted as safe and used to promote the effective extrauterine adaptation of preterm infants (Anderson, 1999). KC consists of the nude, diapered infant being held upright, skin-to-skin between its mother’s breasts and covered with a blanket or the mother’s clothing. The infant may wear a cap if needed for warmth. This arrangement allows spontaneous breastfeeding (Whitelaw & Sleath, 1985). KC is known to have beneficial physiological and well as psychological effects, and preliminary data indicate its efficacy in the promotion of breastfeeding (Anderson, Dombrowski, & Swinth; 2001). Breastfeeding status is the percentage of breastmilk received by the infant compared to the total amount of feeds. Breastfeeding status was recorded in the original study using the Index of Breastfeeding Status (IBS), a schema developed by the Interagency Group for Breastfeeding (Labbok & Krasovek, 1990). The IBS, as revised for this study, consists of eight categories of breastfeeding status: full (exclusive or almost exclusive, 100%), partial (high, >80%; medium-high, 80-50%; medium-low, <50-20%; or low, <20%), token breastfeeding, or none.
Methods: In the original study, the control group received standard nursery care while in the intervention group the experience of unlimited KC was encouraged. KC mothers were welcome to stay at the hospital for five days after delivery. Breastfeeding status was measured using the IBS every shift while the infant was hospitalized, at hospital discharge, and at every follow-up visit after discharge (6 weeks and 3, 6, 12, and 18 months).
Findings: Chi-Square analysis was done to determine if a difference existed in breastfeeding status between groups. The number of KC dyads compared to control dyads who were still breastfeeding at hospital discharge, 6 weeks, and 3, 6, 12, and 18 months respectively was 30 vs. 20, 18 vs. 13, 14 vs. 6, 9 vs. 1, 3 vs. 0, and 2 vs. 0. Percentage of mothers exclusively breastfeeding at these time points was 72% vs. 62%, 35% vs. 18%, 21% vs. 4%, 9% vs. 4%, 0% vs. 0% and 0% vs. 0%. P values were: .370, .267, .171, .041, .192, and .360.
Conclusions: KC dyads consistently breastfed longer, and more exclusively, reaching statistical significance at 6 months postbirth (p < .041). Clinical significance was apparent at all time points.
Implications: KC is an effective intervention that nurses and providers can implement to increase the duration and exclusivity of breastfeeding in preterm infants.
References Anderson, G.C. Kangaroo care of the premature infant. (1999). In E. Goldson (Ed.), Nurturing the premature infant: Developmental interventions in the neonatal intensive care nursery (pp. 131-160). New York, NY: Oxford University Press.
Anderson, G.C., Dombrowski, M.A.S., & Swinth, J.Y. (2001). Extending kangaroo (skin-to-skin) care to other vulnerable populations. Reflections on Nursing Leadership.
Whitelaw, A. & Sleath, K. (1985). Myth of the marsupial mother: home care of very low birthweight babies in Bogota, Colombia. Lancet, 1, 1206-1208.
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