Why Kangaroo care is good for premature babies

Susan Sabano, 30, was seven months pregnant when she went into premature labour. At the time, she was working as a health assistant at Kayunga hospital. That was in early 2013. The labour pain was accompanied by light bleeding. Sabano did not know how to manage the problem, so she decided to consult the doctors at the hospital.

“It was my third birth and I had been attending antenatal care from the same hospital where I worked. All the tests I had done showed the foetus was developing well,” says Sabano.

At the health facility, doctors decided to carry out surgery to remove the feotus before any complications could occur.

“Fortunately, the baby was removed alive and it weighed two kilogrammes. That was a good weight for a baby who still had two more months in the womb,” she says. Sabano was later advised to use the Kangaroo mothercare method, to help the baby grow.

“I was told to use thick clothes to wrap the baby around my chest as a way of keeping it warm,” she adds. Sabano was also advised to clean the baby using a piece of warm cloth, instead of bathing it in water.

She used the Kangaroo method for two months, until the baby was ready to live a normal life on its own. Today, the now one and a half year-old baby girl who was once a delicate premature, is a happy, bubbly child. “She is healthy and has not experienced any health complications so far,” she adds.

Over 10 years ago, if a mother gave birth to a premature baby, it had little chance of surviving. This, however, is slowly changing today. Apart from being put in an incubator, a child who is born as a premature can survive through what is known as Kangaroo mothercare.

When is a child a premature?
Dr Margaret Nakakeeto, a neonatologist newborn specialist and private consultant, says about 10 per cent of babies born annually in Uganda are premature or preterm.

This means that they are born before their expected date of delivery, with some weighing only between 700 and 800 grammes.

Pregnancy is called full term when it is between 37 and 40 weeks. Any baby who is born before that period is considered a premature or preterm.
When a baby is born as a premature, the three major concerns are ensuring it feeds, breathes well and its body temperature is regulated.

This is because premature babies often have underdeveloped immune systems and experience metabolism problems due to under developed body organs such as the liver and heart.

Breathing
This is another common problem among premature babies, as their respiratory systems are usually not developed enough to function on their own. Difficulty in breathing can also be caused by lack of surfactant, a substance that reduces surface tension in the lungs, which subsequently help the baby’s respiratory system to develop.

Production of surfactant does not begin until a baby is about 32 weeks old in the womb.

In cases where the doctor can predict a risk of a child being born as a preterm, the mother can be injected with steroids to induce early production of surfactant for the baby’s lungs.

“A baby who is born as a preterm can have their lungs injected with surfactant to ensure they develop well. The downside to this method is that it is expensive,” explains Dr Nakakeeto.

Feeding
The feeding process for most premature babies is through a tube because their muscles are too weak and their mouths cannot suckle their mother’s breast. “Because of this, mothers are required to express the milk from their breast before feeding the preterm baby,” adds Dr Nakakeeto.

Temperature regulation
Premature babies lose heat rapidly because they do not have the stored body fat of a full-term infant, and cannot generate enough heat to counter lost heat through the surface of their bodies. If the body temperature falls too low, a condition called hypothermia can occur, leading to breathing problems and low blood sugar levels.

That is why premature babies require additional heat, which can be provided either through an incubator or by the mother through kangaroo care.

With Kangaroo care, a mother places her preterm baby on her chest to ensure its body temperature is regulated using the mother’s body. This practice is commonly known as skin-to-skin body contact. It is a low cost intervention that results in significant improvements in the child’s health.

A baby’s temperature rises by one degree per hour of practicing Kangaroo care.

“When doing Kangaroo care, the baby should wear a cap to reduce loss of warmth through the head,” Dr Nakakeeto advises. She says unlike an incubator, where a health worker has to be present at all times to monitor the child, kangaroo care requires minimum supervision from the health worker.

“I usually prefer mothers who have previously had premature babies to offer advise to new mothers who have the same problem,” says Dr Nakakeeto.

Eight hours daily
Through the Kangaroo method, a mother is required to carry her baby for an average of seven to eight hours daily. They can also choose to sleep with their baby on their chest.

“When a mother uses the Kangaroo method, her body temperature rises naturally and falls with that of the baby,” adds Dr Nakakeeto.

Apart from the warmth, Kangaroo care offers a strong bond between the mother and her child. This also helps the mother to easily identify any problem that may affect the child. “Fathers can also engage in Kangaroo care to relieve the mother,” says Dr Nakakeeto.

Popularizing kangaroo care
In 2000, Dr Nakakeeto started a special care clinic for premature babies at Mulago National Referral Hospital, where Kangaroo care was first taught and applied by mothers to their infants.

Over time, more mothers have been encouraged to bring their premature babies to the clinic. Dr Nakakeeto has also been teaching this method of care to mothers and midwives in several districts across the country.

“The challenge, after teaching women to carryout Kangaroo care is consistent practice on the part of mothers,” she says.

Currently, Kangaroo mother care has been endorsed by the World Health Organisation and is a popular method of raising premature babies worldwide.

Survival rate
One of the determinants of the survival rate of preterm babies is the gestation period at birth. “The risk of death is higher when a child is born much earlier than 37 weeks. In this case, the doctor’s focus will be to provide the child with conditions that resemble those in the womb,” says Dr Nakakeeto.

In Uganda, about 33 per cent of annual newborn deaths result from preterm conditions. This means that a high survival rate for premature babies will help reduce the rate of newborn deaths.
State minister for Health, Sarah Opendi says many preterm infants who survive end up with long term health complications, including disability, physical and mental development challenges. Some of the long-term complications include:

Eye problems
These may occur when the retina is detached before the child matures in the womb, leading to vision impairment or blindness.

Neurological damages
This results from poor circulation, insufficient oxygen supply, undernourishment and infections. Premature babies might also contract infections and develop chronic health issues that may present in the long-term.

Other complications may include hearing loss, dental and breathing problems, and delays in physical development. However, Dr Nakakeeto notes, “many of these long-term complications can also occur among full-term babies.”

To prevent such complications, she advises parents of premature babies to give them a lot of fluids, which will help to boost their growth and development at an early age.

Preterm births and how they can be prevented
While most preterm births occur spontaneously, the World Health Organisation says some are due to early induction of labour or caesarean births. Common causes of preterm birth include multiple pregnancies, infections and chronic conditions such as diabetes and high blood pressure.

WHO says more than three-quarters of premature babies can be saved with feasible, cost-effective care, including making available essential care during childbirth and in the postnatal period.

To reduce preterm birth rates, women need better access to family planning and increased empowerment, as well as improved care before, between and during pregnancies.