Dissertations / Theses on the topic 'Kangaroo Mother Care (KMC)'

Philosophiae Doctor - PhD (Nursing)
The number of healthcare institutions that has embraced Kangaroo Mother Care (KMC) as an effective and efficient method of neonatal care especially in Edo State, Nigeria has not multiplied even after more than a decade of its recommendation by the World Health Organisation (WHO) in 2003. Nigeria ranks seventh among the ten African countries where newborns have the highest risk of dying with over 700 newborn deaths per10, 000 live births. This is worrisome because Edo State is one of the 36 states in Nigeria that contribute about 6,700 neonatal deaths to the 255,500 mortality rate recorded in Nigeria annually. This has led to a concern about the knowledge and attitude of the key drivers in neonatal care of simplified methods aimed at reducing neonatal mortality despite previous training efforts. The development of a strategy to enhance the early implementation of the WHO KMC guidelines in all healthcare facilities across the state was therefore conceptualized. Strategies to increase implementation are considered important to the success of KMC because reducing neonatal mortality rate is contextual. This research aimed to explore and describe the application of the KMC guidelines by the nurses, administrators and parents of preterm infants in the care of premature babies and to develop strategies to enhance its early implementation in healthcare facilities in Edo State, Nigeria.

Thesis (MA)--Stellenbosch University, 2004.
ENGLISH ABSTRACT: his review examines the literature on the psychological impact of Kangaroo Mother Care (KMC) on the mother, infant, support personnel and other caretakers. The paper summarizes the findings of the KMC research and considers the implications of it in light of high numbers of premature and low birth weight infants in South Africa. The review briefly considers theories of bonding and attachment adopted in the research and theories on why KMC is effective. The psychological impact of one component of KMC, Skin-to-Skin Care (SSC), used primarily in developed countries to supplement traditional care, has been extensively researched. In contrast, much less research has explored the psychological impact of full KMC programmes in developing countries. Our understanding of the psychological impact of KMC therefore relies predominantly on research from a very different context to the one in which KMC is used. As SSC has been utilised very differently to KMC and in first world settings, it cannot offer mothers or their family reliable information on the psychological demands and benefits ofKMC. Findings: Although KMC appears to offer invaluable physiological benefits and assists in 'humanising' neonatal care in important ways, there is currently very little published research on the short or long-term psychological impact of KMC on the mother, infant, support personnel and other caretakers. On the whole, research findings on the psychological impact of KMC were not conclusive but indicate some positive outcomes for increased maternal sensitivity and confidence, developmental benefits for the infant and an improvement in the clarity of infants' cues and communication with caregiver. Findings on the psychological impact of KMC for support personnel and other caretakers such as the family of the infant are also not conclusive and indicate that more research is necessary. Further research is required regarding cross-cultural experiences of KMC; maternal experiences of depression, anxiety and ambivalence; long-term developmental and attachment outcomes for the infant and the possible preventative value of KMC for maternal and infant mental health.
AFRIKAANSE OPSOMMING: Hierdie hersiening ondersoek die literatuur aangaande die sielkundige uitwerking van Kangaroo Mother Care (KMC) op die ma, suigeling, ondersteunende personeel en ander opsigters. Die artikel is 'n opsomming van die uitspraak van KMC navorsing en oorweeg die gevolgtrekkings daarvan ten opsigte van die hoe getal vroeggebore en lae ligaamsgewig van suigelinge wat in Suid-Afrika gebore is. Die hersiening kyk kortliks na die teorie verbonde aan die binding en gehegtheid van die navorsing en teorie oor hoekom KMC doeltreffend is. Die sielkundige uitwerking van een onderdeel van KMC, Skin-to-Skin Care (SSC), wat meestal in gevorderde lande gebruik word om tradisionele versorg te verryk, is deeglik ondersoek. Inteendeel is ver minder navorsing op die sielkundige uitwerking van volle KMC programme in ontwikellende lande gedoen. Dus is ons begrip van die sielkundige uitwerking van KMC afhanklik op navorsing vanuit 'n ander konteks as die een waarin die eintlik gebruik is. SSC word baie anders benut as KMC, en in eerstewereldkontekste kan dit dus nie veel betroubare inligting op die sielkundige vereistes en voordele van KMC verskaf nie. Bevindings: Al kom dit voor dat KMC waardevolle sielkundige voordele verskaf en help in geboorte nasorg op belangrike maniere, is daar huidiglik baie min navorsing op druk oor die kort- of die langtermyn sielkundige uitwerking van KMC op die ma, suigeling, ondersteunende personeel en ander oppassers. In die algemeen, is die bevindings van navorsing oor die sielkundige uitwerking van KMC nie volkome nie, maar dui positiewe uitslae aan op verhoogde moederlike gevoelens en selfvertroue. Navorsing dui ook ontwikkelingsvoordele vir die suigeling, asook die bevordering van die duidelikheid van sy kommunikasie met die oppasser. Bevindings op die sielkundige uitwerking van KMC op die ondersteunende personeel en ander oppassers, byvoorbeeld familielede van die suigeling, is ook nie volkome nie, en dui die nodigheid van verdere navorsing aan. Verdere navorsing oor die kruiskulturele ervaring van KMC, moederlike ondervinding van moedeloosheid, angs en dubbelsinnigheid is benodig. Langtermyn ontwikkeling en gehegtigheidsake vir die suigeling en die moontlike voorkomende waarde van KMC vir moederlike en suigeling se geestelike gesondheid is ook wel benodig.

Objective: To describe the breastfeeding characteristics of late-preterm infants (LPIs) in a kangaroo mother care unit (KMC). Materials and methods: In a 20-bed KMC unit, the breastfeeding of 73 purposively-selected LPIs’ (mean gestational age: 34.8 weeks) was observed once-off, using the Preterm Infant Breastfeeding Behavior Scale. Participants’ mean age was 9.5 days, mean number of days in the unit was 3.1 days, and mean number of days breastfeeding was 7.5 days on observation. Results: Only 13.7% of participants were directly breastfeeding without supplementary tube-feeding/cupfeeding and 86.3% received supplementary cup-feeding of expressed breast milk. Most participants did not exhibit obvious rooting (83.5%) and although most latched-on (97.3%), those who did, latched shallowly (93%). The mean longest sucking burst was 18.8 (SD: 10.5) and approximately half the participants swallowed repeatedly (53.4%). The mean breastfeeding session duration was 17.8 minutes but most participants breastfed less than 10 minutes (76.7%). No statistically significant associations were found between chronological age and breastfeeding characteristics. A general trend towards more mature behaviors in participants breastfeeding for more days was present for many breastfeeding characteristics. More infants exhibited the most mature behavior for each breastfeeding characteristic when the environment was quiet, rather than noisy and disturbing, except for depth of latching (quiet: 0%, disturbance: 15.2%). Conclusion: LPIs in this sample presented with subtle, moderate breastfeeding difficulties, highlighting their need for breastfeeding support. Further research is required to examine the effect of KMC on breastfeeding in LPIs.
Dissertation (MA)- University of Pretoria, 2017.
Speech-Language Pathology and Audiology
MA
Unrestricted

Philosophiae Doctor - PhD (Nursing)
The number of healthcare institutions that has embraced Kangaroo Mother Care (KMC) as an effective and efficient method of neonatal care especially in Edo State, Nigeria has not multiplied even after more than a decade of its recommendation by the World Health Organisation (WHO) in 2003. Nigeria ranks seventh among the ten African countries where newborns have the highest risk of dying with over 700 newborn deaths per10, 000 live births. This is worrisome because Edo State is one of the 36 states in Nigeria that contribute about 6,700 neonatal deaths to the 255,500 mortality rate recorded in Nigeria annually. This has led to a concern about the knowledge and attitude of the key drivers in neonatal care of simplified methods aimed at reducing neonatal mortality despite previous training efforts. The development of a strategy to enhance the early implementation of the WHO KMC guidelines in all healthcare facilities across the state was therefore conceptualized. Strategies to increase implementation are considered important to the success of KMC because reducing neonatal mortality rate is contextual. This research aimed to explore and describe the application of the KMC guidelines by the nurses, administrators and parents of preterm infants in the care of premature babies and to develop strategies to enhance its early implementation in healthcare facilities in Edo State, Nigeria.

Kangaroo mother care (KMC) was first initiated in Colombia due to shortages of incubators and the incidence of severe hospital infections of new-born infants during hospital stay (Feldman, 2004). Currently it is identified by UNICEF as a universally available and biologically sound method of care for all new-borns, particularly for low birth weight infants (Department of Reproductive Health and Research, 2003) in both developed and developing countries. The Western Cape Provincial Government implemented a policy on KMC as part of their strategy to decrease the morbidity and mortality of premature infants in 2003 (Kangaroo Mother Care Provincial task team, 2003). Essential components of KMC are: skin-to-skin contact for 24 hours per day (or as great a part of the day as possible), exclusive breastfeeding and support to the motherinfant dyad. Successful implementation of KMC requires relevant education of nurses, education of mothers on KMC by nursing staff, monitoring of the implementation of KMC by nurses, planning for a staff mix with varying levels of skill and experience with KMC, the identification of institution specific barriers to the implementation of KMC, and the implementation of institution specific strategies to overcome these barriers (Wallin,et al., 2005
Bergman &
Jurisco, 1994
Cattaneo, et al., 1998). This study aims to determine the knowledge of and attitude towards kangaroo mother care, of nursing staff and kangaroo mothers in the Eastern sub-district of Cape Town.

Aim: The aim of the study was to compare knowledge and attitudes towards Kangaroo Mother Care (KMC) among neonatal unit staff at two neonatal units 2008 and 2010. Method: Members of staff from two neonatal units completed a questionnaire with 22 statements and an open-ended question in 2008 and 2010. The data were analysed with Mann-Whitney U test and content analysis. Results: There were significant differences between unit A and unit B in both the 2008 survey and the 2010 survey, showing better knowledge of KMC and a more positive attitude to KMC in unit A. Content analysis of responses to the open-ended question revealed concerns in unit B that its care environment was not suitable for KMC. Conclusions: Hypothetically, the fact that staff in unit A work in facilities designed to facilitate KMC, receive training in KMC and practice continuous KMC in intensive care as well as in intermediate care, has resulted in good knowledge of KMC and a general improvement of staff attitudes to KMC.

Advances in neonatology have led to increased numbers of high-risk neonates surviving and intensified interest in the developmental outcomes of this population. In the South African context prematurity and low birth weight are the most common causes of death in the perinatal period and the same risk factors that contribute to infant mortality also contribute to the surviving infants’ increased risk for developmental delays. As a result of the interacting biological and environmental risk factors of prematurity, low birth weight, poverty and HIV and AIDS in the South African context Kangaroo Mother Care (KMC) has been developed as best practice to promote infant survival and to facilitate mother-infant attachment. Mother-infant attachment may lead to synchronous interaction patterns between the mother and infant which forms the basis of early communication development. Early communication intervention (ECI) services are recommended as early as possible as high-risk infants are especially at risk for feeding difficulties and communication developmental delays. It is, however, not clear what the content of an ECI programme should be and how it should be implemented according to the changing communication and feeding developmental needs of the infant while receiving KMC. There appears to be a dearth of research on the earliest stages of communication development in high-risk neonates, which should form the foundation of such a programme. A descriptive survey was conducted to describe the development of 25 high-risk infants and their mothers’ changing needs from admission to discharge from a KMC unit. Each participant and mother dyad was followed up over an average of 11 days of data collection with three to four data collection sessions. Data was collected by means of direct observation during routine care-giving activities. The different developmental subsystems of the participants’ feeding, communication, neuro-behavioural organization and mother-neonate interaction were described. The results demonstrated that subtle, but definite changes could be observed in the participants’ development. Development in all the different areas occurred over time as the participants progressed through the three developmental states of the in-turned state, coming-out state and reciprocity state. As the participants progressed during the 11 days of data collection and were increasingly able to attend to their environment, they also developed the ability to regulate and organize their own behaviour in order to develop more complex communication, feeding and interaction skills with their mothers. The functioning of the participants’ sensory systems developed in a specific order namely tactile, auditory and then visual. Although the participants developed consistently throughout their stay in the KMC unit, mother-neonate interaction never reached optimal levels. The importance of an individualized training programme for each mother is reflected in the finding that the neonate’s developmental level and progress needs to be considered when implementing the ECI programme. The need for speech-language therapy involvement in KMC is emphasized in the light of a shortage of practicing speech-language therapists in South Africa. It is therefore imperative that the prevention of communication delays and feeding difficulties in high-risk neonates as well as parent training assume priority.
Dissertation (MCommunication Pathology)--University of Pretoria, 2008.
Speech-Language Pathology and Audiology
unrestricted

Magister Public Health - MPH
Background: Every year, about 20 million infants are born with low birth weight globally, putting a heavy burden on health care and social systems, especially in developing countries as they are often understaffed and/or lack optimally functional equipment. In 1978, Dr E. Rey proposed the Kangaroo Mother Care (KMC) programme which was further developed by coworkers at one of the largest obstetric facilities in Santa Fe de Bogotá, Colombia. KMC was introduced as an alternative to the expensive and seldom used traditional methods to care for low birth weight infants. KMC is currently not practised at Tsumeb district hospital despite many infants born with low weight in the district. Aim: The aim of the study was to explore perceptions regarding the implementation of Kangaroo Mother Care in the maternity ward of Tsumeb district hospital. Study design: This was a qualitative exploratory study. Study population and sampling: The study population are doctors and nurses working in Tsumeb district, the Chief Medical Officer (CMO) as well as the health programme administrators in the family health division of the Ministry of Health and Social Services (MOHSS), Oshikoto region. Purposive sampling was used to select participants. Results: Perceptions were grouped into three main themes namely the parent-related, health worker-related and baby-related. Parent-related perceptions include self-trust, increased competency, less frustration, and active involvement of parents in baby care, which are similar to the literature and regarded as benefits of KMC. Health worker-related perceptions included both reduced workload and an increased workload. Baby-related perceptions are reduced morbidity, increased bonding and improved care. The study also revealed the barriers to KMC implementation as well as factors that can make KMC implementation a success. Conclusions: Three broad themes emerged from the study, parent-related, health worker-related and baby-related. Most of the health workers’ perceptions are similar to the benefits of KMC found in the literature but, some health workers have negative perceptions regarding KMC.

Syfte. Undersöka användningen av kängurumetoden hos extremt för tidigt födda barn. Bakgrund. Kängurumetoden (KM) är en evidensbaserad metod som innebär att barnet bärs hud mot hud på förälderns bröst i upprätt ställning. Metoden har många fördelar för det för tidigt födda barnet och har visat sig vara effektiv för att skapa starka band föräldrar och barn emellan. Forskning visar att det är en säker vårdmetod även för extremt för tidigt födda barn.   Design. En retrospektiv explorativ journalgranskningsstudie med både kvantitativ och kvalitativ ansats. Journaler granskades för de 49 extremt för tidigt födda barn vårdade vid Norrlands universitetssjukhus mellan oktober 2011 och oktober 2013. Metod. Statistiska beräkningar gjordes med icke parametrisk korrelation enligt Spearman och Wilcoxon signed ranks test. I den kvalitativa delen utfördes textanalys av journalanteckningar. Resultat. Medianålder vid kängurudebuten var fyra dagar. De flesta barn kängurudebuterade med mamman, och pappor utövade känguruvård i mindre utsträckning än mammor. Ju tidigare barnet var fött, desto längre dröjde kängurudebuten, men känguruvård har förekommit så tidigt som dag fyra hos de mest för tidigt födda barnen. Slutsats. Neonatalvården har mycket att vinna på om vårdpersonalen lyckas hjälpa föräldrar i allmänhet, och pappor i synnerhet, till att tidigt våga närma sig och känguruvårda sina extremt för tidigt födda barn. Med utbildning och träning för personal och stöd till föräldrarna, kan KM användas i större utsträckning för de extremt för tidigt födda barnen. Kliniska implikationer. Resultaten av denna studie bidrar till insikter och djupare kunskap om användningen av KM för extremt för tidigt födda barn. Resultatet kan användas för att identifiera utvecklingsmöjligheter men även för att utvärdera framtida förbättringsarbete. Kunskapen om och tron på vinsterna med KM kan rädda liv.
Aims. To study the use of the KMC for extremely preterm infants. Background. Kangaroo-Mother care (KMC) is an evidence-based method that involves carrying the infant skin to skin on the parent’s chest in an upright position. The method brings many benefits for the preterm infant and has proven to be effective for creating strong bonds between parents and infants. Research shows that KMC is a safe method even for extremely preterm infants. Design. A retrospective exploratory medical records review using both quantitative and qualitative approach. Medical records were reviewed for the 49 extremely preterm infants cared for at Norrland’s University Hospital between October 2011 and October 2013. Methods. Statistical analysis were made by non-parametric correlation by Spearman and Wilcoxon´s signed ranks test. In the qualitative part text analysis of medical records was performed. Results. KMC onset was in a median age of four days after birth. The kangaroo onset was most often with the mother, and fathers performed less KMC than mothers. The more preterm the infant was born, the later kangaroo onset, but KMC has occurred as early as day four for the most preterm infants. Conclusion. Neonatal care has much to gain if nursing staff succeed in helping parents in general, and fathers in particular, to an early KMC onset. With education and training for staff and support to the parents, KMC can be used for the extremely preterm infants to a greater extent. Relevance to clinical practice. The results of this study contribute to the understanding and deeper knowledge about the use of KMC for extremely preterm infants. The result can be used to identify needs for development, but also to evaluate future improvements. Knowledge of and belief in the benefits of KMC can save lives.

Comprehensive management in the neonatal nursery involves medical treatment of the infant, as well as developmental care and the provision of guidance, counselling and information to the family who are part of the decision-making process regarding the infant’s care. Neonatal communication intervention is of utmost importance in a country such as South Africa, which has an increased prevalence of infants at risk for disabilities and where the majority of these infants live in poverty. Speech-language therapists fulfil an important role in the neonatal nursery and are an integral part of the team involved with the high risk neonatal population. Local literature showed a dearth of information on the current service delivery and roles of speech-language therapists and audiologists in neonatal nurseries in the South African context. From an asset-based perspective it appears that the South African population receiving services in neonatal nurseries have unique characteristics. This provides speech-language therapists with ample opportunity to intervene, providing that intervention is well-timed in the neonatal nursery context. The country-wide initiative to implement the evidence-based technique of kangaroo mother care indicates that speech-language therapists should recognise its importance and develop communication based materials and tools to complement this successful neonatal intervention. The aim of the research was to establish whether speech-language therapists have needs for assessment and intervention tools/materials in this context. The study furthermore aimed to compile a locally relevant neonatal communication intervention instrument/tool for use by speech-language therapists in the neonatal nurseries of public hospitals in South Africa in order to propose a solution to address the shortage of tools in the public health context. The study entailed descriptive, exploratory research. During Phase 1, a survey was received back from 39 speech-language therapists and two audiologists in six provinces. The data revealed that participants performed different roles in neonatal nurseries, which were determined by the environment, tools, materials and instrumentation available to them. Many participants were inexperienced, but were resourceful in their attempts to develop and adapt tools/materials. Participants expressed a need for culturally appropriate and user-friendly instruments for parent guidance and staff/team training on the topic of developmental care. During Phase 2 a tool for parent guidance titled “Neonatal communication intervention programme for parents” was compiled for use by speech-language therapists and justified by participants’ roles and needs as well as current early communication intervention (ECI) literature. The programme was piloted by three participants. Certain suggestions for enhancements of the programme were made such as providing a glossary of terms, adapting the programme’s language and terminology, and providing more illustrations. The programme complied with the guiding principles for best practice in ECI (ASHA, 2008) and can therefore contribute to neonatal care of high risk infants in South Africa. Speech-language therapists and audiologists must contribute to neonatal care of high risk infants to facilitate optimal health and development and to support their families. AFRIKAANS : Omvattende intervensie in die neonatale sorgeenheid behels mediese behandeling van die neonaat, sowel as ontwikkelingstoepaslike sorg en die verskaffing van leiding, berading en inligting aan die gesin wat deel is van die besluitnemingsproses rakende die baba se sorg. Neonatale kommunikasie intervensie is van uiterste belang in Suid-Afrika aangesien daar ‘n hoër prevalensie van babas is wat ‘n risiko het vir ontwikkelingsafwykings en aangesien die meerderheid van hierdie babas in armoede leef. Spraak-taalterapeute vervul ‘n belangrike rol in die neonatale sorgeenheid en is ‘n integrale deel van die span wat betrokke is by die hoërisiko neonatale populasie. Plaaslike literatuur dui op ‘n tekort aan inligting rakende die huidige dienslewering van die spraak-taalterapeut en oudioloog in neonatale sorgeenhede in die Suid-Afrikaanse konteks. Vanuit ‘n bate-benadering kom dit voor of die Suid-Afrikaanse populasie wat dienste in neonatale sorgeenhede ontvang, unieke eienskappe het. Dit bied genoegsame geleenthede aan spraak-taalterapeute om intervensie te verskaf, solank die behandeling betyds in die neonatale sorgeenheid konteks aanvang neem. Daar is ‘n landswye inisiatief om die bewysgerigte tegniek van kangeroe moedersorg toe te pas. Spraak-taalterapeute moet dus die belang daarvan herken en kommunikasie gebasseerde terapiemateriaal ontwikkel om hierdie suksesvolle neonatale intervensie te komplementeer. Die navorsing se doel was om vas te stel hoe wyd spraak-taalterapeute en oudioloe ‘n behoefte aan evaluasie en intervensie instrumente en –materiaal in hierdie konteks het. Die navorsing het verder ten doel gestel om ‘n relevante terapie instrument saam te stel vir spraak-taalterapeute in die neonatale sorgeenhede as ‘n moontlike oplossing vir die tekort aan relevante terapiemateriaal in die plaaslike publieke gesondheidsorgkonteks. Die studie het beskrywende, eksplorerende navorsing behels. Gedurende Fase 1 is ‘n vraelys terug ontvang van 39 spraak-taalterapeute en twee oudioloë in ses provinsies. Die data het aangedui dat deelnemers verskillende rolle in hierdie konteks vervul, wat beïnvloed was deur die omgewing, die instrumentasie en materiaal wat tot hulle beskikking was. Die meerderheid van die deelnemers was onervare, maar was vindingryk in hulle pogings om terapiemateriaal aan te pas en te ontwikkel. Deelnemers het ‘n behoefte vir kultureel toepaslike- en gebruikersvriendelike instrumente en materiaal uitgedruk met die oog op ouerleiding en personeel/span opleiding oor die onderwerp van ontwikkelingstoepaslike sorg. Gedurende Fase 2 is ‘n terapie instrument naamlik “Neonatale kommunikasie intervensie program vir ouers” saamgestel vir die gebruik in die neonatale sorgeenhede deur spraak-taalterapeute. Die samestelling van hierdie program is verantwoord deur die deelnemers se rolbeskrywing en behoeftebepaling van Fase 1, sowel as deur huidige vroeë kommunikasie intervensie (VKI) literatuur. Die program is deur drie deelnemers in ‘n loodsstudie geëvalueer. Voorstelle vir die verbetering van die program is verskaf, naamlik die byvoeging van ‘n terminologielys, aanpassing van die program se taalgebruik en terminologie en verskaffing van meer illustrasies. Die program het ooreengestem met die beginsels vir beste praktyk in VKI (ASHA, 2008) en kan daarom tot neonatale sorg van hoërisikobabas in Suid-Afrika bydra. Spraak-taalterapeute en oudioloë moet bydra tot neonatale sorg van hoërisiko neonate om sodoende optimale gesondheidsorg en ontwikkeling te fasiliteer en gesinne te ondersteun. Copyright
Dissertation (MCommunication Pathology)--University of Pretoria, 2010.
Speech-Language Pathology and Audiology
unrestricted

Background: Kangaroo Mother Care (KMC) is defined as skin-to-skin contact between a mother and her newborn baby, frequent and exclusive or nearly exclusive breastfeeding and early discharge from hospital. This concept was proposed as an alternative to conventional methods of care for low birth weight (LBW) infants, and in response to problems of serious overcrowding in neonatal intensive care units (NICUs). KMC essentially uses the mother as a natural incubator. According to this principle, LBW babies are placed to the mother’s chest in an upright position, where maternal body heat can help control the baby’s body temperature. Although widely used in some parts of the world, this practice is not the norm in the Kingdom of Saudi Arabia (KSA). Aim: The aim was to assess the feasibility and acceptability of running a randomised controlled trial (RCT) to evaluate the effectiveness of KMC in LBW infants in KSA.Study Design: A pilot RCT with supportive qualitative interviews was conducted, underpinned by a post-positivist approach.Methods: This was a mixed methods study. Quantitative methods were used to measure the effectiveness of KMC, and qualitative methods were used to explore women’s and nurses’ experiences of a) KMC and b) trial processes. The study took place in two urban hospitals in Jeddah, KSA. Ethical approval was gained, and data were collected between March and May 2011.The quantitative element comprised a two-group, individually randomised controlled pilot trial with 20 mothers-and-babies per group. The randomisation sequence was computer-generated, and participants were randomised using consecutively numbered, sealed, opaque envelopes. Data were collected using routinely collected case records, specifically designed clinical data sheets and two questionnaires (validated maternal bonding scale and maternal breastfeeding experience questionnaire). For the latter questionnaire, the design was informed by an expectation-fulfilment model. The qualitative element comprised semi-structured interviews, within 48 hours of birth, with a sample of 20 mothers who participated in the pilot RCT and 12 nurses who were attending these mothers. All 40 mothers were also telephoned when their babies were 6 months old to ascertain their feeding method and exclusivity of feeding.Quantitative data were managed using SPSS and analysed descriptively to estimate confidence intervals and effect sizes. Statistical tests and regression models were used to explore associations with potential outcome measures, with findings interpreted with caution as hypothesis-generating rather than hypothesis-confirming, given the small sample size. Qualitative data were analysed manually, using the Framework Approach.Results: The pilot study confirmed that trial processes were efficient, the intervention was acceptable (to mothers and nurses) and that the outcome measures were appropriate; the percentage of women exclusively breastfeeding at 6 months was identified as the most appropriate primary outcome. A large scale trial of KMC would be feasible and acceptable in KSA. However, issues relating to religious and organisational culture would need to be resolved, including improving privacy in the NICU, addressing language issues arising from transcultural nursing and engaging with male partners. A unique finding was the effect of KSA culture on women’s mobility and the impact that this had on their ability to carry out KMC if they were personally discharged but their baby remained in the NICU. Conclusion: A large scale RCT comparing KMC with standard care in KSA is feasible, acceptable and recommended. However, prior to progressing to a large scale study, a thorough planning stage is necessary which considers cultural practices and ward environment. The understandings gained from this research will be transferable to other research within similar settings

Kangaroo Mother Care (KMC) is an alternative model of care that prevents parent-infant separation when preterm infants need neonatal intensive care by skin-to-skin contact between infants and their parents. KMC is also a strategy that involves parents in their infants’ care and enables them to assume the responsibility for the care. Furthermore, KMC promotes parent-infant bonding and attachment. The overall aim of this thesis was to gain a deeper understanding and knowledge about parents’ capacity, willingness, and experiences of KMC and to which extent parents choose to use KMC throughout their infants' hospital stay. These studies were conducted in the NICUs at two Swedish university hospitals (NICU A and NICU B). Mothers of infants cared for at NICU A (n=17) answered a questionnaire about their experiences of KMC (Paper I). Twenty parents of infants cared for at NICU A recorded the duration of each KMC session during a period of 24 hours and the identity the KMC provider (Paper II). Seven fathers were interviewed about their experiences of KMC (Paper III) and 76 mothers and 74 fathers completed a questionnaire about what facilitated or rendered it difficult to perform KMC (Paper IV). The time of initiation of KMC and duration in minutes, and the identity of the KMC providers was recorded continuously during the infants’ (n=104) hospital stay: 83 mothers and 80 fathers also completed a questionnaire during their infants’ hospital stay (Paper V). This thesis provides new knowledge about parents’ practice of KMC, also continuously day and night, in a high tech NICU in an affluent society, with good resources for infant care in an incubator by trained staff. The accuracy of parents’ records of KMC were comparable to nurses’ records. The results indicate that parents want to be together with their infant in the NICU and be actively involved in the infants’ care. Although parents may experience KMC as exhausting and uncomfortable, they still prefer KMC to conventional neonatal intensive care as it supports their parental role. Early initiation of KMC after birth appears to result in a longer total duration of KMC during the infants’ hospital stay.

Introduction: Preterm delivery remains the major cause of newborn infants’ morbidity and mortality globally and more so in low-income countries like Eritrea. Research has shown that the provision of Kangaroo mother care (KMC) can contribute to a reduction in morbidity and mortality among newborn infants. However, there is limited research on the practice of KMC in Eritrea. Methods: A mixed methods approach was adopted in a phenomenographic study to collect the data. Eleven participants with work experience of at least two years were recruited from the Specialised Neonatal Intensive Care Unit (SNICU) at Orotta Paediatric Hospital (OPH), Asmara, Eritrea. Data were collected via individual interviews and observations. Results: The results showed that participants had no prior KMC training and education. In addition, staff had limited knowledge and mixed attitudes about KMC practice. There were also no KMC guidelines and protocols. Furthermore, space was not adequate for full KMC practice except for implementation of the kangaroo position. The researcher’s observation confirmed similar evidence of a lack of availability of a KMC ward and lack of protocols and guidelines. Limited interaction and communication about KMC between participants and parents was also observed. Some of the most common hindrances to KMC practice were the perception that KMC increased staff work load and that it was time consuming. In addition, lack of regular KMC training for staff, lack of a convenient setup and too few staff members were among the hindrances. One staff members also perceived that KMC practice was not culturally accepted. 15 Conclusion: The results of this study showed that there were no proper KMC guidelines and protocols in the ward. In addition, only the kangaroo position was practiced, not the full KMC protocol. Furthermore, staff had limited knowledge and mixed attitudes. The observation component of the research highlighted the lack of space and KMC protocols and guidelines as key limitations for delivering KMC. Therefore, it is recommended that a programme to improve staff knowledge be implemented, that evidence-based KMC guidelines and polices be made available, that the KMC ward be expanded, and that health education about KMC practice be brought to the population through mass media

Background: Over 15 million preterm babies are born annually and are the leading contributor to neonatal deaths. Kangaroo Mother Care (KMC), incorporating skin-to-skin care, breastfeeding, early discharge and close follow up, decreases morbidity and mortality in preterm and low-birth-weight infants. Few recent South African studies have looked at outcomes of KMC beyond the neonatal period. Aim: The primary objective was to describe the post-discharge clinical course of KMC infants over six months. The secondary objectives were to correlate neonatal and maternal characteristics pre-discharge to outcomes – mortality and morbidity. Setting: George Hospital is the regional hospital for the Eden and Central Karoo districts, with its tertiary referral centre 400km away in Cape Town. In these areas, poverty and teenage pregnancies result in more than a quarter of learners dropping out of school before completing Grade 12. The hospital has intensive care, high care and KMC units. Methods: This was a retrospective descriptive study which reviewed folders of neonates discharged from KMC in 2013. Neonates with birth weights of 2000g or more and neonates referred out were excluded. Hospital readmissions were used as a proxy for morbidity and a descriptive analysis was done. Results: Fifty-two infant records were reviewed. Thirteen infants (25%) accounted for 21 readmissions. Six readmissions occurred in winter. There were significant associations between being readmitted and birth weight and breastfeeding. Thirty-five of the 52 infants were alive at six months. None were known to have died. Conclusion: Larger prospective studies on KMC infant outcomes are needed in South Africa

Sammanfattning För att ge förutsättningar till optimal tillväxt och utveckling vårdas idag, tillsammans med andra behandlingar, prematura barnen på neonatalavdelningar hud mot hud. Vård hud mot hud av det prematura barnet sker oftast på mammas eller pappas bröst och forskning visar att detta är en gynnsam miljö för barnets utveckling och hälsa. Det har också en positiv inverkan på föräldrarnas anknytnings process. En otrygg anknytning kan leda till ohälsa längre fram i livet och det är därför viktigt ur ett folkhälsoperspektiv att det finns forskning som visar hur personalen ska gå till väga för att ge stöd och hjälp till föräldrar att vårda sitt barn hud mot hud. Syftet med denna undersökning var att ta reda personalens uppfattning och erfarenheter av att vårda barn hud mot hud. För att undersöka detta genomfördes sju semistrukturerade intervjuer med barnsjuksköterskor och barnsköterskor på en neonatalavdelning på ett sjukhus i mellan Sverige. Materialet som intervjuerna gav analyserades genom kvalitativ innehållsanalys. I resultatet framkom tre kategorier: personalens syn på sin roll, barnperspektiv och föräldraperspektiv. Kategorierna resulterade i temat ”motstridiga känslor hos personalen”. Detta framkom genom att personalen i sin roll och med sin kunskap om hud mot hud även behöver förhålla sig till barnets behov och barnets rätt till bästa vård samt föräldrarnas behov och svårigheter. Sammanfattningsvis framkom att kunskap, kunskapsöverförande samt att ge föräldrar praktisk hjälp är viktiga för att öka antal timmar barnet vårdas hud mot hud.

Aim: To examine the reaction of extreme preterm infants with regarding to body temperature and transepidermal water loss during skin-to-skin care according to Kangaroo Mother Care (KMC) during the infant’s first week of life. Method: This was a descriptive quantitatively designed study, which was a pilot study within the framework of a larger project. Nine children, with a median gestational age of 24.91 weeks, were examined by measuring body temperature (axilla and skin temperature) as well as transepidermal water loss before, during and after KMC. Results: The study showed that skin temperature tended to rise during KMC, especially for those children who were nursed with KMC for more than 60 minutes. Eight out of nine children had, after completing KMC, a normal axilla temperature. As was expected, transepidermal water loss was elevated when measured both pre and post test. Despite this, the children showed normal body temperature. Conclusion: The results of the study support that KMC can create a micro-climate that, for at least one hour, makes it possible for even extreme preterm infants to maintain a body temperature within the normal range during their first week of life.

ABSTRACT Background: Kangaroo-mother care (KMC) is a vital part of the neonatal care. The method is based on skin to skin contact, where the parent or another caregiver, holds the child on itsbare chest for an extensive period of time. This has been proven to have a positive effect on the childs physical and mental development. Less extensive research has been made on the methods effects on the parents.  Aim: The aim of this studie was to describe the parents experience of used KMC during their childs time on a NICU (neonatal intensive care unit).  Method: A literature study with descriptive design. Based off of 12 original qualitative studies from the databases PubMed, CINAHL and Web of Science.  Results: The parents experiences could be devided into four themes: Emotional- and physical experiences as a result of KMC, the unit’s effect on the experience of KMC and bonding. The method was appreciated by the parents and the overall experience was positive. However, the method can be demanding for the parents and the staff and environment on the NICU have a big influence on the experience.  Conclusion: Time on a NICU can be stressful for both child and parents. KMC has been proven to be beneficial for the child, but also for the parents’ experience of their childs care. The method should be practiced as much as possible, with the influence of the health care staff and unit’s environment. Keywords: Kangaroo-mother care method. Intensive care. Neonatal. Infant. Parents.
SAMMANFATTNING Bakgrund: Kängurumetoden (KMC) utgör en vital del av omvårdnaden på neonatala vårdavdelningar. Metoden utgörs av hud mot hud kontakt, där föräldern eller en annan vårdgivare har barnet vilande på bröstkorgen under en längre tid. Detta har visats ha positiv effekt på barnets fysiska och psykiska utveckling. Det finns mindre forskning gällande metodens effekt på föräldrarna . Syfte: Syftet var att beskriva föräldrarnas upplevelse av genomförd kängurumetod under sitt barns vårdtid på neonatal intensivvårdsavdelning. Metod: Litteraturstudie med beskrivande design och som är av kvalitativ karaktär. Baserat på 12 kvalitativa originalartiklar från databaserna PubMed, CINAHL och Webof Science.  Resultat: Föräldrarnas upplevelser kunde delas in i fyra kategorier; känslomässiga upplevelser till följd av KMC, kroppslig upplevelse till följd av KMC, vårdavdelningens påverkan på upplevelsen och anknytning. Metoden var något som uppskattades och upplevelsen var övervägande positivt. Dock ställer den krav på föräldrarna, där också vårdpersonal och vårdmiljö har en viktig påverkan. Slutsats: Tiden på en neonatal intensivvårdsavdelning kan vara påfrestande för både barn och föräldrar. Kängurumetoden har visats vara gynnsam för både barnet men också föräldrarnas upplevelse. Metoden bör tillämpas i så stor utsträckning som möjligt, där vårdpersonal och avdelning har en viktig roll. Nyckelord: Kängurumetoden. Intensivvård. Neonatal. Spädbarn. Föräldrar.

Tio procent av alla barn som föds i Sverige vårdas på neonatalavdelning. Där arbetar barnsjuksköterskor med särskild kompetens inom barn- och barnsjukvård med en viktig roll att stärka barns rätt till hälsa och föräldrarnas delaktighet i vården. Hud-mot-hud är en omvårdnadsmetod som har visat sig ge många fördelar för barnen. Samtidigt har utmaningar identifierats kring hur hud-mot-hud kan genomföras på bästa sätt och att barnsjuksköterskors uppfattningar och attityder kan påverka resultatet. Syftet med studien var att beskriva barnsjuksköterskors uppfattningar om och attityder till att vårda hud-mot-hud på neonatalavdelning. Sex intervjuer med sjuksköterskor har genomförts via digitala videoverktyg. Resultatet visade att barnsjuksköterskor är positivt inställda till att vårda hud-mot hud. De anser att det är det viktigaste föräldrarna kan göra för sitt barn och ser det som sitt ansvar att göra dem delaktiga i vården och stötta dem så att anknytningen främjas. Diskussion har förts utifrån hur det är att vårda de mycket för tidigt födda och svårast sjuka barnen, vad hud-mot-hud betyder för anknytningen och familjecentrerad vård. Slutsatsen blir att barnsjuksköterskor med sin unika kompetens kan stärka föräldrarna i hud-mot-hud-vården så att barnens hälsa främjas.

The old practice of separating the mother-baby-dyad was without measurable benefits to mothers or their infants. Evidence has shown that skin-to-skin care (SSC) prevents hypothermia and hypoglycemia, decreases crying during painful procedures in newborns, and reduces maternal anxiety, stress, and postpartum depression. Rooming-in care (RIC) has been linked to an increase in the rate of breastfeeding and mother-infant interaction, as well as a decrease in the infant morbidity rate. This project assessed the effect of an educational intervention to increase rates of SSC and RIC in an obstetric unit, in addition to measuring nurses’ attitudes and barriers in relation to SSC and RIC. The obstetric nurses received educational content related to SSC and RIC based on Kotter’s model of change. A pre and postintervention evaluation showed a significant increase in the rates of SSC and RIC from pretest of 10%, to posttest of 96%; and RIC from pretest of 10% to posttest of 92%. Using a Wilcoxon test, a significant difference was found from pretest to posttest for every subscale score of the Mother-Newborn Skin-to-Skin Contact Questionnaire and Nurse Attitudes and Barriers to nonseparation Scale (p < 0.001), with the exception of belief about obstacles for SSC, which yielded a nonsignificant change (p = 0.57). This DNP project led to changes in the organization’s culture, including the closure of the well-baby nursery. This project promoted social change across the organization, in that the team health care providers delivered evidence-based, standardized, unbiased, and family-centered care to the mother-baby dyad.

Submitted by Rosina Valeria Lanzellotti Mattiussi Teixeira (rosina.teixeira@unisantos.br) on 2016-06-15T18:02:17Z No. of bitstreams: 1 Laysa Gabrielle Silva Medeiros.pdf: 1788729 bytes, checksum: e020ca14a18dbb540c4e2962dcd57577 (MD5)
Made available in DSpace on 2016-06-15T18:02:17Z (GMT). No. of bitstreams: 1 Laysa Gabrielle Silva Medeiros.pdf: 1788729 bytes, checksum: e020ca14a18dbb540c4e2962dcd57577 (MD5) Previous issue date: 2016-02-23
Introduction: Every year, 20 million of newborns born with low weight mainly as a result of premature births. This fact represents an important public health problem that reflects in high rates of neonatal and maternal morbimortality. Scientific advances in neonatal intensive care have contributed significantly to reduce perinatal mortality rates promoting an increase in the survival chance of newborns with low weight and the emergence of perinatal care models that improve the quality of care. One of the most important actions is the Kangaroo Method. Objective: Analyze the perceptions of mothers with preterms and/or low weight newborns about the second phase of Kangaroo Method and the coping strategies adopted in a public maternity in the interior of Paraíba. Methodology: A qualitative research was developed and were interviewed, from May to August 2015, ten mothers that were hospitalized in a Kangaroo Mother Accommodation experiencing the second stage of the method in integral way with their babies. The Data Saturation criteria was used to limit the number of participants. The data were collected using semi-structured interviews and were analyzed through Bardin's Content Analysis, from which emerged three categories: Baby hospitalization and maternal feelings; Kangaroo Mother Accommodation: maternal experiences; Experiencing the Kangaroo Mother Care. Results: With a hospitalized baby, mothers face a period a disturbance period involving suffering, fear, sadness, despair, fault and anger, resulting in impairment on their self confidence and self-esteem. However, despite these feelings, mothers can confront the difficulties through religious and/or family support. About to being close to the baby in the Kangaroo Method and deliver the her care, the mothers reported being happy and satisfied, emphasizing the child's improvement after the use of the method. To the mothers, this method was an opportunity to have a more intimate contact with the baby, but also brought difficulties such as distance and the missing of the family. In a general way, the mothers expressed to be satisfied as to the assistance given, the environment and operation, highlighting the role of staff, which contributed to the development of maternal safety. Final considerations: This study helped in understanding the maternal experiences and coping strategies within the Kangaroo Method, highlighting the necessity for reflection on the role of mothers in the context of the method, considering their entirety and individuality.
Introdução: Em todo o mundo, nascem anualmente 20 milhões de recém-nascidos de baixo peso, em consequência principalmente de partos prematuros. Tal fato configura importante problema de saúde pública refletido nas altas taxas de morbimortalidade neonatal e materna. Os avanços científicos, empregados à terapia intensiva neonatal têm contribuído significativamente para redução das taxas de mortalidade perinatal, promovendo um aumento da chance de sobrevida dos recém-nascidos de baixo peso e o surgimento de modelos de assistência perinatal voltado para a melhoria da qualidade do cuidado. Dentre essas ações, destaca-se o Método Canguru. Objetivo: Analisar as percepções das mães de recém-nascidos pré-termo e/ou baixo peso sobre a segunda etapa do Método Canguru e as estratégias de enfrentamento adotadas por elas, em uma Maternidade Pública no interior da Paraíba. Metodologia: Trata-se de uma pesquisa qualitativa, na qual foram entrevistadas, no período de maio a agosto de 2015, dez mães que estiveram internadas no Alojamento Mãe Canguru, vivenciando a segunda etapa do método de forma integral junto com seus bebês. Para delimitação do número de participantes foi utilizado como critério a saturação dos dados. Os dados coletados por meio de entrevista semiestruturada, foram analisados através da Análise de Conteúdo de Bardin, na qual emergiram três categorias: Hospitalização do bebê e sentimentos maternos; Alojamento Mãe Canguru: experiências maternas; Vivenciando o Método Canguru. Resultados: Com a hospitalização do bebê, as mães enfrentam um período que envolve sofrimento, medo, tristeza, desespero, culpa e raiva, resultando no comprometimento da autoconfiança e autoestima. Entretanto, apesar desses sentimentos, as mães conseguem lidar com as dificuldades, através da religiosidade e/ou apoio familiar. Quanto a estar junto ao bebê no Método Canguru e realizar os cuidados com ele, as participantes relataram estar felizes e satisfeitas, enfatizando a melhora do filho após o uso do método. Para as mães, o método foi uma oportunidade de ter um contato mais íntimo com o filho, mas que também trouxe dificuldades, como a distância e saudade da família. De forma geral, as mães expressaram estar satisfeitas quanto à assistência prestada, o ambiente e funcionamento, com destaque para papel da equipe, que contribuiu para o desenvolvimento da segurança materna. Considerações Finais: Este estudo auxiliou na compreensão das experiências maternas e estratégias de enfretamento no âmbito do Método Canguru, destacando a necessidade de reflexão sobre o papel das mães no contexto do método, considerando-as em sua integralidade e individualidade.

Bakgrund: KMC (kangaroo mother care) är en metod där det prematura barnet ligger hud- mot-hud med en förälder. Metoden har tidigare visats vara bra för både barnet och modern. Syfte: Syftet är att, i jämförelse med traditionell vård, beskriva effekten av känguruvård på det prematurt födda barnet både gällande fysiska effekter och barnets anknytning till föräldrarna. Metod: Litteraturöversikt med kvantitativa studier. I studien ingick 12 artiklar varav 10 hade RCT (Randomiserad kontrollerad studie) som metod. En kvasiexperimentell artikel och en överkorsningsstudie analyserades också till resultatet. Resultat: Resultaten visade att KMC kan reducera smärta hos prematura barn vid provtagning, vilket visas genom att barnet gråter mindre och grimaserar mindre i jämförelse med barn som enbart fått traditionell vård. Vid brukandet av KMC sjunker kortisolnivåerna hos barnet, speciellt över tid. Detta betyder att barnet blir mindre stressat. KMC bidrar också till en snabbare tillväxt och stabilare parametrar i form av hjärtfrekvens, saturation och medeltemperatur. Det har även visat sig att KMC kan underlätta och påskynda anknytningen mellan modern och barnet. Alla skillnader sågs vid jämförelse med traditionell vård. Slutsats: KMC har positiva effekter på fysiska parametrar och verkar påverka anknytningen positivt mellan förälder och barn. De fysiska parametrarna blir mer stabila och får bättre värden vid brukandet av KMC. Slutsatsen är därför att KMC bör rekommenderas som metod. Nyckelord: Känguruvård, hud-mot-hudvård, prematur, anknytning, fysiska effekter
Background: KMC (kangaroo mother care) is a method were the premature child lay skin to skin with a parent. The method has earlier shown to be good for both the child and the mother. Aim: The aim was to, in comparison to traditional care, describe the effect of kangaroo mother care on the premature child both including physical effects and the childs attachment to the parents. Method: Litterature overview with quantitative design. The study included 12 articles were 10 of them had RCT (Randomized controlled trial) as design. One qvasiexperimental article and one crossover trial were also analyzed. Result: The results showed that KMC can reduce pain in preterm infants during painful procedures, in comparisson to traditional care. This was evident as the baby was crying and grimacing less. By using the KMC method the babys’ cortisol level decreased, especially over time. This indicates that the baby was less stressed when KMC was used compared to when it was not. KMC also contributed to a faster growth in length and weight, more stabile parameters as heart rate, saturation and mean temperature. It was also shown that KMC can facilitate and favour attatchment between the mother and the infant. All differences were shown when compared to traditional care. Conclusion: KMC have positive physical effects on the premature child and affect the attachment between parent and child. The physical parameters become more stabile and better while using KMC. The conclusion is that KMC should be recommended as a method. Key Words: Kangaroo mother care, skin-to-skin care, premature, attachment, physical effects

A dor no recém-nascido é um fenômeno complexo, constituído por diferentes estímulos e tipos de dor, que pode envolver várias combinações de receptores e mecanismos do sistema nervoso em desenvolvimento. No Brasil, é direito de cidadania da criança e do adolescente não sentir dor, quando existirem meios de evitá-la. Esse direito também está previsto na Declaração Universal dos Diretos do Prematuro, segundo a qual a dor do prematuro deverá ser sempre considerada, prevenida e tratada por meio dos processos disponibilizados pela ciência atual. Entre as medidas não farmacológicas para o manejo da dor aguda decorrente de procedimentos de apoio ao diagnóstico e terapêuticos, tem-se particular interesse no contato materno pele a pele, por sua comprovada efetividade no alívio da dor em prematuros. Pesquisadores do Grupo de Pesquisa em Enfermagem no Cuidado à Criança e ao Adolescente da EERP-USP, preocupados com a problemática da dor em recém-nascidos a termo e pré-termo e crianças, desenvolveram pesquisas que comprovaram a eficácia deste contato também para o alívio da dor durante a coleta do teste do pezinho. O intuito do grupo, assim como o de outros pesquisadores, é reduzir a lacuna entre o conhecimento produzido e a prática clínica para a avaliação e o manejo da dor em crianças, incentivando a participação materna e da família. A atual motivação reside em investigar a perspectiva materna no processo de alívio da dor aguda do recém-nascido pré-termo mediada pelo contato pele a pele. Assim, o objetivo do presente estudo é analisar os significados atribuídos pela mãe em sua vivência de contato pele a pele com seu filho prematuro para o alívio da dor decorrente da coleta do teste do pezinho em unidade neonatal. Trata-se de estudo descritivo, na abordagem qualitativa, tendo como quadro teórico o cuidado humanizado, integral e centrado na família. Realizou-se a investigação na unidade de cuidado intermediário neonatal do hospital universitário de Ribeirão Preto - SP. Os dados foram coletados mediante entrevista semiestruturada com 15 mães de prematuros. Da análise de conteúdo dos discursos emergiram seis eixos temáticos: Pele a pele mãe e filho gera prazer; Pele a pele tranquiliza e acalma o bebê; Contato materno pele a pele alivia a dor do prematuro; Contato pele a pele insere a mãe no cuidado do filho mesmo durante procedimento doloroso - resgata o papel materno; Desejo de realizar o contato pele a pele durante outros procedimentos com o filho prematuro; e Indicando e incentivando o pele a pele para outras mães. Constata-se que as mães possuem sentimentos positivos reconhecendo que o contato pele a pele com o filho promove alívio da dor, com consequente redução de manifestações comportamentais durante o teste do pezinho. Os significados atribuídos a esta vivência materna corroboram estudos que mostram a redução da reatividade biocomportamental do prematuro em posição canguru, cuja prática deve ser amplamente utilizada para o alívio da dor decorrente de procedimentos dolorosos
Pain among newborns is a complex phenomenon composed of different stimuli and types of pain, which may involve various combinations of receptors and mechanisms of the developing nervous system. In Brazil, children and adolescents are entitled not to suffer pain whenever it is avoidable. In addition, there is the Universal Declaration of the Rights of Preterm Infants, in which it is stated that the pain of a premature infant should also taken into account, prevented and treated using processes enabled by current science. Among the non-pharmacological measures used to handle acute pain accruing from procedures that support diagnosis and therapeutic action, there is special interest in skin-to-skin contact with the mother, the effectiveness of which has been proven to alleviate pain among preterm infants. Researchers from the Research Group in Nursing Care Provided to Children and Adolescents at EERP-USP, concerned with pain among at term and preterm infants and children conducted research that proved the efficacy of skin-to-skin contact in the alleviation of pain during the heel prick screening test, among others. They work to reduce the gap between knowledge and clinical practice in regard to assessment and handling pain among children, encouraging the participation of both mother and family. Currently, the motivation is to investigate the maternal perspective of the process of alleviating acute pain in preterm newborns, mediated by skin-to-skin contact. This study\'s objective was to analyze the meanings assigned by mothers to their experience of skin-to-skin contact with their preterm children to alleviate the pain accruing from the heel prick test in a neonatal ward. The theoretical framework of this descriptive study with qualitative approach is integral, humanized and family- centered care. The study was conducted in the neonatal intermediate care unit at the University hospital at Ribeirão Preto, SP, Brazil. Data were collected through semi- structured interviews conducted with 15 mothers of preterm infants after free and informed consent forms were signed. Content analysis was used to analyze data, from which six thematic axes emerged: Mother and child skin-to-skin contact generates pleasure; Skin-to-skin reassures and calms down the baby; Maternal skin- to-skin contact alleviates pain in preterm infants; Skin-to-skin contact included the mother in the care provided to the child even during a painful procedure - redeems the maternal role; Desire to have skin-to-skin contact during other procedures with the preterm child; and Encouraging other mothers to practice skin-to-skin contact. The mothers reported positive feelings, acknowledging that skin-to-skin contact with their children promotes pain relief and that behavioral manifestations decreased during the heel prick test. The meanings assigned to this maternal experience corroborate studies that show reporting reduced biobehavioral reactiveness among preterm infants in the kangaroo position, a practice that should be widely used to alleviate pain accruing from painful procedures

Premature birth is a frequent occurrence even in developed countries. Technological advances have increased survival rates even for very premature. Prematurity is a risk factor for much morbidity, including developmental delay, deficits in somatic growth and difficulty of affectionate bonds with family. The Kangaroo Mother Care (KMC) has emerged as an alternative treatment of low birth weight infants, being part of the national policy of humanization in health, aiming higher attachment, breastfeeding promotion, improved development and security, including how to handle the baby and family relationships. This research aimed to evaluate the evolution of premature assisted by KMC from birth to six months of age, including weight gain, frequency of breastfeeding, duration of hospitalization and development at six months. This is an observational and prospective cohort study of preterm babies at KMC, born between July 2011 and January 2012 in a terciary public maternity with birth weight less than 1750 g and in clinical conditions required for application of the method. The sample consisted of 137 newborns, with a mean birth weight of 1.365±283 g, mean gestational age of 32±3 weeks and 26,2% adequate for gestacional age. They were admitted to the Kangaroo Ward at 19±18 days, weighing 1.430±167g on average, and at this time 57.7% were underweight. They were discharged after 36.8±21.8 days, weighing 1.780±165g and 67.9% were underweight. Those who had apnea in the neonatal intensive care unit, who used vasoactive agents or third-line antibiotics and diagnosed with bronchopulmonary dysplasia had a greater length of stay in hospital (p <0.001). At 6 months (n = 76) had an average weight of 5.954±971g and 68.4% were with weight percentiles between 3 and 97. Denver Developmental Screening Test II was considered suspect at 17.1% of them. The variables strongly associated with this outcome were: peri-intraventricular hemorrhage, bronchopulmonary dysplasia and weight below the 3rd percentile at six months of age. Exclusive breastfeeding rate at discharge was 56.2% and at 6 months was 14.4%. Conclusions: In this sample, children assisted by KMC had adequated weight recovery in the first six months of life, as well as low frequency of developmental delay. At six months, the exclusive breastfeeding rate was low.
O nascimento prematuro é uma ocorrência frequente, mesmo em países desenvolvidos. Os avanços tecnológicos têm proporcionado taxas de sobrevivência cada vez maiores, mesmo para os muito prematuros. A prematuridade é um fator de risco para várias morbidades, dentre elas atraso no desenvolvimento neuropsicomotor, déficit no crescimento somático e dificuldade de vinculação afetiva com a família. O Método Canguru (MC) surgiu como alternativa de assistência ao recém-nascido de baixo peso como parte da política nacional de humanização na saúde, objetivando maior apego, incentivo ao aleitamento materno, melhor desenvolvimento e segurança, inclusive quanto ao manuseio do bebê e ao relacionamento familiar. Esta pesquisa teve como objetivo avaliar a evolução dos prematuros assistidos pelo MC, do nascimento aos seis meses de idade, incluindo evolução ponderal, frequência de aleitamento materno, tempo de hospitalização e desenvolvimento. Trata-se de um estudo observacional e descritivo de uma coorte de bebês prematuros assistidos pelo MC, nascidos entre julho de 2011 e janeiro de 2012 em uma maternidade pública de nível terciário, com peso ao nascer igual ou menor que 1750 g e em condições clínicas necessárias para aplicação do método. A amostra foi constituída por 137 recém-nascidos, com média de peso ao nascer de 1,365±283 g, idade gestacional média de 32±3 semanas, sendo 26,2% com peso ao nascer adequado à idade gestacional. Foram admitidos na Enfermaria Canguru com 19±18 dias de vida, pesando 1.430±167g em média, sendo que, nesse momento 57,7% da amostra tinham baixo peso para a idade cronológica (BP). Tiveram alta hospitalar com 36,8±21,8 dias, pesando 1.780±165g e 67,9% tinham BP. Aqueles que tiveram apneia na unidade de terapia intensiva neonatal, que usaram drogas vasoativas ou antibióticos de terceira linha e os com diagnóstico de displasia broncopulmonar tiveram maior tempo de hospitalização (p< 0,001). Aos seis meses (n=76), tinham peso médio de 5.954±971g, sendo que 68,4% estavam com o peso entre os percentis 3 e 97. Tiveram resultado do Teste de Triagem de Desenvolvimento de Denver II considerado como suspeito 17,1% deles. As variáveis que estiveram fortemente associadas a este resultado foram: hemorragia peri-intraventricular, displasia broncopulmonar e peso abaixo do percentil 3 aos seis meses de idade. A frequência de aleitamento materno exclusivo na alta foi 56,2% e aos 6 meses foi 14,4%. Conclusões: Na amostra estudada as crianças assistidas pelo Método Canguru tiveram recuperação ponderal adequada nos primeiros seis meses de vida, bem como baixa frequência de alteração no desenvolvimento. A frequência de aleitamento exclusivo aos seis meses foi baixa.

Made available in DSpace on 2016-04-28T20:39:09Z (GMT). No. of bitstreams: 1 Ana Paula Marson.pdf: 673352 bytes, checksum: 9c50a1e9a8526b3c7e6ee5ad0a0cfb26 (MD5) Previous issue date: 2015-09-18
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
This study investigates the Kangaroo Care intervention possibilities concerning the mother's approach to her premature baby, surrounded by a technological barrier that permeates treatment. The survival and development of the baby depend on technology, medicines and health professionals, as they represent, in his early life, safety for him and his mother. In the face of the adversities of this situation, the aim of the study is to analyze the challenges of the implementation of the 1st phase of the Kangaroo Care in a neonatal unit. Kangaroo Care not only provides early skin-to-skin contact between the infant and the mother and father, allowing greater participation in caring, but also enables the organization of the neonatal environment as to noise and lighting, and pain control, in order to decrease the negative effects on the infant s development. The basis of Winnicott's thought shows that the consistency of maternal care ensures continuity of being or continuing baby's existence. Thus, the baby depends emotionally on the mother for his survival and, in the neonatal unit, depends on the professionals present there. Thus, the concern of this research is to look closer at the medical professionals who work in the neonatal unit, because the physical and mental health of the premature baby depends on them. The research was conducted at the Neonatal Unit of the University Hospital of the State University of Londrina. We used a qualitative research method, participant observation and interviews, contextualizing the first stage of the Kangaroo Care implementation through evaluation of benefits and difficulties
O presente estudo investiga as possibilidades de intervenção do Método Canguru no que diz respeito à aproximação da mãe com seu bebê prematuro, envolto em toda barreira tecnológica que permeia o tratamento. A sobrevivência e desenvolvimento do bebê dependem do maquinário, de medicamentos e de profissionais atuantes nesse contexto, visto que se tornam, no início da sua vida, a segurança para ele e para a sua mãe. Diante das adversidades que essa situação coloca, o interesse deste estudo consiste em analisar os desafios da implantação da 1ª etapa do Método Canguru em uma unidade neonatal. O Método Canguru proporciona o contato pele a pele precoce entre a mãe-bebê e o pai, permitindo uma maior participação desses no cuidado com seu bebê, como também permite toda a organização do ambiente neonatal no sentido de diminuição de ruídos, de luminosidade, controle de dor, a fim de minimizar os efeitos negativos no desenvolvimento do prematuro. A base de todo pensamento winnicottiano evidencia que a constância do cuidado materno assegura a continuidade do ser ou existência continuada do bebê. Sendo assim, o bebê depende emocionalmente da mãe para sua sobrevivência e, na unidade neonatal depende dos profissionais lá presentes. Desse modo, a preocupação desta pesquisa consiste em voltar um olhar mais atento aos personagens que participam da neonatal, pois deles dependem o seguimento da saúde física e mental do bebê prematuro. A pesquisa foi desenvolvida na Unidade Neonatal do Hospital Universitário da Universidade Estadual de Londrina. Para isso, utilizou-se do método qualitativo de pesquisa, com uso da observação participante e de entrevistas, contextualizando a primeira etapa da implantação do Método Canguru mediante avaliação de benefícios e dificuldades

Submitted by Fernando Souza (fernandoafsou@gmail.com) on 2017-09-08T14:42:01Z No. of bitstreams: 1 arquivototal.pdf: 3017374 bytes, checksum: 992b3bd4f1ee14178ecc46c753714ca0 (MD5)
Made available in DSpace on 2017-09-08T14:42:01Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 3017374 bytes, checksum: 992b3bd4f1ee14178ecc46c753714ca0 (MD5) Previous issue date: 2017-04-18
Introduction: In recent years, the Ministry of Health has been carrying out actions to contain the fragmentation of care provided to pregnant women and newborn babies and reduce the neonatal morbidity and mortality in Brazil. The Kangaroo Mother Method was incorporated as a health policy for improving care to the newborn premature, with active participation of Primary Health Care. Objective: To analyze the maternal care with the newborn in the third step of the Kangaroo Mother Method and the assistance given by professionals of the Family Health Strategy to the mother-baby kangaroo. Method: This is a qualitative research, descriptive-exploratory, submitted to the Research Ethics Committee at the Lauro Wanderley University Hospital, getting opinion 1,515,237 CAAE 54391316.7.0000.5183.The participants were 10 mothers of newborn infants whose parturition was performed in one of the maternities entered the study. The data were collected by means of interviews, in the months of May and June of 2016, analyzed from the content analysis technique proposed by Bardin. Had as its backdrop the obstetrical clinic of a university hospital and a public maternity hospital that meet the preterm and/or low birth weight babies, in addition to Family Health Units in the city of João Pessoa, PB. Results: The reports of mothers-kangaroo show feelings like fear, insecurity and tiredness, to take care of the child in the household; experienced lack of family support and professionals for continuity of method, resulting in weakness of the assistance to the mother-baby at this stage of the kangaroo mother method. Conclusion: To continue to provide care to the mother-baby kangaroo, it is necessary to train professionals in the Family Health Strategy in relation to the method, strengthen the bond of family healthcare team with the community, establish a home visit to this dual, in the routine of teams, and propitiate the comprehensiveness of care.
Introducción: En los últimos años, el Ministerio de Salud ha venido llevando a cabo acciones para contener la fragmentación de la atención prestada a las mujeres embarazadas y los niños recién nacidos y reducir la morbilidad y mortalidad neonatal en Brasil. El Método Madre Canguro fue incorporado como una política de salud para mejorar la atención al recién nacido prematuro, con la activa participación de la Atención Primaria de la Salud. Objetivo: Analizar la atención materna con el recién nacido en el tercer paso del método madre canguro y la ayuda prestada por profesionales de la Estrategia Salud de la Familia a la madre-bebé canguro. Método: Se trata de una investigación cualitativa, descriptiva-exploratoria, presentada a la Comisión de Ética en Investigación del Hospital Universitario Lauro Wanderley, obtención de opinión 1,515,237 CAAE 54391316.7.0000.5183. Los participantes fueron 10 madres de recién nacidos, cuyo parto se realiza en una de las maternidades que entraron en el estudio. Los datos fueron recolectados por medio de entrevistas, en los meses de mayo y junio de 2016, analizó a partir de la técnica de análisis de contenido propuesto por Bardin. Tuvo como telón de fondo la clínica obstétrica de un hospital universitario y un hospital público de maternidad que cumplen los recién nacidos prematuros o de bajo peso al nacer, además de unidades de salud familiar en la ciudad de João Pessoa, Paraíba. Resultados: Los informes de las madres-canguro muestran sentimientos como el miedo, la inseguridad y el cansancio, a cuidar al niño en el hogar; el experimentado falta de apoyo familiar y profesionales para la continuidad del método, resultando en debilidad de la atención a la madre-bebé en esta etapa del método madre canguro. Conclusión: En seguir prestando atención a la madre-bebé canguro, es necesario capacitar a los profesionales de la Estrategia Salud de la Familia en relación con el método, fortalecer el vínculo de la familia con el equipo de salud de la comunidad, establecer una visita a la casa a este doble, en la rutina de los equipos, y propiciar la integralidad de la atención.
Introdução: Nos últimos anos, o Ministério da Saúde vem realizando ações para conter a fragmentação da assistência prestada às gestantes e aos recém-nascidos e reduzir a morbimortalidade neonatal no Brasil. O Método Canguru foi incorporado como política de saúde para melhorar a assistência ao recém-nascido prematuro, com participação ativa da Atenção Primária à Saúde. Objetivo: Analisar o cuidado materno com o recém-nascido na terceira etapa do Método Canguru e a assistência dada pelos profissionais da Estratégia Saúde da Família ao binômio mãe-bebê canguru. Método: Trata-se de uma pesquisa qualitativa, descritivo-exploratória, submetida ao Comitê de Ética em Pesquisa do Hospital Universitário Lauro Wanderley, obtendo parecer 1.515.237 CAAE 54391316.7.0000.5183. Participaram da pesquisa dez mães de recém-nascidos, cujo parto foi realizado em uma das maternidades inseridas no estudo. Os dados foram coletados por meio de entrevista semiestruturada, nos meses de maio e junho de 2016, analisados a partir da técnica de análise de conteúdo proposta por Bardin. Teve como cenário a Clínica Obstétrica de um Hospital Universitário e uma maternidade pública que atendem a recém-nascidos pré-termo e/ou de baixo peso, além de Unidades de Saúde da Família do município de João Pessoa-PB. Resultados: Os relatos das mães-canguru evidenciam sentimentos como medo, insegurança e cansaço, ao assumir os cuidados com o filho no domicílio; vivenciaram falta de apoio familiar e de profissionais para continuidade do método, resultando em fragilidade da assistência ao binômio mãe-bebê nessa etapa do método canguru. Conclusão: Para continuar a prestar cuidados ao binômio mãe-bebê canguru, é necessário capacitar os profissionais da Estratégia Saúde da Família em relação ao método, fortalecer o vínculo da equipe de saúde da família com a comunidade, instituir visita domiciliar para essa dupla, na rotina das equipes, e propiciar a integralidade da assistência.

O canguru é efetivo no alívio da dor aguda em prematuros, porém pouco se sabe sobre o papel da mãe na regulação da dor e estresse neonatal. Tem-se como objetivo geral investigar a associação entre os fatores maternos (comportamento, estado emocional e humor e estresse) e a resposta à dor e ao estresse de prematuros submetidos à punção de calcâneo para exame de triagem neonatal em posição canguru. Trata-se de experimento não-controlado, realizado na unidade neonatal de um hospital universitário de Ribeirão Preto-SP. Participaram do estudo 42 mães e seus filhos prematuros, após obtenção de consentimento livre e esclarecido. Os dados foram coletados em três fases: basal - FP (10 minutos), procedimento - FP (coleta do exame) e recuperação - FR (10 minutos). Coletaram-se amostras de saliva da mãe e do prematuro antes e após o exame doloroso e da mãe à noite e ao despertar. Mensuraram-se as variáveis: mímica facial (Neonatal Facial Coding System - NFCS), sono e vigília, duração do choro e frequência cardíaca (FC) neonatal, comportamento materno e interação mãe-filho (Maternal Mood Infant Pain Behavior Coding System), estado emocional e de humor materno (Inventários de Depressão e de Ansiedade de Beck). Explorou-se a relação entre as variáveis maternas e neonatais (análise bivariada), a influência do estado emocional e humor materno nas variáveis neonatais (análises de variância com medidas repetidas) e quais variáveis explanatórias maternas interferem nas variáveis de resposta neonatais (regressão múltipla). O escore médio do NFCS, a porcentagem de duração do tempo de choro e a FC média não alteraram significativamente entre as fases da coleta, ao controlar-se a porcentagem de duração dos estados de sono e vigília basal. As concentrações médias de cortisol salivar neonatal e materno pós-punção em relação a pré-punção não diferiram estatisticamente (p=0,731; p=1,000, respectivamente). Encontrou-se associação entre o escore médio do NFCS na FP e a concentração de cortisol salivar pré-punção materno (r=0,32; p=0,040); a porcentagem tempo do choro na FP e a concentração de cortisol salivar pré-punção materno (r=-0,32; p=0,047); a FC neonatal na FP e as concentrações de cortisol salivar noturno (r=-0,49; p=0,002), pré-punção (r=-0,34; p=0,025) e pós-punção (r=-0,51; p=0,001) materna; a FC neonatal na FR e as concentrações de cortisol salivar noturno (r=-0,45; p=0,004), prépunção (r=-0,41; p=0,007) e pós-punção (r=-0,50; p=0,001), as concentrações de cortisol salivar pré-punção neonatal e noturno materno (r=0,39; p=0,016) e as concentrações do cortisol pós-punção neonatal e materno (r=0,34; p=0,027). A presença de sintomas de ansiedade e depressão e o comportamento maternos não influenciaram a resposta de dor e estresse do prematuro. A concentração do cortisol salivar materno pré-punção foi preditor da variância da concentração do cortisol salivar pós-punção do prematuro [coeficiente R2 ajustado=0,092; F(1,36)=4,764; p=0,036]; a concentração de cortisol salivar noturno materno, juntamente com a idade pós-natal do prematuro, explicaram a variância da FC neonatal [coeficiente R2 ajustado=0,282; F(2,35)=8,219; p=0,001]. Concluiu-se que a capacidade das mães participantes do estudo em regular o seu próprio estresse pode contribuir para a resposta de dor e estresse do prematuro. Outros estudos são necessários para fortalecer as evidências.
Maternal kangaroo care (MKC) effectively reduces acute pain and stress in the preterm, but very little is known about the maternal role during MKC. The main purpose of the present non-controlled intervention study was to examine relationships between maternal factors (caregiving behaviour, depression and anxiety and maternal own stress) and preterm infant pain and stress response during heel lance (HL) for routine neonatal blood screening while in MKC. The study was carried out in a neonatal unit at a university hospital in Ribeirao Preto- SP and involved 42 consenting mothers and their stable preterm infants. Maternal and infant data were collected during three study phases: Baseline (10 minutes - before HL), HL procedure (during blood collection) and Recovery (10 minutes - post HL). On the day of the infant\'s scheduled HL, maternal and infant salivary cortisol samples were collected at baseline and 20 minutes post-HL. Two additional maternal salivary cortisol samples were collected (night and awakening). Continuous measures of infant heart rate (HR) were collected and maternal caregiving behaviour and infant pain behaviour (facial action, cry and infant state) were continuously videotaped during the three study phases. Within the following week of each infant\'s HL, the emotional state of study mothers was assessed using the Beck Depression and Anxiety Inventories. The Neonatal Facial Coding System (NFCS) and the Maternal Mood Infant Pain Behaviour Coding System were used to code infant and maternal behaviour, second-by-second, from which time based measures of behaviour were generated. Relationships between maternal and neonatal measures were initially analyzed using bivariate analyses and RM-ANOVA was used to examine change in maternal and infant measures. Multiple regression analyses were then used to test which maternal variables predicted neonatal responses. No statistical significant differences in infant mean NFCS score, cry percentage duration and HR were observed across the study phases when baseline percentage duration of infant sleep-awake state was controlled. Also, maternal and neonatal salivary cortisol pre-HL and post-HL did not differ statistically (p=0.731; p=1.000, respectively). However, mean NFCS score and percentage duration of infant cry during the HL procedure were found to be associated with maternal pre-HL salivary cortisol level (r=0.32; p=0.040 and r=-0.32; p=0.047, respectively). Associations were also observed between neonatal HR duration and maternal nocturne (r=-0.49; p=0.002), pre-HL (r=-0.34; p=0.025) and post-HL (r=-0.51; p=0.001) salivary cortisol levels. Further, neonatal HR post HL procedure was related with nocturne (r=-0.45; p=0.004), pre-HL (r=-0.41; p=0.007) and post-HL (r=-0.50; p=0.001) maternal salivary cortisol. In this study, maternal scores of depression and anxiety and percentage of time spent expressing typical and typically depressed behaviour were not found to predict preterm pain and stress response. However, mother salivary cortisol level pre-HL predicted preterm salivary cortisol post-HL [adjusted R2=0.092; F(1,36)=4.764; p=0.036]; and maternal nocturne salivary cortisol together with gestational age predicted neonatal HR [adjusted R2=0.282; F(2,35)=8.219; p=0.001]. Study findings support the effectiveness of the maternal regulatory role in MKC but do suggest that the stress regulatory ability (as reflected by maternal cortisol levels) of the studies mothers may be predictive of alteration in pain and stress response in preterm offspring. Similar studies are needed to substantiate and to build on study findings.

Introdução: O controle da dor em recém-nascidos (RN) é necessário, tendo em vista que a exposição contínua e repetitiva à dor poderá trazer consequências ao desenvolvimento da criança. Há evidências consistentes sobre o efeito analgésico e segurança de se administrar a oferta oral de soluções adocicadas em RN submetidos a procedimentos dolorosos agudos. A amamentação e o contato pele a pele são práticas rotineiras, de baixo custo e incentivadas pelo Programa Hospital Amigo da Criança, com evidência de efetividade analgésica que pode ser adotada, como medida alternativa à oferta de soluções adocicadas. Entretanto, é preciso avaliar se seu efeito analgésico e sua segurança superam a solução adocicada na administração de vacinas, antes de recomendar sua adoção. Hipótese: O efeito analgésico combinado da amamentação com o contato pele a pele é superior à oferta oral de glicose 25% na administração da vacina BCG em RN. Objetivo: Avaliar o efeito analgésico da combinação da amamentação com contato pele a pele na administração da vacina BCG em RN a termo. Método: Ensaio clínico randomizado, conduzido em um hospital de ensino da cidade de São Paulo, certificado como Hospital Amigo da Criança. A amostra foi composta por 109 RN a termo, saudáveis, internados na Unidade de Alojamento Conjunto do HU, entre agosto e setembro de 2015. A amostra foi randomizada e os RN alocados nos Grupos Experimental (GE amamentação + contato pele a pele iniciada 5 minutos, antes da administração da vacina de BCG) e Controle (oferta oral de 2 ml de solução glicosada 25% ao RN posicionado verticalmente no colo materno, 2 minutos, antes da administração da vacina de BCG). O desfecho primário analisado foi o escore de dor obtido com a avaliação pela escala Premature Infant Pain Profile- Revised (PIPP-R). O escore de dor foi obtido em seis intervalos de 30 segundos (30, 60, 90, 120, 150 e 180 segundos) pós-administração da vacina. Os desfechos secundários avaliados foram os indicadores fisiológicos frequência cardíaca (FC) e saturação de oxigênio (SatO2), além de alterações na mímica facial - sobrancelhas salientes, olhos espremidos e sulco nasolabial, duração do choro e eventos adversos. Os dados foram obtidos por meio de filmagens do recém-nascido para captar a mímica facial e do display do monitor multiparamétrico com os registros da FC e SatO2. Os dados foram extraídos por meio da análise segundo a segundo das filmagens e foram registrados em formulário impresso próprio e, posteriormente, armazenados em planilha Microsoft Excel. A análise estatística foi processada no programa do pacote estatístico SPSS 20. Para analisar a homogeneidade da amostra, foram utilizados os testes Qui-quadrado ou Exato de Fisher para variáveis qualitativas e o teste t pareado para comparar as médias das variáveis quantitativas. Os dados das variáveis quantitativas das medidas repetidas, como FC e SatO2, foram analisados com o Modelo de Análise Misto, e as medidas repetidas de escores de PIPP-R analisadas pelo modelo ANOVA (Modelo Geral Linear). O projeto de pesquisa foi aprovado pelos Comitês de Ética da Escola de Enfermagem e do Hospital Universitário da Universidade de São Paulo e registrado no Registro Brasileiro de Ensaios Clínicos. Resultados: A distribuição das variáveis sexo, gemelaridade, tipo de parto, Apgar, peso, idade gestacional, número de procedimentos dolorosos anteriores e tempo desde a última mamada apresentaram distribuições homogêneas entre os grupos experimental e controle. Os escores de dor foram inferiores no GE (p=0,002). Não houve diferenças estatisticamente significantes em relação ao tempo de choro (p=0,745) e ocorrência de eventos adversos (p= 0,618). Conclusão: A combinação da amamentação no contato pele a pele apresentou efeito analgésico superior à oferta oral de glicose 25% com o RN no colo materno, como resposta dolorosa do RN à vacina de BCG e que apresenta segurança para ser indicada, como intervenção analgésica na prática clínica.
Introduction: Pain management in infant newborns is necessary, given the continuous and repeated exposure to pain can have negative consequences for the child\'s development. There is robust evidence of the analgesic effect and safety of administering oral sweetened solutions to newborns undergoing acute painful procedures. Breastfeeding and the skin-to-skin care are routine clinical practices, with low cost, and the Baby-Friendly Hospital Initiative recommends them. There is evidence of both practices regarding their analgesic effectiveness, which can be adopted as an alternative treatment to sweetened solutions. However, it is necessary to assess whether the analgesic effect and safety of these measures outweigh sweetened solutions in the administration of vaccines, before recommending its adoption. Hypothesis: The analgesic effect of combining breastfeeding plus skin-to-skin contact is superior to the taste of 25% glucose in the BCG vaccination in infant newborns. Objective: To evaluate the analgesic effect of combining breastfeeding plus skin-to-skin contact in the BCG vaccination in term infant newborns. Methods: A randomized clinical trial conducted at the University of São Paulo Teaching Hospital certified as a Baby-Friendly Hospital from August to September 2015. This study was performed on 109 healthy term infants who were born during the study, admitted at a rooming-in ward. The sample was randomized and infants were allocated in Experimental Group (GE breastfeeding plus skin-to-skin contact which begun 5 minutes prior to the administration of BCG vaccine) or Control Group (CG taste of 2 mL 25% glucose administered 2 minutes prior the BCG vaccination with the mother holding her baby upright on her lap). The primary outcome analyzed was the pain score assessed by the Premature Infant Pain Profile - Revised (PIPP-R). The pain score was assessed in six intervals of 30 seconds (30th, 60th, 90th, 120th, 150th and 180th) after the BCG vaccine administration. The secondary outcomes were: physiological parameters heart rate (HR) and oxygen saturation (O2Sat), and changes in facial expression brow bulging, eyes squeezed and nasolabial furrow, crying duration and adverse events. Data was obtained from video records of the newborn facial expressions and HR and O2Sat of multiparametric monitor display. Data was extracted from the video records after being analyzed throughout every second. Data was stored in the Microsoft Excel spreadsheet. Statistical analysis was performed by statistical package SPSS 20. To analyze the homogeneity of the sample, chi-square test or Fisher\'s exact was performed for qualitative variables, to compare the means of quantitative variables, paired t-test was used. Quantitative variables of repeated measures, as HR and O2Sat were analyzed with Mixed Model Analysis and repeated measurements of PIPP-R scores were analyzed by ANOVA (General Linear Model). The ethics committee of the School of Nursing and University Hospital, both from the University of São Paulo, approved the research project. The research project is registered at the Brazilian Registry of Clinical Trials. Results: The distribution of gender, twin pregnancy, mode of delivery, Apgar, weight, gestational age, number of previous painful procedures and time since last feeding showed homogeneous distribution between the Experimental and Control groups. Pain scores were lower in the EG (p = 0.002). There were no statistically significant differences in relation to the crying duration (p = 0.745) and adverse events (p = 0.618). Conclusion: The combination of breastfeeding plus skin-to-skin contact showed superior analgesic effect regarding the comparative intervention of oral 25% glucose with infant positioned vertically in mothers lap and it is safe to be prescribed as an analgesic treatment in clinical practice.

ABSTRACT The purpose of this study was to understand the mothers lived experience and perception towards 24-hour Kangaroo Mother Care (KMC) during hospitalization of their preterm babies. A qualitative design was used and phenomenological methods used to collect data. Nine in-depth unstructured interviews were with purposely-selected participants. The meaning of their experience was analyzed using Collaizzi’s (1978) steps to phenomenological data analysis. Data analysis revealed major three themes: (a) “it is a bond between me and my child” (b) nurse-parent interaction, and (c) “it is tiring and exhaustive”. However, the study found that all the mothers in spite of exhaustion, reported some high level of satisfaction with KMC because it allowed them to be closer to their babies. hence giving them the opportunity to observe their growth and become fully involved in the care. KMC was additionally noted have provided a comforting and warm environment for the babies, thus enabling them to grow faster and this in turn increased maternal satisfaction. Recommendation was made regarding further research preferably quantitative study to establish relationship between production of breast milk and the use of KMC. The principle of 24-hour KMC should also be incorporated and emphasized in all levels of educational training as this practice has been found to have numerous benefits both to the mothers and to their preterm babies.

Kangaroo Mother Care (KMC) is a fairly new concept to the patients and personnel at the R. K. Khan Hospital. Arising from one of the Governmental initiatives, KMC was introduced to KwaZulu Natal in 2001. The personnel at this hospital were briefly introduced to this alternate method of care for a low birth weight baby, by means of symposia and in-service. Soon after this in-service education, the personnel were requested to implement KMC. This study was undertaken to explore the perceptions of carers for the preparation and experience of KMC and to describe the experiences of the carers who have implemented KMC. Furthermore, this study determined whether carers received support during the implementation of KMC and in so doing to identify the sources of this support. The selection of this particular field of study arose out of the researcher's professional role in educating personnel in the theory and practice of midwifery. The lack of documented evidence to problems that they may have been encountered and management strategies to deal with these prompted this study. The intention was to obtain empirical findings so that personnel would be provided with appropriate and precise information on the subject. A phenomenological approach was used. The sample was obtained from the R. K. Khan Hospital neonatal unit. This is a regional hospital that is located in Chatsworth, Durban. The sample comprised often mothers who were practicing KMC in the post-natal ward, or mothers who were discharged and were still practicing KMC for the past two to four weeks. Data were collected by means of face-to-face interviews. Interviews were conducted using a semistructured interview guide. These interviews provided the researcher with rich, personal and narrative experiences of the carers before and during KMC. The results of this study indicated that KMC was indeed new to most of the mothers and this evoked apprehension, doubt and fear, but once the mothers had tried it and were successful, they felt a sense ofjoy. Nursing personnel formed part of the supportive environment for the mothers practicing KMC. The latter is a prerequisite for the success of KMC. Since KMC is associated with many benefits to the mother, the baby and the institution, for the future it could be incorporated into the midwifery curriculum for student midwives. Recommendations concerning nursing practice, nursing education and nursing research were made at the end of the study including the limitations affecting the study.
Thesis (M.Cur.)-University of Natal, Durban, 2003.

碩士
中山醫學大學
護理研究所
100
This quasi-experimental design study was to investigate Kangaroo Mother Care (KMC) on the behavioral state of hospitalized preterm infants during hospitalization and the attachment to their mothers. Six sessions of 60-min KMC for 6 times were practiced at a medical center hospital in Taichung City. Premature infants and their mothers recruited under IRB review, agreed to participate in this study, and the Anderson Behavioral State Scale (Anderson Behavioral State Scale, ABSS) was used to assess the behavior of premature infants during hospitalization and Muller''s Maternal Attachment Inventory( MAI) was used to assess attachment of their mothers. Results: Premature infants in KMC group compared to infants of control group had a more quiet awake state which showed a statistically significant difference (18% vs 3%, p = .001); in the state of drawsy, there was a statistically significant difference between KMC group compared with the control group (1% vs 9%, p = .000). KMC group showed more quiet sleep (37% vs 27%), but not reach a significant difference was found in this study. Post test of Maternal attachment scores were higher among the KMC mothers, and showed a statistically significant difference (p = .03). but not reach statistically significant difference (p = .18). These findings can be used to be an assessment guiding for giving appropriate kangaroo care model and create a more comfortable environment and implementation process for hospitalized preterm infants.

Infants in the NICU undergo many painful procedures and literature supports KMC as an effective intervention to diminish pain however, it is not used routinely in NICUs. The purpose of this qualitative study is to provide NICU nurses an opportunity to describe their experience of utilizing KMC for pain, and to interpret this experience with the goal of generating patterns that explain this understanding. The findings can be used to formulate interventions that foster the use of KMC. Using Interpretive Description as a philosophy of inquiry and research methodology, 8 NICU nurses were interviewed and participated in a focus group. Four patterns emerged: (1)”Seeing is Believing”; (2) Human Heartedness: “It’s the Least I can do”; (3) Playing it Safe; and (3) Creating the Possibility within Constraints.

Tese de doutoramento, Enfermagem, Universidade de Lisboa, com a participação da Escola Superior de Enfermagem, 2011
Preterm neonates in intensive care units endure frequent procedures that may cause pain, warranting the study of interventions that will decrease this pain. The primary aim of this study was to compare the efficacy of the combination of sucrose, pacifier and kangaroo mother care (S+KMC), with that of sucrose and pacifier (S), in reducing the pain responses of preterm infants undergoing venepuncture. Secondary objectives addressed to babies in S+KMC were to examine the relationship between maternal anxiety and the pain responses of the babies; and to explore mothers’ perceptions of KMC during venepuncture. A randomized-controlled trial was conducted in two neonatal intensive care units in Portugal. One-hundred and ten preterm infants without severe illness, stratified by gestational age, were randomly assigned to receive S+KMC or S for venepuncture. Measures of pain responses were the Premature Infant Pain Profile, heart rate, oxygen saturation, facial actions, behavioral state, heart rate variability and recovery time, which were analysed with repeated-measures ANOVA. Mothers’ anxiety was measured with the State-Trait Anxiety Inventory. Their perceptions were obtained through content analysis of semi-structured interviews. Compared to infants in S, infants in S+KMC displayed significantly less facial action; were more likely to have recovered heart rate baseline values at 60 and 90 seconds after the procedure, if they were 32 weeks gestational age and above; and changed from sleep to wake states significantly less. Maternal anxiety was low to moderate and was not correlated to specific pain responses. Mothers emphasized their feelings of wellbeing in comforting and protecting the babies. In conclusion, combining sucrose, pacifier and kangaroo mother care is effective and safe in preterm infants undergoing venepuncture for blood-draw; low to moderate levels of anxiety of mothers do not interfere with the pain responses; mothers appreciate holding the baby skin-to-skin when the infants are enduring pain.
Os recém-nascidos pretermo que necessitam de cuidados intensivos são frequentemente submetidos a procedimentos diagnósticos e terapêuticos que podem causar dor. Contrariamente ao que se pensava há duas décadas, a evolução ontogenética da dor iniciase cedo e, a partir das 24 semanas de gestação, o feto dispõe do equipamento neurosensorial necessário à experiência de dor. Todavia, as vias de controlo descendente não se encontram ainda suficientemente desenvolvidas, resultando em hipersensibilidade dolorosa. As consequências da exposição repetida à dor no período neonatal têm vindo a ser estudadas, sendo hoje conhecidos os efeitos a curto prazo da dor não tratada, como a hiperalgesia e a alodinia nos recém-nascidos, e alguns efeitos a médio e longo prazo como as alterações da sensibilidade e da reactividade ao stress em crianças de idade escolar. O alívio da dor nesta população vulnerável é, pois, uma tarefa imperiosa. Dado o reduzido leque de fármacos disponíveis para estas idades e o seu potencial para efeitos adversos, torna-se necessária a investigação de intervenções não-farmacológicas. Entre estas, a sacarose oral com chupeta tem sido exaustivamente demonstrada como eficaz, sendo utilizada por norma em muitas unidades neonatais antes da realização de procedimentos como a punção do calcanhar e a punção venosa. Durante estes procedimentos, também o contacto pele-a-pele entre mãe e bebé, conhecido como canguru materno, pode ser utilizado como forma de reduzir as respostas de dor dos recém-nascidos. Desconhecia-se, todavia, se ao adicionar o canguru materno ao uso da sacarose com chupeta seria possível reduzir ainda mais as respostas de dor dos recém-nascidos pretermo. Por outro lado, dada a co-regulação fisiológica mãe-bebé, colocava-se a questão de saber se a ansiedade materna poderia comprometer o efeito analgésico do canguru materno. Finalmente, as percepções das mães sobre a realização de canguru materno durante a venopunção não haviam sido exploradas. Assim, os objectivos definidos para este estudo foram: 1) comparar as respostas de dor dos recém-nascidos pretermo aos quais é proporcionado canguru materno, sacarose oral e chupeta durante a punção venosa para colheita de sangue, com as respostas dos recém-nascidos aos quais é proporcionada apenas sacarose oral com chupeta; 2) analisar a relação entre a ansiedade materna e as respostas de dor dos recém-nascidos que efectuaram canguru materno; e 3) explorar as percepções maternas sobre a realização de canguru materno durante a venopunção. Para dar resposta ao primeiro objectivo, foi realizado um estudo randomizado, controlado, cego, em duas unidades de cuidados intensivos neonatais portuguesas. Cento e dez recém-nascidos sem doença grave, estratificados por idade gestacional (28 a 31 semanas e seis dias, e 32 a 36 semanas e seis dias) foram aleatoriamente alocados a dois grupos: um recebeu sacarose oral com chupeta (grupo Sacarose); o outro recebeu sacarose oral com chupeta e canguru materno (grupo S+CM) antes, durante e após venopunção. As respostas de dor foram medidas através da escala Premature Infant Pain Profile (PIPP) e foram analisadas a frequência cardíaca, a saturação de oxigénio da hemoglobina, as acções faciais (percentagem de tempo em saliência interciliar, olhos apertados e prega nasolabial), o estado comportamental, a variabilidade da frequência cardíaca (baixa frequência, alta frequência e ratio entre ambas) e o tempo de recuperação da frequência cardíaca inicial após o final do procedimento. As acções faciais foram gravadas em vídeo e as variáveis fisiológicas foram registadas através do Somté® Compumedics, ao longo de cinco fases: antes do procedimento, preparação da pele, punção, compressão e repouso. Para a determinação do score PIPP, a análise das gravações foi efectuada por codificadores cegos aos propósitos do estudo. Para dar resposta ao segundo objectivo, foi realizado um estudo descritivo-correlacional analisando a relação entre a ansiedade materna medida pela escala de Estado de Ansiedade do State-Trait Anxiety Inventory (STAI) e as respostas de dor dos recém-nascidos (N= 60). As percepções maternas foram estudadas através da análise de conteúdo das entrevistas semi-estruturadas realizadas às mães que tinham efectuado canguru materno (N= 52). A comparação dos dois grupos de intervenção quanto a variáveis socio-demográficas e clínicas não revelou diferenças significativas. Em todos os testes foi utilizado como nível de significância α< .05. A ANOVA de medidas repetidas (fases do procedimento) a dois factores (intervenção e idade gestacional) revelou o efeito principal da intervenção sobre a percentagem de tempo em saliência interciliar, F(1, 98)= 5.12, p= .026, e olhos apertados, F(1, 98)= 6.02, p= .015. A análise posthoc mostrou que no momento da punção, a saliência interciliar ocorria durante menos tempo nos recém-nascidos do grupo S+CM (M= 15.89, EP= 4.58) do que no grupo Sacarose (M= 29.22, EP= 4.75). O mesmo se verificou para o tempo em olhos apertados (M= 13.85, EP= 4.36 no grupo S+CM e M= 29.13, EP= 4.52, no grupo Sacarose). O efeito principal da idade gestacional verificou-se na frequência cardíaca mínima e média e no índice baixa frequência da variabilidade da frequência cardíaca. A reactividade dos recém-nascidos durante o procedimento foi semelhante nos dois grupos de intervenção, observando-se o efeito principal da fase do procedimento sobre a PIPP, a frequência cardíaca, a saturação máxima de oxigénio, as expressões faciais e o índice baixa frequência da variabilidade da frequência cardíaca. Tal indica uma variação significativa destes sinais de dor ao longo das fases do procedimento, com aumento dos sinais de dor desde o momento antes do procedimento até à punção, seguido de uma diminuição desses sinais até ao repouso. O teste de Qui-Quadrado para cada fase do procedimento mostrou uma associação significativa entre intervenção e estado comportamental: em todas as fases, a proporção de bebés em estado de sono (versus estado de alerta) era significativamente mais elevada no grupo S+CM. Apesar não ter havido uma diferença significativa no tempo médio de recuperação da frequência cardíaca de base após o procedimento, a probabilidade (odds-ratio) de ter recuperado aos 60 e 90 segundos após o procedimento foi cerca de 3 vezes mais elevada nos recém-nascidos do grupo S+CM com 32 ou mais semanas de gestação, do que nos do grupo Sacarose. Durante o procedimento não se verificaram efeitos adversos em qualquer dos grupos de intervenção. A ansiedade materna foi baixa, sendo significativamente mais baixa nas mães do grupo S+CM (M= 37.78, SD= 9.13) do que nas mães do grupo Sacarose (M= 43.48, SD= 9.82), t(87)= 2.65, p= .009. Nas entrevistas, as mães salientaram a sensação de bem-estar em ter o bebé em contacto pele-a-pele, o contentamento em poder protegê-lo da dor e a importância que esse acontecimento havia tido para a realização do seu papel parental. Estes resultados demonstram que a combinação sacarose, chupeta e canguru materno é eficaz e segura em recém-nascidos pretermo, permitindo reduzir a expressão facial e o tempo de recuperação quando comparada com a utilização de sacarose com chupeta; níveis baixos e moderados de ansiedade materna não interferem na redução das respostas de dor dos bebés; as mães apreciam o contacto pele-a-pele durante o procedimento doloroso e sentem o seu papel parental reforçado por poderem participar no alívio da dor do seu bebé. Em conclusão, o canguru materno pode ser adicionado ao uso da sacarose com chupeta para reduzir as respostas de dor de recém-nascidos pretermo acima das 28 semanas de gestação durante a colheita de sangue por venopunção. Palavras-chave: dor, recém-nascido pretermo, sacarose, canguru materno, punção venosa.

MCur
Department of Advanced Nursing Science
Each year, an estimated 3.6 million infants die worldwide in the first four weeks of life due to complications of premature birth. One-third of Low Birth Weight (LBW) babies die within the first 12 hours after delivery. The main reasons premature babies are at greater risk of illness and death is that they lack the ability to control their body temperature meaning that they get cold or hypothermic very quickly. Kangaroo Mother Care reduces mortality and if widely applied it could reduce deaths in premature newborn babies. The purpose of this study is to explore and describe the lived experiences of mothers when providing Kangaroo Mother Care at the hospitals in Vhembe District of Limpopo province. Qualitative approach with explorative descriptive, contextual and phenomenological designs were employed to explore the experiences of mothers when providing Kangaroo Mother Care. The study population consisted of all mothers who were providing Kangaroo Mother Care. A non-probability convenience sampling method was used to determine the sample of the study. The size of the sample was determined by data saturation. In-depth individual interviews were conducted using a central question. The Tesch’s eight steps of open-coding model guided the process to analyse data. Trustworthiness was ensured throughout by employing the principles of credibility, dependability, conformability, and transferability. Ethical considerations were followed to protect the participants. Recommendations were made based on the research findings. The findings of the study revealed that mothers who provide Kangaroo Mother Care experience challenges. They received inconsistent information about the practice of Kangaroo Mother Care from nurses. The relationship between mothers and nurses was good. Recomendations were made based on the findings and relevant structures in order to ensure that mothers challenges are addressed. The study revealed ineffective support provided to mothers by nurses and family members.
NRF

As intensive care of preterm infants and high-risk infants has evolved, the practice of close physical contact between parents and their infants has been curtailed, with the separation of mothers and their infants more the norm than the exception (Browne, 2004). However, in the past two decades, the physiologic and socio-emotional benefits of close physical contact between parents and their high-risk infants has been revisited, with the practice of Kangaroo Mother Care (skin-to-skin contact) dramatically increasing in neonatal care units worldwide (Browne, 2004). Although research on Kangaroo Mother Care’s effects is plentiful, literature reveals gaps in the research pertaining to the experiences of midwives and nurses in its practice (Chia, 2006 & De Hollanda, 2008). As the role of midwives/nurses has been identified as crucial for Kangaroo Mother Care practice, this gap was recognised, and impelled this research study to be conducted in order to further extend the practice of KMC for its benefits to infants and their families. Due to current staff shortages and poorly resourced neonatal facilities in our local hospitals, local data on midwives’ experiences of Kangaroo Mother Care was perceived to be a vital first step in exploring these experiences. The purpose of this qualitative study was to explore the lived experiences of midwives regarding the Kangaroo Mother Care initiative at a selected tertiary level hospital in the Ethekwini District. Interpretive phenomenology informed this study design, data collection and analysis. As Kangaroo Mother Care is a complex phenomenon, an interpretive paradigm allowed the researcher to access the meaning of participants’ experiences as opposed to explaining their predicted behaviour. Purposive sampling was used by the researcher to select the eight midwives working in the tertiary hospital in the Ethekwini District. The midwives were selected from the neonatal unit during August 2011. Data was collected through a single in-depth interview with each participant in the neonatal unit. The interviews were recorded and later transcribed verbatim to facilitate analysis. Colaizzi’s method of data analysis and representation was utilised. Eleven themes emerged from the analysis of the data. Themes were aligned to the research objectives and included the participants’ experiences of conceptualisations, experiences, hindering and facilitating factors of Kangaroo Mother Care. Conceptualisations were aggregated into two themes pertaining to a physiological concept of KMC and an emotive concept of KMC. The physiological concept regarded the catalytic action of KMC as a promotive agent in health through its effect in increasing average weight gain. Furthermore, KMC was seen as a protective agent in reducing cross-infection and hypothermia. These findings aligned with findings from authors in the literature review. An emotive concept of KMC was revealed by the participants’ input regarding the effect of the skin-to-skin contact in facilitating maternal-infant attachment through bonding. This study finding is supported by current literature. Lived experiences emerged regarding the theme of KMC in maternal instinct and capability, which findings encompassed increased maternal confidence and competence with which several authors concurred. Factors considered as hindering KMC included five themes which emerged as maternal concerns, increased work-load, lack of training, management support and resource scarcity. Contrary to these, facilitators of KMC included the need for motivation and education as well as the provision of a comfortable environment conducive to the practice of Kangaroo Mother Care. A number of recommendations for nursing practice, nursing education, communities and research based on the findings from the study were made available to relevant stakeholders. If implemented effectively, these recommendations may assist in the continued and increasing practice of KMC; resulting in its beneficial effects changing infants’ and families’ lives.
Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2011.

Die doel van hierdie studie is die ontwikkeling van 'n ouerleidingsprogram vir moeders wat hul premature babas in 'n kangaroemoedersorgprogram versorg. Die program het ten doel om die moeders in die onmiddelikke versorging, sowel as die toekomstige begeleiding van hut kinders, toe te rus. 'n Literatuuroorsig word gegee van prematuriteit as fenomeen en van kangaroemoedersorg (KMS) as versorgingswyse, met spesifieke verwysing na die toepassing daarvan in Kalafonghospitaal. Die grondslae van ouerteiding word uit die literatuur opgesom en riglyne word ook gestef vir die samestelling van 'n ouerfeidingprogram. Die kwalitatiewe navorsingsmetode word gebruik om die inhoud van die ouerfeidingsprogram te bepaal en om ondersoek in te stel na die mees geskikte aanbiedingswyses. Die verslag word afgesluit met riglyne vir die samestelling van 'n prakties-toepasbare ouerleidingsprogram waarin inhoudsmoontlikhede, idees vir aanbieding en wyses vir die bepaling van gestelde uitkomste uiteengesit word.
The aim of this study is the development of parental guidance for mothers who take care of their premature babies in a programme of Kangaroo Mother Care. The programme aims to equip mothers for immediate and future care of their children. A literature review of prematurity as phenomenon and of kangaroo mother care as care method is presented with specifK: reference to the way it is applied in Kalafong-hospital. The basics of parental care are summated from literature and guidelines are set to design a parental guidance programme. The qualitative research method is put into operation to determine the content of the parental guidance programme and to investigate the most appropriate method of presentation. The report is concluded with guidelines for setting up a practical and applicable parental guidance programme in which subject possibilities, ideas for presentation and means for determining set outcomes are explained.
Educational Studies
M.Ed.(Spesialisering in voorligting)

v anglickém jazyce The thesis deals with the care of premature newborns. The structure of the thesis is divided into several chapters, which focus on the definition of neonatology and development of the neonatal care in the Czech Republic and abroad and on the definition of premature newborn and their most common diseases. Substantial part is devoted to development of the care of premature newborn and its current status. The final part of the thesis is devoted to interviews with the nurses, who have been working in the neonatal intensive care unit for long time. The thesis is formed by description and used it in written and electronic resources. The aim of the thesis is overview of the development of care of premature newborn in the past and present. Key words: Neonatalogy, development of neonatalogy, Oxygen therapy, Kangaroo mother care, history of incubators, Virginie Apgar, UPMD history, classification of the newborn, resuscitation of the newborn, congenial defects, history of Gynaecology and Obstetric Clinic VFN, history of the Institute for the care for mother and child, newborn screening, newborn nutrition