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Kangaroo Care Annotated Bibliography and References to Videos, Books, Webinars, Wraps, Researchers, etc

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Kangaroo Care Annotated Bibliography and References to Videos, Books, Webinars, Wraps, Researchers, etc.

United States Institute for Kangaroo Care.

Made possible by Susan Ludington, Ph.D., RN, CNM, CKC, FAAN

International Network of Kangaroo Mother Care and United States Institute for Kangaroo Care Bibliography 5/17/2014
The entire August 2011 Issue of Current Women’s Health Reviews is about KC

Table of Contents 001

Poems 002

Upcoming conferences 003

Original articles 004

Original articles, duplicate from V-Z 278

Foreign language articles 280

Abstracts, published 292
Textbooks addressing KC
VIDEOs/WEBINARS available 305
Protocols 310
Pamphlets 312
Related Literature 314

Co-bedding and Co-sleeping 349

References to Kangaroo Care 352
Kangaroo Care Stories 355
Lay publications/TV/Radio about/including KC 356
Researchers in Kangaroo Care 359
Other notables in KMC 366

Early Hospital Adopters of KC in US (outdated list) 369

Milk leakage devices, 369
Kangaroo Jewelry (sterling silver) 369

WRAPS/Carrying Devices for 24hr/day KMC 370

Chairs 371
Foundations 371
Literature Thoughts (Mechanisms of how KC works) 372

The annotations are done by Dr. Susan Ludington and do not represent the opinions or reviews of other members of the International Network of Kangaroo Mother Care, United States Institute for Kangaroo Care, or anyone else.

Kangaroo Care BIBLIOGRAPHY Developed by Dr. Susan Ludington Updated: 5/17/2014 ©2006-2014 Ludington-Hoe SM and United States Institute for Kangaroo Care

The following is a list of published articles and materials related to Kangaroo (Mother) Care. For professionals, the resource that will be easiest and most comprehensive to have about Kangaroo Care is Dr. Susan Ludington’s book called “Kangaroo Care: The Best You Can Do for Your Preterm Infant,” that was published in 1993 by Bantam Books. You can buy a copy from any e-reader book seller, from Dr. Ludington at Frances Payne Bolton School of Nursing, 10900 Euclid Ave. room 322D, Cleveland, OH 44106-4904, from La Leche League at 1400 N. Meacham Rd., Schaumburg, Ill. 60173, or from for about the same cost. As of Sept. 2011 the book is available on ereader services such as Nook,, etc. For consumers, the best book to have is Jill Bergman’s book, (2011). Hold Your Preemie. Captetown: New Voices Publishing, Pp. 1-144. It is a wonderful book for parents, interactive, helpful, practical advice, clear guidelines, and eases anxiety about the preterm birth experience as well. Now available from Geddes Productions in Los Angeles. Contact them at or Thank you.

Kangaroo Mother Care: Baby’s Right – Mother’s Delight! (Kangaroo Mother Care Initiative of India – see AIIMS et al., 2004 and Parikh et al., 2004).
Mrs. Kangaroo, is it true

You are hiding someone new

In the pocket part of you?

There must be someone new and growing

It’s little ears have started showing.

Kitty McCausland RN, BSN, UCLA

In talking to the kangaroo,

Its opinion would be

To care “for your child as

My mother cared for me.”

In order to be stable,

When you are able,

“Care for your child the way

My mother cared for me.”

Close to her heart –

Warmth, gentle beating,

Love unfleeting.

Research shows it’s so,

This Kangaroo Care.

No matter what the species,

It’s a mother’s care. By Joan Moon, CNM, MSN [Moon, J. 2004. Kangaroo Care. Journal of Perinatal Education, 13(1), p. iii.]
“Keep them bare for Kangaroo Care”. Created by Kellie Kinas, RN of Fairview Hospital, Cleveland, OH.

Oh, tiny baby a few minutes old

All bundled up to fight off the cold,

Kangaroo care, or skin-to-skin,

Much more resembles the past world within.

Before I take a needed rest

I want to place you on my chest,

This will calm you and help you grow,

Keep you safe from things you don’t know

This world is so big to one so small,

My breathing and heartbeat you can recall.
Skin-to-skin and close to my heart,

In my memory forever, will not part.

Although life’s not easy, I can attest

Yours will be healthier when fed at the breast.

This new phenomenon called Kangaroo Care

Has been with us forever, we weren’t aware.

So rest little one, close to my heart

And know you are loved, right from the start. Sandra D. Brown, RN, IBCLC

Close and warm, skin-to-skin

Is a loving way for life to begin.

Parent and baby make a loving pair

Sharing the embrace of Kangaroo Care. Intensive Wear, Rt 2, Box 4310, Berryville, VA 22611 (540) 955-9513 or (800) 556-4230.


October 21, 22,2013 Kangaroo Mother Care StakeholdersMeeting,Istanbul, Turkey. Sponsored by the Bill and Melinda Gates Foundation. By invitation only to find ways to scale up KMC use to prevent deaths in the first day of life in poor countries. See Engmann et al., 2013 for report of this meeting.

June 6-8, 2014. 8th Annual National Intensive Kangaroo Care Certification Course by the U.S. Institute for Kangaroo Care at Fairview Hospital on Lorain Avenue in Cleveland. Starts Friday night with a KC film fest (and popcorn, soda pop, and candy bars and many KC films), and then two full days (8-5:30 on Saturday and 8:30-3:45 on Sunday) of certification lectures, demonstrations, skills labs, question and answer periods and family panels. Approx. 17 CEUs and 19 CERPs and 4 hours of Baby Friendly USA credit. For more information contact US Institute for Kangaroo Care at or or or register at USIKC, 6803 Forest Avenue, Parma, OHIO 44129. Participants at the 2011course said the course was “”AWESOME,” “FABULOUS” and “REALLY STRETCHES YOUR MIND.” Participants at the 2012 course said “Everyone should take this course!!!” “The best course I have EVER taken.”
2013 & 2014. Meeting the Mandate: Fast Track to Breastfeeding. A four hour course of essentials to get every member of health staff on board with the Joint Commission’s mandate that begins Jan. 1 2014 that every healthy term infants should be exclusively breast milk fed by discharge. This cannot happen without Kangaroo Care and the course relates the effects of KC on breastfeeding, how it all occurs, how to conduct safe kangaroo care at birth, how to support the first breastfeeding, and safe kangaroo care throughout postpartum for continuing breastfeeding, and how to manage breastfeeding problems. Good for 4 hours of CEUs and 4 hours of Baby Friendly USA credit too. Contact the US Institute for Kangaroo Care at or Dr. Susan Ludington at This course has been exceptionally well received with perfect scores from those attending in 2013.
2014 Nov. 17-19, 10th International Workshop of the International Network of Kangaroo Mother Care (INK) will be in Kigali City, Rwanda, AFRICA at the Kigali Serena Hotel. The Ministry of Health is sponsoring the4 day meeting. Get more information by contacting the conference web site or you can contact Dr. Natalie Charpak at the INK website: or through her email ( or http://kangaroo,

The organizer of the conference in Rwanda is Mivumbi N. Victor, MD, Mmed (OG). MDA/Newborn Health/MCH/MoH. His phone in Rwanda is +(250) 788615979 and his email is:

Fall 2016 20th Anniversary of the International Network of Kangaroo Mother Care (INK). The meeting will be in Trieste, Italy. The 10th Anniversary special was in Cleveland, and the celebration was hosted by Johnson & Johnson Pediatric Institute.
PAST INK (International Network of Kangaroo Mother Care) Meeting:
A revised draft of the Baby Friendly Hospital Initiative program has been adapted for neonatal wards (NW) often called NICUs, called BFHI-NW, is available on the website. The expert group is currently preparing a draft of the External Assessment Tool which will be pilot tested in 2013, preliminarily in Quebec, Canada, Finland, and Sweden. The final tool is expected to be completed during 2013. This tool will be available from the UNICEF web site in the ame way as the original BFHI tool. On the UNICEF website, there will be a link to the BFHI-NW document at another web site yet to be determined.
This bibliography contains original articles from all around the world, published abstracts, published articles in foreign languages, a list of sample pamphlets and protocols that are available and a list of researchers in the area and what they are studying. Some of the articles listed are annotated. The bibliography is available online at thewebsite of the United States Institute for Kangaroo Care ( go to the Resources page) of from

Susan M. Ludington, CNM, Ph.D., FAAN

Walters Professor of Pediatric Nursing,

FP Bolton School of Nursing, Case Western Reserve Univ.

10900 Euclid Ave. Room 322D Cleveland, OH 44106-4904

(216) 368-5130 Email:

Terminology: KC = Kangaroo Care; KMC = Kangaroo Mother Care (KC given by mother); KFC = Kangaroo Father Care (KC given by father); KPC or PKC = Kangaroo Parental Care (KC given by mother and father and data reported as results of parental KC); KSC = Kangaroo SURROGATE Care (KC given by someone other than biological parents). PT = preterm; FT = fullterm, KCBF = breastfeeding while in Kangaroo Care position, BF = breastfeeding, RCT= randomized controlled clinical trial.
_____.(2013). Pain in the neonatal period 11. Non-pharmacological and pharmacologisl treatment. Akush Ginekol (Sofiia). 2013;52(6):29-37. In their postnatal development the newborns are often exposed to the influence of procedural and repetitive painful stimuli that worsen their status. This requires the implementation of non-pharmacological and pharmacological treatment. The aim was to explore the literature data on the possibilities of non-pharmacological and pharmacological treatment methods which are implemented to reduce and control pain in neonatal period. Some of the non-pharmacological strategies are the priority of the personnel who give care of newborns (swaddling, nonnutritive sucking, usage of sweet solution, etc.) The participation of mother (parents)in the care of her child's comfort and pain reduction is also presented. Breastfeeding and "kangaroocare additionally reduce negative effects of pain. The importance of music continues to be explored. The principles of pharmacological therapy include: control of procedure pain, its treatment during mechanical ventilation and at the time and after surgical intervention which is based on analgesia. Specificities of the pharmacotherapy of newborns and premature infants require careful application of the medications and additional studies on these children. The elimination of neonatal pain and its negative effects on the newborn is achieved by applying different strategies. Non-pharmacological methods reduce pain stimuli and ensure the child's comfort and the pharmacological methods block and eliminate the pain. Most often a combination of them is used in practice. Review, FT, PT, Pain, parental involvement in pain management.
________(2013). Hospital celebrates skin to skin contact to raise awareness. Nurs Child Young People. 2013 Jun;25(5):5. doi: 10.7748/ncyp2013. Neonatal nurses at Birmingham's City Hospital have been celebrating the benefits of skin to skin contact with premature babies. They held a week of celebrations in the unit last month, in which they promoted the kangaroo care technique and breastfeeding to parents. PT, practice report, Not on Charts 9/13/2013. TRY TO GET THIS we need it.

________(2012). Evaluation of the Effects of Kangaroo Mother Care on Mental and Psychomotor Development in Very Low Birth Weight (VLBW) infants. International Journal of Nursing Studies. Few longitudinal studies with VLBW infants have been reported, so a retrospective panel cohort study was used that included 5 cohrots of VLBW infants (n=631 cases) who were born between 2003 and 2007 in one hospital in Taiwan. Bayley MDI and PDI at 6, 12,and 24 months were performed on 63.23% of infants who completed the study (there were 96 deaths and 136 missing cases).. KMC group had 219 infants, and 180 infants got no KMC. AT start of study KMC infants had lower GA, lower birthweight, and more cases of chronic lung disease, but still at all three time periods the KMC infants got higher MDI and PDI scores than non-KMC infants. Birthweight was a predictor of MDI and PDI at 24 months, but no interactions were present. KMC has good long term effects on mental and physical development. Authors recommend that KMC be included in routine care and actively promoted for VLBW. Retrospective qualitative study, KMC, development, mental and motor development, micropreemie

________, (2008). Community Kangaroo Mother Care Manual. Available for free from Community KC PT.
________(2007). Better births feature continuous care for moms: “Kangaroo” care for kids. Medical News, 2007. Available from http:/ Released July 12, 2007..Author may be “newswise” or “health behavior news service”. 30 studies with 1925 mother-infant pairs were reviewed in this updated meta-analysis of KC immediately after birth and within 30 miinutes of birth. Pairs who had early skin-to-skin contact were more likely to breastfeed and to breastfeed for longer than those who did not. The review also showed that baqbies who had KC immediately after birth “interacted more with their mothers, stayed warmer, and cried less.” See following citation which is very similar. Review of new Cochrane (Moore et al., 2007) results, BirthKC, VEKC, Breastfeeding, crying, interaction, fullterm
_________(2007). Better births feature continuous care for moms, “Kangaroo” care for kids. Health Behavior News Service. July 12, 2007. Available from This is a review of two recent publications, one being Hodnett’s review of 16 studies and 13,391 women showing that continuous supportive one-on-one care throughout labor and massage (i.e doula care) has many benefits and “should be the norm, rather than the exception.” The second study reviewed is Moore et al.’s 2007 Cochrane review of 13 randomized controlled trials and 1,925 subjects (some were in control groups so not all were KC).. Relates that Moore says time immediately after birth is a sensitive period for programming future infant behavior and maternal behavior. Some near term infant studies were included in Moore’s Cochrane of 2007.. Review, full term infants, meta-analysis, BF, near term (late preterm)
________(2006). Management of asymptomatic hypoglycaemia in healthy term neonates for nurses and midwives. Australian Nursing Journal, 13 (2) (June), pg. 13. Evidence Based Practice report. An increasingly litiginous society has caused the lower level of euglycemia to rise from that which existed in the original work by Hartmann and Jaudon in 1937 (i.e. the limits are within 2 standard deviations of population mean for both healthy term and preterm infants). “Healthy term newborns that are breast-fed on demand need not have their blood glucose routinely checked and need no supplementary foods or fluids” is a WHO 1997 recommendation that is still considered a grade A recommendation. Other WHO 1997 recommendations that still have grade A best practice status are: “Thermal protection (the maintenance of normal body temperature) in addition to breastfeeding is necessary to prevent hypoglycaemia” and “Given the importance of thermoregulation, skin to skin contact should be promoted and “kangaroo care” encouraged in the first 24 hours after birth.” The standards for evidence based practice used in this article are those of the Joanna Briggs Institute ( and are: Grade A=effectiveness established to a degree that merits application; Grade B=effectiveness established to a degree that suggests application, Grade C=effectiveness established to a degree that warrants consideratioin of applying the findings, Grade D= Effectiveness established to a limited degree, Grade E= Effectiveness not established. Recommendations, hypoglycemia, breastfeeding, birth KC, evidence-based guidelines, fullterm.

_________(2002). Newscap: Kangaroo Care. American J. Nursing. April 2002. This is an early report of the US Survey by Engler in MCN. Survey report. PT

_________(2001). Third International Workshop on Kangaroo Mother Care: Indonesia November, 2000. Report and abstracts from the meeting. Meeting report. PT How do we access these?
______ (1999). Kangaroo care tops incubators. Childbirth Instructor Magazine, 9(1), 7. Clinical Report, Warming, fullterm. Birth KC/VEKC
_______ (1997). “Kangaroo care” helps preemies. Indian Med Trib 5 (1-2),1. This is a summary of the Bier study. Clinical report, Preterms
______, 1995. Appropriate technologies can help make motherhood safer. Safe Mother, 18, 4-8. Review of available technologies and KC is one that is identified as keeping the infant warm against the mother’s skin and is recommended. Review. Temperature, Fullterm
_______, 1985. The marsupial mother. Lancet 2(8446), 99-100. This is a commentary on the article entitled Myth of the Marsupial Mother by Waterston, T. in June 29, 1985 Lancet ;1(8444):1507-8. Review PT GET Both
Abdel Razek, A & Az El-Dein, N. (2009). Effect of breast-feeding on pain relief during infant immunization injections. International J Nursing Practice, 15(2), 99-104. Doi: 10.1111/j.1440-1721X.2009.01728.x Quasi-experiimental study of FT infants under 1 year of age coming to Jordan clinic for immunization. 60 infants in (short duration? Less than 5 minutes? Unspecified in study but says that shot was given as soon as infant had full areola in mouth and that KC occurred before,during and after the study) KC group (private room, seated, reclined mom, awake infants in arms, no cloth, with clean diapers, cradled during breastfeeding to maintain full body skin-to-skin contact during immunization. 60 infants in control group. Control was routine (mom in room and clothed infant seated on table not breastfeeding, not being held, just touched by mother for positional support, nurse give shot). Pain measured by Facial Pain Rating Scale and Neonatal/Infant Pain Scale before, during and after injection. HR measured before (KC=129; control = 125) and after (KC= 149; Control = 162) injection – text says there was significant difference between groups but the table reports a p = 1.33 which is not significant, so I do not know the effect on HR between groups except to guess that HR after injection was lower in KC group than controls (Pg. 101, 102) and the variability in HR for KC group was half that for the control group in both before and after measurements. Stopwatch for crying from insertion of injection up to cessation of crying duration of crying was shorter in breastfed + KC group during and after injection (M=125.33) than control (M=148.66 seconds (10 KC infants had audible cry vs. 39 controls, so fewer KC infants cried than controls), also KCers spent 16.7% of time crying and controls spent 65.3% of time crying (pg. 103), free cry and end cry were also measured but not explained as to what they meant (pg. 102). Crying time was shorter in KC Breastfed group (duration of crying shorter during and after KC (Residual effect). No changes in HR, NIPS, or facial coding scale scores. NIPS pain scores consistently lower in KC than controls (no significance level computed), and more facial pain in KC group than control (p<0.05, pg. 103). KC and breastfeeding significantly reduce crying during immunization. On page 103 it says that crying was reduced in BF+KC group because “this reflects the penfecilarity of BF over other types of pain reduction as destruction of attention.” What this means is beyond me! Does also say that “function of mother-infant interaction serves as a means of preventing and/or reducing pain and stress among infants”pg. 103 and cites Barr R, Young S. 1999. A two phases model of the soothing taste response implication for temperament and emotion regulation, soothing and stress. Hillsdale, NJ: Erlba Um. (This is an incomplete reference). Quasi-experimental (no randomization to groups), HR, stability, crying, NIPS, pain, FT, facial coding .not on Charts yet 4/30/09
Abolyan, L.V. (2006). The Breastfeeding Support and Promotion in Baby-Friendly Maternity Hospitals and Not-as-Yet Baby Friendly Hospitals in Russia. Breastfeeding Medicine 1(2), 71-78. Randomized evaluation of 741 mothers (383 experimentals from the 4 Baby Friendly Hospitals; 358 controls from not as yet Baby Friendly Hospitals) interviewed about infant breastfeeding rates. Mothers in Baby Friendly Hospitals had positive effect of BFH on increased rate of exclusive BF, duration of BF, mothers and baby’s health, and maternal knowledge about BF. BFH moms liked rooming-in, BF on demand, taking care of baby by themselves. Initiation and one year BF rates higher in BFH group. Baby Friendly Hospitals in Russia have a few shortcomings: frequent use of labor anesthesia, insufficient placing of newborns on the mother’s abdomen (birth KC), rooming-in insufficient, and insufficient intiating of breastfeeding immediately after birth, and a short length of “skin-to-skin” contact (<30 minutes total). But, Russia is in compliance with Baby Friendly Intiative Goals for the country. RCT, fullterm, Breastfeeding duration and exclusivity, birth KC Put on Charts.
Aboudiab, T., Vue-Droy, L., Al Hawari, S., Attier, S., & Chouraki, J.P. (2007). Is there a risk with skin-to-skin practice at baby’s birth? Archives de Pediatrie, 14(11), 1368-1369. Two case studies in France of healthy, normal APGAR, full term infants, one boy and one girl, who were given Birth KC and then had cessation of breathing while on the mother’s chest. The baby girl was placed in Birth KC immediately after birth and in the first few minutes experienced cyanosis, cessation of breathing and was hypotonic. She was taken from the mother’s chest and given oxygen by mask and stimulation and recovered quickly and did not go to the NICU. The baby boy was also placed in Kangaroo Care immediately after birth and at 45 minutes post birth was seen to have palor and be hypotonic and was treated with stimulation and oxygen by mask, but persistence of palor and bad coloring required him being taken to the NICU where his lactate was elevated to 8.7 nmol/l. He recovered rapidly and the mother was very tired. Birth KC is a risk factor for apparent life threatening events. Pediatricians and obstetricians believe that observation of the newborn is very important and that this responsibility is the nurses’ and is particularly important for mothers during the immediately postpartum period. Nurses should not abstain from vigilant observation. Case studies, Birth KC, Fullterm, life threatening events,
Abouelfettoh, A., & Ludington-Hoe, S.M. (2014 in press). Preterm twins cardiorespiratory, thermal, and maternal breast temperature responses to shared kangaroo care. International Journal of Nursing and Midwifery, in press. This is a descriptive study of 5 mother-twin triads who all got Kangaroo Care for 1.5 hours. Baseline (5 minutes) and KC measures were taken every 30 seconds throughout. No difference in HR, RR, SaO2 and infant temp between baseline in incubator and KC periods, but maternal breast temperatures wer highly, positively, and significantly related to infant temperatures and behaved independently of each other. PT, Temp, HR, RR, SaO2, breast temp, Twins

Abouelfettoh A., Ludington-Hoe, S.M., Burant, C., & Visscher, M. (2011). Effect of skin-to-skin contact on preterm infant skin barrier function and hospital-acquired infection. Journal of Clinical Medicine Research, 3(1), 36-46. Doi: 10.4021/jocmr479w Descriptive study (N=10) of infants 30-32 wks GA tested within 9 days of birth and without signs of infection who received 5 days of KC (1.5 hours/day). On Days 1 and 5 pretest (incubator) values of stratum corneum hydration and TEWL (transepidermal water loss) were taken and compared to values at beginning, middle, and end of KC session and then posttest values were taken too. Stratum corneum hydration and TEWL increased during KC, indicating a higher humidity environment, better skin barrier function (increased stratum corneum hydration), and the expected higher humidity (transepidermal water loss – water in the skin-to-skin interface) in the enclosed interface occurred. No infant had any infection while hospitalized after KC had begun and no mothers reported signs of infection within the first month post-discharge. PT, pretest-test-posttest within subjects control descriptive (or quasi-experimental) study, skin hydration, TEWL, infection, barrier function, separation.

Academy of Breastfeeding Medicine. (2007). Protocol #2, 2007 Revision: Guidelines for hospital discharge

of the breastfeeding term newborn and mother: “Going home protocol”. Breastfeeding Medicine, 2(3), 158-165. DOI: 10.1089/bfm.2007.9990 Retrieved 6/2/2011from FT. BF

Academy of Breastfeeding Medicine (2002). Peripartum breastfeeding management for the healthy mother and infant at term. Academy of Breastfeeding Medicine Protocols, protocol #5, 1-2. All protocols are on their website. “The healthy newborn can be given directly to the mother for skin-to-skin contact until the first feeding is accomplished. The infant may be dried and assigned APGAR scores and the initial physical assessment performed as the infant is placed with the mother. Such contact provides the infant optimal physiologic stability, warmth, and oppprtunities for the first feeding. Delaying procedures such as weighing, measuring, and administering vitamin K and eye prophylaxis (up to an hour) enhances early parent-infant interaction”. Available from website: THEN type in peripartum.pdf (2002) or cosleeping.pdf (2003) or mhpolicy_ABM.pdf (2004a) or near_term.pdf (2004b) or NICUGradProtocol.pdf (2004c)for the ones relevant to KC. Fullterm FT, BF, Birth KC, guideline
Academy of Breastfeeding Medicine Protocol Committee. (2007). ABM clinical protocol #7. Model breastfeeding policy. Breastfeeding Medicine, 2(1), 50-55. This is an excellent protocol article that endorses birth KC by saying “At birth or soon thereafter all newborns, if baby and mother are stable, will be placed skin-to-skin with the mother. Skin-to-skin contact involves placing the naked baby prone on the mother’s chest. The infant and mother can then be dried and remain together in this position with warm blankets covering them as appropriate.Mother-infant couples will be given the opportunity to initiate breastfeeding within 1 hour of birth. Post-cesarean birth babies will be encouraged to breastfeed as soon as possible, potentially in the operating room or recovery area. The administration of Vitamin K and prophylactic antibiotics to prevent opthalmia neonatorum should be delayed for the 1st hour after birth to allow uninterrupted mother-infant contact and breastfeeding.”(pg. 52). FULL TERM, BF, Birth KC, guidelines NOT ON KC BIB
Academy of Breasfeeding Medicine Protocol Committee. (2010). ABM clinical protocol #7. Model hospital policy. Revision 2010. Breastfeeding Medicine 5(4), 173-177. This is an update of the 2007 Model breastfeeding policy listed above. It is also an EXCELLENT article on directions to give new mother about breastfeeding while we are doing immediate Birth KC. Protocol #7 has several things to say about KC: At birth or soon thereafter all newborns, if baby and mother are stable, will be placed skin-to-skin with the mother. Skin-to-skin contact involves placing the naked baby prone on the mother’s chest. The infant and mother can then be dried and remain together in this position with warm blankets covering them as appropriate.Mother-infant couples will be given the opportunity to initiate breastfeeding within 1 hour of birth. Post-cesarean birth babies will be encouraged to breastfeed as soon as possible, potentially in the operating room or recovery area. The administration of Vitamin K and prophylactic antibiotics to prevent opthalmia neonatorum should be delayed for the 1st hour after birth to allow uninterrupted mother-infant contact and breastfeeding.” (pg. 173).Breastfeeding mother–infant couples will be encouraged to remain together throughout their hospital stay, including at night (rooming-in). Skin-to-skin contact will be encouraged as much as possible. (pg. 173-174) . “After 24 hours of life,….. skin-to-skin contact will be encouraged.” (pg. 175). Fullterm, cesarean, BF, Birth KC, Postpartum KC, guidelines (not on charts)
Academy of Breastfeeding Medicine. (2010). Clinical Protocol Number #23: Non-pharmacologic management of procedure-related pain in the breastfeeding infant. Breastfeeding Medicine 5(6), 1-5. DOI: 10.1089/bfm.2010.9978. It states on page 1: “Coordinating a breastfeeding session with the timing of the procedure is best, but, if this is not possible, skin-to-skin contact can comfort infants undergoing a procedure such as heel lance. Skin- to-skin contact also gives the mother a caretaking role during the procedure that is unobtrusive, and by Cong infant stress, it can increase maternal confidence as to her value to the infant (based on Gray, Watts,and Blass). “sucrose and pacifier can both be combined with the skin-to-skin component of parental contact”. On page 2 it says “Skin-to-skin contact provides effective pain reduction for premature infants.” PT, FT, Guidelines, Pain, Not on Charts Yet 2/1/7/2011
Academy of Breastfeeding Medicine Protocol Committee: Chantry C, Howard CR, McCoy RC. (2002) & (2003). Clinical Protocol #5: Peripartum breastfeeding management for the healthy mother and infant at term. New Rochelle, NY: Americann Academy of Breastfeeding Medicine. Protocol #5 , 1-2. Retrieved 6/2/2003 from but this URL is NOT GOOD in 2013 because the protocol was update in 2008 and is found on under Perinatal Breastfeeding Management (NGC: 006817 – see publication below). Protocol #5 on Breastfeeding recommends birth kc to promote temperature regulation, maintenance of euglycemia and successful BF. Protocols of Academy of BF Medicine are available at the website listed directly above. Says babies and mothers should not be separated. Full term, BF, Birth KC, separation. NOT ON CHARTS YET This 2002 protocol was updated in 2008 and is listed below as a 2008 publication.
Academy of Breastfeeding Medicine Protocol Committee. (2004). Protocols #6, 7, and 20. Peripartum breastfeeding management for the healthy mother and infant at term.
Academy of Breastfeeding Medicine Protocol Committee. (2008). ABM Clinical Protocol #5: Peripartum breastfeeding management for the healthy mother and infant at term. Revision, June 2008. Breastfeeding Medicine,3(2), 129-133. This is available from and type in Perinatal Breastfeeding management and several guidelines will come up, but the first one is from Academy of Breastfeeding medicine and it is NGC:006817. This is an update of the 2002 protocol #5. These revised guidelines state that prenatal education should be given to the mother, give group discussions, and peer counseling. Under labor and delivery it says that” women will benefit from the continous presence of a close companion (doula) throughout labor and delivery”pg. 129. Under immediate postpartum it states “1. The healthy newborn can be given directly to the mother for skin-to-skin contact until the first feeding is accomplished. The infant may be dried and assigned APGAR scores, and the initial physical assessment performed as the infant is placed with the mother. Such contact provides the infant with optimal physiologic stability, warmth, and opportunities for the first feeding. Extensive skin-to-skin contact may increase the duration of breastfeeding.” (pg. 129-130). Under #2. It speaks to separation: “Whenever possible, mothers and infants are to remain together during the hospital stay. To avoid unnecessary separation, infant assessments in the immediate postpartum time period and thereafter are ideally performed in the mother’s room” (pg. 130). FT, Guidelines, BF, Birth KC, non-separation Not on Charts as of 9/9/09

Acolet D, Sleath K, & Whitelaw A. (1989). Oxygenation, heart rate, and temperature in very low birthweight infants during skin-to-skin contact with their mothers. Acta Paediatrica Scandinavica, 78, 189-193. KC for 10 minutes in 14 very low birth weight infants 6-134 days old and between 1000-1200 grams (five infants had BPD; two on nasal cannula, and 9 had no lung disease). When asleep, infants placed prone in incubator or prone 60º incline on mom’s chest. 5 minutes of stabilization and then VS every 30 seconds for 10 minutes. Then positions were changed (KC went to incubator; incubator went to KC) for another 10 minutes. During KC HR rose significantly within normal limits, BPDers had significant rise in transcutaneous pO2, no infant had apnea, bradycardia during KC, all maintained their temperature. Concluded KC was safe for BPD babies. No change in RR. States they do not do KC with infants having serious apnea/bradycardia. Descriptive comparative (Cross Over Study), PreTerm, VLBW (Micropreemie), BPD, Nasal cannula, HR, RR, SaO2, Axillary Temp, Bradycardia, apnea, Safety

Adam T, Lim SS, Mehta S, Bhutta ZA, Fogstad H, Mathai M, Zupan J, & Darmstadt GL (2005). Cost effectiveness analysis of strategies for maternal and neonatal health in developing countries. British Medical Journal, ,31(7525),1107-1113. Descriptive study of the cost of 21 interventions (ie. Screening for pre-eclampsia, management of LBW babies by giving feeding support, additional warmth, close monitoring, and treatment with oxygen if necessary). Kangaroo Care or skin-to-skin contact is not mentioned per se anywhere in the article, but is ASSUMED to be referred to by the “additional warmth for LBW infants” because of Zupan’s and Darmstadt’s inclusion as authors. The researchers took trials and expert opinion papers and WHO guidelines and assigned costs to the 21 interventions. Concluded that preventive interventions at community level for newborn care are highly cost effective (pg. 3 of 6) followed by antenatal screening.. Evaluative Descriptive, Fullterm, preterm Community-based interventions (may include KC for warmth).
Advance for Nurses. (2009, November 24). Joint Commission introduces perinatal care core measures set. Retrieved from This is a review of the perinatal care core measures set (see also Joint Commission for Accreditation of Health Care Organizations citations in this bibliography). This review lists the exclusively breastmlk fed by discharge for healthy term infants and says that skin-to-skin contact is the key to exclusive breastfeeding and should be the new vital sign for maternity care. Review, Guidelines, BF, Exclusive breastfeeding, birth KC, Vital Sign (Not on charts 9/9/2011). See also US BF Committee that put out many things to help hospitals achieve this new guideline.
Affonso, D.D., Bosque, E., Wahlberg, V., & Brady, J. (1993). Reconciliation and healing for mothers through skin-to-skin contact provided in an American tertiary level intensive care nursery. Neonatal Network 12 (3), 25-32. Mothers interviewed two years after preterm birth who had KC during hospitalization had better resolution of the birth experience and were able to move on better than control mothers who were still asking basic questions about the hospitalization experience. KC helps closure over preterm birth. PT, Qualitative, maternal feelings.
Affonso, D.D., Wahlberg V, & Persson, B. (1989). Exploration of mothers’ reactions to the Kangaroo method of prematurity care. Neonatal Network, 7, 43-51. Mother’s have lots to say about preterm birth as it is very stressful to them, and KC helps with the maternal “psychological hemorrhage” associated with preterm birth (pg.50). PT, Descript. Maternal confidence, psychological stability.
Aghdas, K., Talat,K. & Sepideh, B. (2013, Nov). Effect of immediate and continuous mother-infant skin-to-skin contact on breastfeeding self-efficacy of primiparous women: A randomized control trial. Women and Birth, 27(1), 37-40. pii;S127(1871-5192(13)00401-0. DOI:10.1016/J.WOMBI.2013.09.004. Purpose was to determine effect of immediate skin-to-skin contactafter birth on primip mom’s breastfeeding self-efficacy (at 28 days post-birth; self efficacy in KC group was 53.42 +/-8.57; in control was 49.85+/-5.50; p=0.0003)) by randomized controlled trial with 92 (47dyads kn KC; 45 inn routine care group) 18-35 year old Iranian women with healthy infants after normal spontaneous vaginal delivery. Successful BF initiation rate was56.6% in KC, 35.6% in controls (p=0.02)) and mean time of first breastfeeding was 21.98 +/-9.10 minutes I KC vs. 66.55+/-20.76 minutes in control (p<0.001). Skin to skin contact at birth is easy, available melthod of enhancing BF self-efficacy. High breastfeedng self efficacy increase EXCLUSIVE breastfeeding duration. . Full term, BF, Exclusive/exclusivity of BF, BF self-efficacy, RCT. Not on charts 12/24/2013.GET THIS
Agostino, R., DeLuca, T., Marino, P., Gerardi, R., Patrizi, S.& Bucci, G. (1988). La marsupioterapia come nuovo approccio per favorire l'attaccamento madre bambino nei neonati di peso molto basso. Risultati prelimina. Italian Journal Pediatrics, Supple. 14(5), p. 136-139. ITALIAN Preterm LBW
Aguilar Cordero, M.J., Batran Ahmed, S.M., Padilla López, C.A., Guisado Barrilao, R., & Gómez García, C.(2012). [Breast feeding in premature babies: development-centered care in Palestine]. Nutr Hosp. 27(6):1940-4. doi: 10.3305/nh.2012.27.6.5995. [Article in Spanish]. In addition to its important role in the initiation of breastfeeding, early skin-to-skin contact benefits both mothers and their babies. Objective was to inform all mothers of premature babies about the importance of skin-to-skin contact and breast-feeding in order to foment a closer bond between mother and child (development-centered care). A prospective cohort study was conducted in various hospitals on the West Bank in Palestine during 2008-2011 where there were an estimated average of 2,500 childbirths per year in each hospital. All of the subjects in the sample population of n = 252 (SML question: over three years in more than one hospital with 2,500 births per year of which 250 at least would have been premature, they only got/studied 252 subjects? Whyso few?) babies had a gestational age of less than 37 GWs, and had weighed less than 2,500 grams at birth. For health reasons, they were hospitalized in neonatal care units. In Palestine, young women tend to breastfeed their babies and have skin-to-skin contact with them more often than older mothers. Once the new mothers were informed of the advantages of these practices, they showed greater interest in learning how to care for their babies in the neonatal care units. Breastfeeding premature babies as well as having skin-to-skin contact with them was made possible by informing and teaching new mothers about the advantages of this type of infant care. This research has had widespread impact and has been very well received by the female population in the country. This is the first study of its kind to be carried out in Palestine. 3rd world, PT, descriptive study, just teaching KC increased KC, implementation, developmental care
Ahmed, S., Mitra, S.N., Chowdhury, A.M.R., Camacho, L.L., Winikoff, B. & Sloan, N.L. (2011). Community kangaroo mother care: implementation and potential for neonatal survival and health in very low income settings. Journal of Perinatology, 2011, 1-7 Community KC, Birth KC, mortality. Not on Charts 2/17/2011
Ahmed A.H. & Sands L.P. (2010). Effect of pre- and post-discharge interventions on breastfeeding outcomes and weight gain among premature infants. J Obstetric, Gynecologic, and Neonatal Nursing (JOGNN), 39(1), 53-63. A systematic review of 310 studies, only 8 were Randomized controlled trials of infants <37 weeks GA that measured breastfeeding and weight . Kangaroo care (based on Hake-Brooks & Anderson, 2008), peer counseling, in-home breast milk intake measurement and postdischarge lactation support improved breastfeeding outcomes among preterm infants, and that maternal satisfaction improved with post-discharge interventions. KC during hospitalization was associated with increased EXCLUSIVITY and DURATION of BF (pg. 58). Also tested cup feeding before discharge and found no differences in BF outcomes and a high non-compliance rate with cup feeding. Late preterm infant costs are 3 times higher (12,247.00) than term infant costs (4069.00) (McLaurin KKet al., 2009, Persistence of morbidity and cost differences between late-preterm and term infants during the first year of life. Pediatrics 123(2), 653-659). Review, preterm, BF, Exclusivity, Duration, post-discharge intervention, COST of Prematurity, cup feeding, peer counseling. Not on Charts as of 6/19/2010 LOOK AT FOLLOWING CITATION
Ahmed AH & Sands LP. (2010). Effect of pre- and postdischarge interventions on breastfeeding outcomes and weight gain among premature infants. J Obstetric, Gynecologic, and Neonatal Nursing, 39(1), 53-63. 310 studies were reviewed and 8 met inclusion criteria (<37 wks GA, RCT in English, in developed countries and had BF and weight gain outcomes). The systematic review of 8 RCTs revealed that KC (along with peer support, in home breast milk intake measurement, and postdischarge lactation support ) improved breastfeeding outcomes, maternal satisfaction improved with postdischarge interventions, and no difference in weight gain found between pre and post discharge interventions. Used Hake-Brooks & Anderson 2008 for the KC RCT and says that national “guidelines are now available and provide a protocol for implementation of KC by health professionals (pg. 58)” PT, BF, Meta-analysis
Ahn, J.Y., Lee, J., & Shin, H.J. (2010) Kangaroo Care on premature infant growth and maternal attachment and post-partum depression in South Korea. Journal of Tropical Pediatrics, 56(5), 3343-344. Experimental study of 10 sessions of 60 min KC for 3 weeks in a level III NICU. KC infants had increased length, larger head circumference but not weight differences. Maternal attachment scores were higher in KC group. Kc has beneficial effects on infants and mothers. RCT? Experimental PT, weight, length, head circumference, postpartum depression.

AIIMS - New Delhi, IOG – Chennai, KEM- Mumbai, KGMU-Lucknow, & PGI-Chandigarh. 2004. Presentation at “Workshops on KMC at Neoncon 2004. XXIV NNF Annual Convention at Chandigarh, 28October, 2004” Available from file://E:\KangarooMotherCareInitiative(KMCI)..htm. This is a report of a KMC network in India that has the goals to disseminate awareness about KMC among health care providers by conducting workshop in the country and by providing knowledge and evidence for KMC through the website, to catalize initiation of KMC practice at selected hospitals by onsite training of personnel in outreach hospitals, to provide in service training opportunities about KMC for healthcare providers, and to promote research and generate evidence about feasibility of KMC in the community. The network gives support for implementation of KMC and wants KMC to spread around India. Policy report, Preterm, 3rd world, network, implementation. Not yet on charts

Akcan E, Yigit R, & Atici A. (2009). The effect of kangaroo care on pain in premature infants during invasive procedures. Turkish J Pediatrics 51(1): 14-18. No doi. Randomized controlled trial of 25 KC (30 minutes of KC before invasive procedure and then 10 minutes after procedure) vs. 25 controls (in incubator for invasive procedure). Infants were 26-36 weeks gestational age and 0-28 days postnatal age when tested once. No infant received narcotic analgesic. Behavioral (crying), physiologic (HR), and PIPP were measured. PIPP was significantly lower during and after the procedure in KC group. HR results???, behavior results???. KC is effective in decreasing pain during and after invasive procedure in preterm infants. PT, RCT, pain, HR, crying, PIPP. Not on Charts 4/30/09, Get this.
Albright, L. (2001). Kangaroo Mother Care: Restoring the Original Paradigm for Infant Care and Breastfeeding. LEAVEN, 37(5), 106-107. Review of Nils Bergman’s talk about habitat and original paradigm.. Available from nhtml:file://G:\Research\Articles\BFDG Initiation\1-18-2007\KMC original paradigm 200… FTGET COPY FROM BARB

Ali Z & Lowry M. (1981). Early maternal-child contact: Effects on later behaviour. Developmental Medicine and Child Neurology 23, 337-345. 50 fullterm healthy newborns given 45 minutes of skin-to-skin contact immediately after birth in Jamaica. These infants were compared to matched controls at 6 and 12 weeks age.More early contact moms Breastfed exclusively than non-contact moms, early contact infants were less likely to be crying or restless during 6 and 12 week interviews. At 12 weeks, early contact moms were more likely to rise and follow their babies when babies were taken from them, gazed more frequently at their infants, and were more likely to vocalize to the infants during interview. Early contact promotes a closer relationship between mom and infants. RCT, Fullterm ,BF, Exclusive BF, Maternal Behavior, birth KC, 3rd world., crying, restless, Interaction

Alisjahbana, A., Usman, A., Irawaty, S., & Triyati, A. (1998). Prevention of hypothermia of low birth infants using the kangaroo method. Paediatrica Indonesiana, 38, 205-214.
Als, H.B. & McAnulty, G. (2011). The Newborn Individualized Developmental Care and Assessment Program (NIDCAP) with Kangaroo Mother Care (KMC): Comprehensive care for preterm infants. Current Women’s Health Reviews, 7(3), 288-301 doi: 10.2174/157340411796355216. NICU has costly repercussions. Everyone caring for these infants needs to know about preterm infant personhood as well as the neuro-essential importance of the parents, otherwise even the best care jeopardizes infants’ long term potential and deprives parents of their critical role. This is time of rapid brain growth, conventional NICU contributes to long term physical and mental health problems and developmental disabilities. NIDCAP aims to prevent iatrogenic sequelae of intensive care and to maintain the intimate connection between infant and mother, one EXPRESSION of which is KMC. NIDCAP embeds the infant in the natural parent niche, avoids over stimulation, stress, pain, isolation and supports self-regulation, competence, and goal orientation. NIDCAP improves brain development, functional competence, health and life quality. It is cost effective, humane, and ethical, and promises to become the standard for all NICU care. (To Susie, this sounds like an advertisement for NIDCAP and puts KMC as only one feature of NIDCAP, and it is a separate, independent intervention that should be joined with NIDCAP, not considered one piece of NIDCAP which has been previously identified as having 27 components to its program (Als, 1986). Not until 1992 did Als acknowledge t hat KMC could be different than skin-to-skin contact as she said at the International Conference of Infant Studies in Miami Beach in 1992, “having the baby at breast is skin-to-skin contact.” And then Susie got up and told her that skin-to-skin contact, and using those words, indicated chest-to-chest skin-to-skin positioning of the infant, not breastfeeding. And in fact, Als has failed to identify any parameters of frequency, duration, intensity of KMC as part of NIDCAP in any of her publications about NIDCAP and its results. ) PT, Review, developmental care, NICU environment. Not on Charts 10/2/2011.
Altimier L. (2001). Preface: Alternative therapies. Newborn and Infant Nursing Reviews 1(4), 204. This is an editorial introduction to the move from “minimal handling” to providing developmentally supportive care. She presents the Eichel article on KC with ventilated infants and an article by Jones and Kassity in the same issue. The editor comments that KC benefits are improved oxygenation, stable heart rate and respirations, thermal synchrony, longer periods of sleep, and faster weight gain. Review, PT, comment, vent kc, wgt, HR, RR, stability, oxygenstaion, sleep, temp.Not on Charts Yet

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