Premature babies, or preemies, require special attention. Preemies in the intensive care nursery (ICN) at John Muir Health often receive kangaroo care, a simple but powerfully effective therapy that is very helpful for baby and mom.
Kangaroo care is one of several techniques in the ICN to help these delicate, sensitive babies thrive. It is a skin-to-skin experience in which a preemie is next to her mother's chest while the mother is resting in a reclining chair.
“The rise and fall of the mother's chest as she breathes and the sound of her heartbeat provide a soothing rhythm for the baby,” says Sue Cleaver, ICN clinical coordinator. “The mother's body warmth keeps baby comfortable and feeling safe.”
The process gets its name from the experience of a kangaroo baby, or joey. A joey is born before it is fully developed and for its first six months lives in its mother's pouch. When ready, it leaves the warmth and safety of the pouch to venture outside.
Janine Pearson offers a strong endorsement for kangaroo care and her overall birthing experience at John Muir Health. Her son Nicholas, a preemie, was born there.
“I just can't say enough about the experience,” Pearson says. “All the nurses and staff were so open. Dr. Scott (medical director of the ICN) was first rate. They all listened to me and educated me. They made a big effort to get me any information or help I wanted.”
Pearson explained that she entered the hospital when she was only 24 weeks pregnant and starting to go into labor. Since 24 weeks is far short of the 38 to 40 weeks of a full term pregnancy, she chose to enter the hospital where she could stay in bed and hope to postpone the birth.
This tactic delayed the birth for about four weeks and Nicholas was born at 28 weeks and 5 days, weighing 3 lbs. He weighed 5 lbs. 12 oz. when he went home a little more than a month later.
After birth, Nicholas’ doctor put him on a continuous positive airway pressure device to facilitate breathing, Pearson explained. After the third day, Nicholas was off this machine and breathing well by himself.
Then came kangaroo care. Pearson says, “It's as close to being in the womb as you can get. From the beginning, he settled down and seemed just to melt into me. It was so bonding and was very calming for him and me. And, Eric (his dad) liked doing it too.”
Kangaroo care is a simple practice with profound benefits, says Cleaver. Studies show these babies get off ventilators sooner, gain weight faster, do better with feeding, and go home sooner.
Parents also experience less anxiety. “It's very empowering for them. They no longer feel like helpless bystanders,” Cleaver says.
Among the other kangaroo care benefits for preemies are:
- Decrease in the output of stress hormones
- Less crying
- Lower oxygen requirements
- Increased intimacy and attachment
Benefits for moms include:
- Improved breast milk production
- Increased self-confidence in caring for their preemie
- Knowledge that they are doing something positive for their baby
- Less anxiety
For dads, the benefits of kangaroo care include increased self-confidence in caring for preemies and the knowledge they are helping their baby in a very significant way.
A guiding principle when caring for preemies is remembering that they would, under normal circumstances, still be in the womb.
Preemies are underequipped to deal with the stimuli they receive in the ICN, Cleaver says. They have to deal with bright lights, noise, and the discomfort of medical procedures. They can quickly use up all their reserves of energy.
The main goal is to keep each baby as comfortable and free from stress as possible. For example, nurses put these little patients into a soft cocoon of buntings and blankets so that they can stay in a fetal position with their arms and legs tucked close to their body.
This technique is one of many aimed at providing comfort and reassurance to preemies.
Golden hour script
Another important element of ICN care is the golden hour script, which is a set of guidelines for doctors and nurses treating extremely premature babies.
The golden hour — the first hour of a premature baby's life — is vital because treatment during that time can have long-term effects. The process begins in the delivery room, Cleaver says.
If a newborn is experiencing breathing problems, doctors and nurses insert a tube into the baby's mouth and windpipe. The tube has a special device called a Neopuff, which assists the baby's breathing by providing breaths at a constant pressure.
“We are getting babies off ventilators sooner and have observed a drop in chronic lung disease,” says Cleaver. “We believe the golden hour script will have long term effects for our premature babies and possibly help them go home sooner.”