Thursday, February 28, 2013

Premature Babies: Combining Two Methods to Save a Fragile Life

Sitting restlessly, watching her child fight for his/her life from inside the incubator case. Wires are hooked up to machines and tubes surround this helpless baby body. The expression on her face is one of confusion and sorrow because of what her newborn has to endure. She knows there is nothing she can do for her child, she's disappointed in herself because she can't fulfill her duties as a mother. However, incubator care in conjunction with an alternative method such as Kangaroo Mother Care proves to be the best technique in ensuring the best possible outcome for a premature infant's health and future.

Mothers of preemies are more susceptible to depression because of the endangered health of their babies. Because of hormonal changes in the body and elevated emotions are high, 10 to 15 percent of women are diagnosed with Post Natal depression.

About 12.8 percent of all births are premature in the United States. These babies are generally born anywhere from 28-36 weeks into gestation. Premature babies aren't able to thrive in this world because of severe birth defects such as breathing problems, heart conditions, anemia and hemorrhaging. These tiny babies have to overcome much in order to live. This is why the incubator was established to mimic being inside the mother's womb. The air and temperature inside the incubator is monitored to insure that the baby is at the proper environment in order to thrive. Since the baby is not well enough to breast feed from it's mother special tubes need to be attached to the baby to allow for essential nutrients to flow throughout their bodies. These nutrients will help the babies heart and lungs grow as well as improve vital antioxidants in order for them to fight off future infections.

The first incubator was built by a man named Alexandre Lion in 1891. The Lion incubator was kept warm by a water boiler mounted on the outer wall of the incubator. Fresh air would travel into the incubator by an electric fan that was blowing through a large pipe on the outside of the building. The air was then moistened by a layer of absorbent wool. This air then passed over the hot coils of the water heater. The process allowed premature babies to live in a steady warm temperature while in the incubator. This revolutionary medical device did not make its debut in a hospital or doctor's office. Instead incubators were taken to the TransMississippi and International Exposition where they were first put on display by a man named Martin Couney. He had originally seen Alexandre Lion trying to promote the incubators in Berlin when it had gained much popularity. Martin Couney decided to bring his show to America. He used incubators to attract large crowds that were curious and entertained by viewing the small babies that were in the see-through glass boxes. Couney charged admission for people to see the babies that were being taken care of. Even though the show was in a fair, doctors and nurses were working to take care of each and every baby. Before, the incubator was invented mothers would give birth at home and if the baby was born prematurely, the doctor would do nothing to save the child. Doctor's did not feel any responsibility to help the baby because it was too weak to live. The survival rate for premature babies in the 1900s was less than 15%. With the incubator exhibits at the famous World Fair or the Couney's Park Luna Exhibit at Coney Island, survival rates for premature infants jumped to about 85%. It was not until the 1940s that hospitals began to use incubators to help premature babies.

In 1978, there were little to no incubators in Colombia so Dr. Rey and Dr. Martinez had to start a new kind of care called Kangaroo Mother Care. Infection was spreading throughout preterm infants and the doctors had to find a way to keep the babies warm and protected from infection. The doctors decided to try to use a mother's body as an incubator just like how a kangaroo keeps her baby in her pouch. They felt that technology could not replace a mother. Incubators could be used to support and help premature babies, but not replace a mother and her touch. In the early 1980's UNICEF noticed what the doctors in Colombia were doing and appraised the effect that Kangaroo Mother Care was hands on for premature infants. UNICEF is a strong supporter of breast feeding babies and with Kangaroo Mother Care this action is strongly encouraged. Because, UNICEF recognized the efforts of the Dr. Rey and Dr. Martinez in Colombia, this practice slowly spread to third-world countries such as Africa, Vietnam and Brazil. In fact, this type of care for premature infants has become so useful that it has been paired hand in hand with Incubator care. This type of care is still relatively new and experiments are still being done to explore the full effects of skin to skin care between mother and baby.

Mothers who give birth to healthy full-term infants are able to feel the effects of the "golden moment". This special moment happens because the mother releases a hormone from her body called oxytocin, which induces bliss and relief. This feel-good drug does not only affect the mother but also the baby (these effects can also be felt during an orgasm). The drug causes a love-at-first sight moment and can be critical to a mother and baby bonding. This moment is not essential to bond with your baby, but it is a definite plus with the mother and baby's relationship. These released hormones are powerful and both mother and baby are attracted to each other chemically. The hormones also help the baby "sniff" out the mother's nipple to begin breast-feeding for the first time. Pediatrics recommend skin-to-skin contact for these crucial baby moments. If, these moments are robbed by hospital policy or the baby is taken away to be cleaned do not worry. There will be many other chances to bond with your newborn baby. The most important information to know about bonding with your baby is quality time, not the quantity of time. Babies are most comfortable with the scent of their mothers, also the mother's breast milk tends to soothe the baby and reduce his/her stress.

Depending on the mother, the anesthesia (epidural) that is administered in cesarean section may cause her to be drowsy. In this sleepy state she is most likely not able to care for her baby properly. Although this may be disappointing for the mother, this does not mean that the premature baby needs to be taken to the NICU. According to a study by Christensson, Fagerberg, Erlandsson and Dsilna, fathers can step in and take an important role in the development and bonding with the baby. The study was carefully done with 29 families. Fourteen families would wrap a baby and place it in a cot with their father beside them, the other 15 families would have the baby naked and placed on their father's chest. The father's in the cot group were not able to pick up their child at all. The scientists would both observe the actions of each group by how much infants cry by attaching a microphone close to their mouths. The results were that the babies in the skin-to-skin group were significantly less than babies that were kept in a cot. The skin-to-skin group had a mean score of 13.4 seconds per 5-minute period while the cot group had 33.4 seconds per 5-minute period. The cot group cried less as time passed but the skin-to-skin group decreased rapidly after being put skin-to-skin with their fathers, within the first 15 minutes. Also, skin-to-skin contact showed infants in a drowsy state within 60 minutes of contact with their father while the cot group only achieved this state with 110 minutes. This type of care is recommended for the care of preterm infants when the mother is not present. During the separation of mother and baby the father should be considered the primary caregiver.

Premature infants have the hardest time trying to adapt to the outside world. Their immune systems are weak and they are not strong enough to fend off infections and temperature changes. Also, the premature baby is not as developed. They exhibit signs of lower cognitive and motor skills. This can cause mothers to have problems bonding with their child. Incubators can make social interaction with their children even more difficult. Kangaroo Mother Care is helpful in this instance to aid in the bonding and health of a premature baby. The simple touch of a mother and baby will stimulate growth and development of the infant's brain and bodies. This important touch has a high possibility with breast feeding your infant because of the skin to skin contact. The more time a mother can have to hold her baby and gaze into his or her eyes will help her feel less depressed and she will perceive her infant as less abnormal. Women who tend to their child using Kangaroo Mother Care were more able to talk about their feelings, positive or negative. Kangaroo Mothers shared their strong emotions with their care givers and support groups. Premature mothers had feelings of great disappointments and loss of a normal pregnancy. Also, guilt over their child's stressful and painful life so far. These emotions slowly started to fade as Kangaroo Mother Care was administered and mother and baby began to acquaint themselves. Because, mother and infant begin to build a strong relationship, mothers have increased self esteem and more joy. They are fully confident in taking their infant home and caring for them.

Scientists did a study to compare Kangaroo Mother Care against incubator care for thermal regulation. Hypothermia is common in low birth weight infants. Premature babies use half of all their energy trying to maintain body temperature. This takes a toll on premature babies because they don't have enough energy to fend off infection and support body development. KMC has shown to improve blood oxygenation, lower infection rates. The babies cry less and are alert for a longer period of time. This also leads mothers to breast feed for a longer period of time and mothers to stay in the hospital for a shorter period of time. The study was done in Nigeria from May to July 2001. Thirteen infants were tested in this experiment. Because this study was done in a third-world country the results will be even more effective in first-world situations. Low body weight infants were observed to have fewer episodes in KMC than in incubator care. Some cases of hyperthermia were documented for babies of Kangaroo Mother Care. Hyperthermia is when the body temperature becomes too high and above the norm. Because the incubators were in a third-world country the electricity would shut off and babies temperature will become irregular. Kangaroo Mother Care is better for third-world mothers because they are able to regulate their babies' body temperatures more easily.

The last key to a successful Kangaroo Mother Care treatment is full support from the close family. Both mother and father should participate in the care for their own infant and build their relationship with their newborn together. The transition from hospital to home can be a tough one. There are no nurses to take care of you and doctors to constantly monitor you throughout the day. Many mothers of premature infants may see this as a daunting task but thankfully Kangaroo Mother Care prepares mother and father exactly for this moment. Kangaroo Mother Care should empower them with confidence that they can take care of and raise their child even though he or she was born premature.

In 2008, a group of researching scientist wanted to test out the hypothesis that Kangaroo Mother Care creates a climate in the family, which enhances infants' performance on the developmental quotient scale. They used the HOME (Home Observation for Measurement of the Environment) test in determining whether or not Kangaroo Care mothers create a better overall environment for the premature baby then a traditional care mom whose baby was treated in an incubator. The father's involvement in the raising of his premature infant greatly affected the home environment of the baby. The information was gather by an interview composed of 45 yes or no questions. Of the 45 questions, 18 of the questions can be answered by simple observation and the other 27 require an interview. The results of the interviews and observations suggested that Kangaroo Families (mean =.28) compared to Traditional Care families (mean = -.51) provided a more developmentally oriented caregiving environment. Kangaroo Families are also more open and welcoming into their home opposed to the traditional care group. High father involvement had a huge positive impact in the family atmosphere. When fathers are more involved the families are more stimulating and open to neighbors and mothers have more positive interactions with her infant. There was a strong association between HOME scores and the infants' developmental quotient, indicating that infants benefit more from a positive home environment. This study promotes the idea that both parents should take a part in Kangaroo Mother Care for the full effects to take place in their premature infant. Mother and Father will gain strong bonds with their premature baby by continuously providing care and support for each other and their child.

Kangaroo Mother Care consists of three key components the kangaroo position, breast feeding and family support. The first key to help develop a premature baby after birth is to position the baby on the mother's chest if the infant is healthy enough. This should mimic the same body-temperature regulation as an incubator. This skin-to-skin contact will allow the mother to realize that she is able to take care of the premature baby despite the child's size. The second key is breast feeding and the importance of touch. This component is important to stabilize the babies health and start a special bond between both parents and infant. Kangaroo Mother Care allows parents to feel that they are no longer helpless to their premature infant's situation. They can now feel responsible and the connection between infant and parents are now stronger. This special closeness between mother and baby will allow the mother to heal psychologically but also help regulate the baby's temperature and heart rate. Breast feeding has also been shown to improve neurological development and IQ. The final and most important key to the long-term development of a premature infant is family support. This key is essential for both mother and infant. The father's role in family support is significant to the overall home environment. Mother's become more receptive and aware of the infant. With both parents working in unison with one another to promote the health of the premature infant the family environment will become more stimulating and positive. A strong home environment will cause the premature infant to grow and mature faster than traditional care infants.

Kangaroo Mother Care can be used in a variety of different scenarios. The lowest level of care that KMC can be administered is to setting with little to no neonatal care for the premature infant. This environment may be a birth that has taken place at home or in a country where there are little to no incubators. Kangaroo Mother Care can also be applied in middle to low income countries. The hospitals in these countries may only have a limited amount of incubators for premature infants. Therefore, with no space left infants will need to be taken care of by a human incubator, their mother. In high-income countries where access to numerous amount of incubators are readily available Kangaroo Mother Care is not needed because of an insufficiency but to establish a bond between mother and infant; also to encourage breast feeding. Premature babies are able to be quickly stabilized in an incubator and then taken out to reunite with it's mother. This moment will allow mothers and infants a time to lower their stress levels and bond on a deeper level. The quicker a premature infant can be returned back to their mother, the more of a bond they can establish before they are discharged home.

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