---

Kangaroo Mother Care (KMC) — Paediatrics Theory Exam Notes

---

1. Definition

• Early, continuous, and prolonged skin-to-skin contact between the mother (or other caregiver) and the baby
• Combined with exclusive breastfeeding (or expressed breast milk feeding)

---

2. Components of KMC (The "Three Pillars")

---

3. Indications / Eligibility

• All preterm (< 37 weeks gestational age) or low birth weight (LBW) infants (< 2500 g)
• Classically: Infants < 2.0 kg (previous threshold for hospital-based KMC)
• Current WHO 2022 Guideline (Updated): KMC is recommended for all preterm/LBW infants, including those on supplemental oxygen or other support — initiated as soon as possible after birth

---

4. WHO Recommendation (2022 Update — Important for Exams)

"KMC is recommended as routine care for all preterm or low-birth-weight infants. KMC can be initiated in the health-care facility or at home and should be given for 8–24 hours per day (as many hours as possible)." Strong recommendation, high-certainty evidence (p. 25)

---

5. KMC Position — Details

• Baby placed vertically (upright) on mother's chest
• Head turned to one side (neck slightly extended) — ensures airway patency
• Hips flexed and abducted (frog position)
• Abdomen at level of mother's epigastrium
• Secured with a binder/wrap/cloth

---

6. Benefits of KMC

Physiological Benefits

Clinical Outcomes

• ↓ Neonatal mortality (especially in LBW)
• ↓ Nosocomial/hospital-acquired infections (sepsis)
• ↓ Hypothermia
• ↓ Duration of hospital stay
• ↓ Risk of hypoglycemia

Neurodevelopmental Benefits

• Better brain development
• Improved neurobehavioural outcomes
• Reduced pain perception during procedures

Breastfeeding Benefits

• Promotes breastfeeding initiation and duration
• Stimulates milk production via prolactin

Maternal/Psychological Benefits

• Reduces maternal anxiety and depression
• Strengthens mother-infant bonding
• Empowers parents in neonatal care

---

7. Kangaroo Position vs. Incubator

---

8. Duration

• Minimum: 8 hours/day (the more, the better)
• Ideal: 20–24 hours/day (continuous)
• Can be alternated between mother and father/other caregivers

---

9. Discharge Criteria from KMC (NNPD/WHO)

1. Weight ≥ 1800–2000 g (or ≥ 35 weeks corrected gestational age)
2. Breastfeeding well
3. Maintaining temperature in room air
4. No apnea, bradycardia, or desaturation
5. Gaining ≥ 15–20 g/kg/day
6. Caregiver confident and trained

---

10. Contraindications (Relative)

• Severe respiratory distress requiring mechanical ventilation (though newer guidelines support KMC even then with precautions)
• Major surgical conditions requiring prone positioning
• Maternal illness (e.g., severe sepsis, eclampsia)

---

11. Monitoring During KMC

• Temperature (axillary): 36.5–37.5°C — check every 4–6 hours
• Respiratory rate, heart rate, SpO₂
• Weight: daily or alternate day
• Feeding: breastfeeding assessment, urine output (≥6 wet diapers/day)
• Danger signs: cyanosis, apnea, hypothermia, poor feeding

---

12. Types of KMC

---

13. Exam High-Yield Points

• KMC was first introduced in Bogotá, Colombia in 1978 by Edgar Rey Sanabria
• The mother's chest acts as a "biological incubator" — skin temperature self-regulates to maintain infant normothermia
• KMC reduces mortality in LBW infants by up to 40% (Cochrane evidence)
• Thermoregulation is the most immediate and critical benefit
• India's Navjaat Shishu Suraksha Karyakram (NSSK) and NHM programs include KMC as a key intervention
• NNF India: KMC recommended for all newborns < 2000 g
• Father/paternal KMC is equally effective — important point for exams
• KMC is a key component of Essential Newborn Care (ENC)

---

14. Steps for Initiating KMC (Practical Steps)

1. Explain to mother and obtain consent/cooperation
2. Mother wears a front-open shirt/blouse; baby placed skin-to-skin
3. Secure baby with binder/cloth wrap
4. Baby's head in "sniffing position" — airway clear
5. Monitor vitals; encourage breastfeeding on demand
6. Counsel family on danger signs and when to seek help

---