The Effect of Kangaroo Mother Care Applied to the Healthy Newborns on Breastfeeding
Condition: Breastfeeding; Kangaroo Mother Care; Breastfeeding, Exclusive
Study type: Interventional

Summary: 
      This study aims to determine the effect of kangaroo mother care (KMC) applied to the healthy
      newborns in the early postpartum period on breastfeeding.

      The results of the study are expected to contribute to promoting the practice of KMC in an
      effort to encourage breastfeeding not only in Turkey's hospitals but also in other developing
      countries where practices that negatively affect breastfeeding are prevalent.

      The hypotheses of the study were determined as: Infants administered KMC start to breastfeed
      sooner (H1), breastfeed more frequently (H2), breastfeed for longer periods (H3), are more
      successful at breastfeeding (H4) than infants receiving standard postpartum care (SPC).
    

Detailed description: 
      Setting: The study was conducted over the period June 1 - August 25, 2016 as randomized
      controlled experimental research at a Training and Research Hospital in Istanbul, Turkey.

      Participants: The participants were 112 healthy mothers and their babies; the women were
      between the ages 18-42, had delivered normal vaginal birth between gestational weeks 38-40,
      met the sample inclusion criteria and consented to be a part of the study. Instrumental
      vaginal deliveries were excluded from this study.

      The sample selection criteria were determined as: normal delivery, healthy mother and child,
      newborn being at term (in the 38th-42nd week), with a birthweight of 2500-4000 gr. The
      inclusion criteria were determined as: no serious case of asphyxiation in the newborn, an
      APGAR score of at least 7 at Minute 1 and Minute 5, no health problem in the newborn to
      prevent it from breastfeeding (e.g., cleft palate, harelip, esophageal atresia).

      Sample and randomization: The researcher met with the mothers who fulfilled the selection
      criteria prior to the birth and briefly informed them of the scope and content of the study,
      asking them if they wished to participate. At this stage, participation was proposed to 119
      mothers. Of these, 112 mothers and their babies were randomized into two groups with 56 in
      the study group (KMC) and 56 in the control group (SPC). A computerized randomization method
      was used for implementing the random selection. The newborns that exhibited a health issue
      following the birth were excluded from the study. In their place, the same randomization
      method was used until 56 cases were defined. The number of newborns held outside the scope of
      the study after birth was 5 in the study group and 2 in the control group.

      Power analysis was performed using the G*Power (v3.1.9) program in order to determine the
      number in the sample. Sample size was determined on the basis of the infants' breastfeeding
      scores obtained on LATCH. It was foreseen that a unit of difference in LATCH scores between
      groups would be clinically significant. In a study by Yenal et al., when the LATCH mean score
      and standard deviation were accepted as a reference for control group data, effect size was
      calculated as d=0.566. It was calculated that at least 51 individuals would have to be
      included in the groups, a total of 102, to realize the effect level of α=0.05 at a power of
      80%. Taking into consideration possible losses, it was decided that the groups would each
      comprise at least 56, meaning a total of 112 individuals.

      Data collection: The study data were collected in line with the literature using the Data
      Collection Form developed by researchers. The infants' suckling skills were assessed with the
      "LATCH Breastfeeding Assessment Tool" developed in 1994 by Jensen et al.

      Consent: Permission for conduct of the study was obtained from the hospital and the ethics
      committee (10840098-604.01.01-E.1108). At the same time, prior to the start of the study, the
      mothers were informed about the purpose and methodology of the research and the mothers
      agreeing to participate were asked to sign a written Subject Informed Consent Form.

      Data analysis: The NCSS (Number Cruncher Statistical System) 2007 (Kaysville, Utah, USA)
      program was used in the statistical analysis. In the evaluation of the study data, besides
      descriptive statistical methods (means, standard deviation, median, frequency and
      percentages), the Shapiro-Wilk test and box plot graphs were employed in testing normality.
      The Independent Samples T Test was used to analyze two groups of quantitative data displaying
      normal distribution such as the newborns' weight, height, head circumference, number of
      breastfeedings received, mother's age. The Mann-Whitney U test was used in the case of
      variables not showing normal distribution, such as the newborns' APGAR scores at Minutes 1
      and 5, the first interaction of the mother with her infant, the first time of breastfeeding,
      the number of breastfeedings in the first 3 hours and their duration. The comparison of
      qualitative data such as the infants' gender, the mother's educational status, the status of
      being breastfed in the first half-hour and hour was undertaken with Pearson's Chi Square
      while the Fisher-Freeman-Halton test was used to compare the mothers' eagerness to
      breastfeed. The results were analyzed at a confidence interval of 95% with significance
      expressed at a level of p<0.05.
    

Intervention name(s): Kangaroo Mother Care (KMC)
Intervention type(s): Other
Intervention description(s): Kangaroo mother care is a method of care of infants. The method involves infants being carried, usually by the mother, with skin-to-skin contact. Kangaroo mother care (KMC). early after delivery have better success at breastfeeding and achieve this success sooner. In this method The newborns' diapers were tied, their caps put on and then they were positioned on their mother's naked chest for KMC. The KMC session was continued for 3 hours.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Randomized Controlled Study
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: Kangaroo Mother Care; Breastfeeding; Postpartum Period; Term Newborn; Midwifery