Effect of Kangaroo Mother Care Versus Hammock Positioning

Study Overview
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Brief Summary
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Aim This study aimed to investigate the effect of kangaroo mother care (KMC)versus hammock positioning (HP) on physiological indices and behavioral organization among preterm neonates. Hypotheses Preterm neonates who receive KMC exhibit more stable physiological indices and behavioral organization state than those who do not . Preterm neonates who receive HP exhibit more stable physiological indices and behavioral organization state than those who do not . Preterm neonates who receive KMC exhibit more stable physiological indices and behavioral organization state than those who receive HP.

Detailed Description
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A quasi-experimental, pre-posttests, research design was carried out at the Neonatal Intensive Care Unit (NICU) of Specialized University Hospital . A sample of 90 preterm neonates were randomly assigned into three equal groups. The preterm neonates in the control group received the routine care of the NICU, which entails; encircling the neonate in a fetal position using rolled towel inside the incubator. For the KMC group: Researchers contacted the mother a day before applying KMC, and advised her to take shower and abstain from using perfumes before attending to the NICU. On days of KMC application, the researchers asked the mother to remove the upper clothes in a private room and put on an open-front gown and mask. The mother was assisted to sit in a comfortable chair with a soft backrest and footrest to prevent fatigue. Then, the preterm neonate was carefully put naked except for the head and diaper area on the mothers' bare chest with flexed arms and legs as in froglike position, and the head was turned sideways. The researchers wrapped and secured the mother's gown and put a blanket on the neonates' back to ensure neonatal thermal insulation. The mother was instructed to support the neonate's bottom with the right hand while supporting the head and neck with the other hand. For HP group: Researchers made a hammock by using a rectangular cotton cloth with ropes that passed through the circular openings of the incubator and tied on the upper part of it. After one hour of feeding, the preterm neonate was placed in a supine fetal position in the hammock where the head was supported in a neutral midline position by using rolled towel without neck hyperflexion or hyperextension. Moreover, the spine of the preterm neonate was supported while arms and knees were flexed. Kangaroo mother care and HP were performed in the morning shift for one hour from 10 am till 11 am on three consecutive days. Behavioral states of preterm neonates were assessed in the three groups four times during the intervention at fixed intervals in order to minimize the measurement errors due to fluctuations in their behavioral states. In case of incidental neonatal distress, the intervention was discontinued. After one hour of applying KMC or HP, the preterm neonates were placed in the incubator as the routine NICU care. Finally, neonates' physiological indices and behavioral states in the three groups were recorded after 15 min from the intervention using tools I&II. Data were collected over 12 months from March 2020 till the end of February 2021.

Official Title
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Effect of Kangaroo Mother Care Versus Hammock Positioning on Physiological Indices and Behavioral Organization Among Preterm Neonates: A Humanized Nursing Approach

Conditions
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Behavior, Child

Intervention / Treatment
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* Behavioral: Kangaroo Mother Care
* Behavioral: Hammock Positioning
* Behavioral: Routine Care of NICU


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Preterm Neonates Hemodynamically stable Exclusion Criteria: Mechanically Ventilated Pulmonary Disorders Cardiac Disorders, Neurological Disorders

Ages Eligible for Study
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Minimum Age: 1 Day
Maximum Age: 28 Days

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Kangaroo Mother Care<br>Researchers contacted the mother a day before applying KMC, and advised her to take shower and abstain from using perfumes before attending to the NICU. On days of KMC application, the researchers asked the mother to remove the upper clothes in a private room and put on an open-front gown and mask. The mother was assisted to sit in a comfortable chair with a soft backrest and footrest to prevent fatigue. Then, the preterm neonate was carefully put naked except for the head and diaper area on the mothers' bare chest with flexed arms and legs as in froglike position, and the head was turned sideways. The researchers wrapped and secured the mother's gown and put a blanket on the neonates' back to ensure neonatal thermal insulation. The mother was instructed to support the neonate's bottom with the right hand while supporting the head and neck with the other hand. | Behavioral: Kangaroo Mother Care<br>* the preterm neonate was carefully put naked except for the head and diaper area on the mothers' bare chest with flexed arms and legs as in froglike position, and the head was turned sideways. The researchers wrapped and secured the mother's gown and put a blanket on the neonates' back to ensure neonatal thermal insulation<br>|
| Experimental: Hammock Positioning<br>Researchers made a hammock by using a rectangular cotton cloth with ropes that passed through the circular openings of the incubator and tied on the upper part of it. After one hour of feeding, the preterm neonate was placed in a supine fetal position in the hammock where the head was supported in a neutral midline position by using rolled towel without neck hyperflexion or hyperextension. Moreover, the spine of the preterm neonate was supported while arms and knees were flexed. | Behavioral: Hammock Positioning<br>* After one hour of feeding, the preterm neonate was placed in a supine fetal position in the hammock where the head was supported in a neutral midline position by using rolled towel without neck hyperflexion or hyperextension. Moreover, the spine of the preterm neonate was supported while arms and knees were flexed<br>|
| Active Comparator: NICU Routine Care<br>The preterm neonates in the control group received the routine care of the NICU, which entails; encircling the neonate in a fetal position using rolled towel inside the incubator. | Behavioral: Routine Care of NICU<br>* ; encircling the neonate in a fetal position using rolled towel inside the incubator.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Neonates' Heart Rate (HR) | The researchers recorded the neonates' heart rate from the ECG monitor | immediately after the intervention | 
| Neonates' Respiratory Rate (RR) | The researchers recorded the neonates' Respiratory Rate (RR) the ECG monitor | immediately after the intervention | 
| Neonates' Oxygen Saturation (SpO2) | The researchers recorded the neonates' oxygen saturation (SpO2) using the pulse oximetry | immediately after the intervention | 
| Neonates' Temperature | The researchers measure the neonates' temperature using electronic thermometer | immediately after the intervention | 
| Neonates' Weight | The researchers measure the neonates' weight using digital weighing scale | 3 days After the intervention | 
| Anderson Behavioral State Scale | This scale was adopted from Anderson et al. (1990) to assess the behavioral organization of preterm neonates. Neonates' behavioral state is judged by observing their respiratory regularity, opening or closing of the eyes, limb and trunk activity, and the intensity of crying. Based on the observations, the scale will differentiate 12 behavioral states, including; regular quiet sleep (1), irregular quiet sleep (2), active sleep (3), very active sleep (4), drowsy (5), alert inactivity (6), quite awake (7), active awake (8), very active awake (9), fussing (10), crying (11) and hard crying (12). Scores from 1 to 5 indicate that the neonate is in a sleep state. Scores from 6 to 8 denotes that the neonate is awake and calm. Scores from 9 to 12 indicate that the neonate is in a restless state of or fussiness. | immediately after the intervention | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Kangaroo-Mother Care Method, Patient Positioning, Infant Behavior, Physiological, Premature, Neonatal Nursing