2 • 2021 • Developmental Observer Early Kangaroo Mother Care in Preterm Infants: Is it Safe? Bedetti L1, Bertoncelli N2, Lugli L2, Spaggiari E2, Cuomo G2, Cosimo AC2, Di Giuseppe M2, Ierardi G2, Lelli T2, Muzzi V2, Paglia M2, Pezzuti L2, Piccolo A2, Sabbioni F2, Torcetta F2, Torelli P2, Lucaccioni L2, Ferrari F3, Berardi A3 1 PhD in Clinical and Experimental Medicine, University of Modena and Reggio Emilia – Italy 2 Department of Mother's and Child's Health, Neonatal Intensive Care Unit, AOU Modena – Italy 3 University of Modena and Reggio Emilia - Italy Aims Kangaroo mother care (KMC) was first described in 1978 by Dr. Edgar Rey Sanabria as an alternative to the incubator in low- resource countries. Over time this practice has been extended to high income countries because it is effective in improving infant growth and neurodevelopment, especially in preterm infants. However, KMC is frequently feared by health care professionals, particularly nurses who are in charge to support infants and parents during the procedure. The aim of this study is to demonstrate the safety of early KMC in preterm infants. Methods A prospective observational monocentric study was performed. Infants born between June 2018 and June 2020, with gestational age <33 weeks and birth weight <2000 grams were monitored while having KMC during the first three weeks of life. Infants with necrotizing enterocolitis, sepsis, congenital malformations, receiving mechanical ventilation or with more than five apneic episodes in the hour prior to KMC were excluded. Continuous oxygen saturation (SaO2), heart rate (HR) and respiratory rate (RR) as well as body temperature were registered during KMC, and in the hour prior to KMC. The minimum duration of the KMC session was 90 minutes. Information regarding post conceptional age, weight, respiratory support, presence of central venous catheter and onset of sepsis within 72 hours after the procedure was collected. Two physicians, blinded to patient conditions and period of analysis (before or during KMC) evaluated desaturation episodes (SaO2 <85%, >15 seconds), bradycardia (HR <100, >15 seconds), and apnea (pause in breathing > 20 seconds associated with desaturation or/and bradycardia). Wilcoxon signed-rank test was used for statistical analysis. The study was approved by the Local Ethics Committee. Results We analyzed 83 episodes of KMC for a total of 38 infants. Mean gestational age at birth was 29 weeks (range 23-33 weeks). Mean post conceptional age, days of life and weight at KMC were 31 weeks (range 25-34 weeks), 10 days (range 1-20 days) and 1131 grams (631-2206) respectively. Seventy-seven percent of patients were on respiratory support and 47% of patients had a central venous catheter (umbilical catheter or peripherally inserted central catheter) during KMC. Total duration of desaturation, total duration of bradycardia, number of apnea episodes and body tem- perature were not statistically different during KMC episode and the hour prior to KMC. No adverse events related to catheters were reported. One session was followed by sepsis. Conclusion KMC plays a key role in the care of the preterm infants, and deserves to be increasingly offered to infants and to their families. The results of this study should reassure health care professionals, highlighting the safety of the procedure in preterm infants and the possibility to perform KMC in an intensive care setting in the first weeks of life. References: 1. Boundy EO, Dastjerdi R, Spiegelman D, Fawzi WW, Missmer SA, Lieberman E, Kajeepeta S, Wall S, Chan GJ. Kangaroo Mother Care and Neonatal Outcomes: A Meta-analysis. Pediatrics. 2016 Jan;137(1). DOI: https://doi.org/10.1542/peds.2015-2238 2. Shattnawi KK, Al-Ali N, Alnuaimi K. Neonatal nurses' knowledge and beliefs about kangaroo mother care in neonatal intensive care units: A descriptive, cross-sectional study. Nursing and Health Sciences. 2019 Sep;21(3):352-358. DOI: 10.1111/nhs.12605 3. Park HK, Choi BS, Lee SJ, Son IA, Seol IJ, Lee HJ. Practical Application of Kangaroo Mother Care in Preterm Infants: Clinical Characteristics and Safety of Kangaroo Mother Care Journal of Perinatal Medicine. 2014 Mar;42(2):239-45. DOI: 10.1515/jpm-2013-0066 4. Kommers DR, Joshi R, van Pul C, Atallah L, Feijs L, Oei G, Bambang Oetomo S, Andriessen P. Features of Heart Rate Variability Capture Regulatory Changes During Kangaroo Care in Preterm Infants. Journal of Pediatrics. 2017 Mar;182:92-98. DOI: 10.1016/jjpeds.2016.11.059 5. Carbasse A, Kracher S, Hausser M, Langlet C, Escande B, Donato L, Astruc D, Kuhn P. Safety and Effectiveness of Skin-to-Skin Contact in the NICU to Support Neurodevelopment in Vulnerable Preterm Infants. Journal of Perinatal and Neonatal Nursing. 2013 Jul-Sep;27 (3):255-62. DOI: 10.1097/JPN.0b013e31829dc349 A semi-annual publication of the NIDCAP Federation International ©2021. The statements and opinions contained in this newsletter are solely those of the individual authors and contributors and not necessarily of the NIDCAP Federation International. Articles from the Developmental Observer, duly acknowledged, may be reprinted with permission. Please contact us at: developmentalobserver@nidcap.org. Senior Editor Kaye Spence AM Associate Editors Diane Ballweg, APRN, CCNS, Deborah Buehler, PhD, Sandra Kosta, BA gretchen Lawhon, PhD, RN, FAAN, Maria Lopez Maestro, MD Associate Editor Jeffrey R. Alberts, PhD for Science Column Editor Debra Paul OTR/L Contributions We would like to thank all of our individual donors for their generous support of the NFI and its continuing work. Developmental Observer DOI: 10.14434/do.v14i1.31808