PowerPoint-Prsentation

25/01/2014KMCKangaroo Mother Care

Page Nr.1GIZ Health Programme We support the health sector in 5 key areas of health systems strengthening;Social Health ProtectionQuality Health Services (focus on Sexual and Reproductive Health and Rights)Decentralized health Governance Cooperation with the Private SectorCivil Society Organizations Our Aim: Important preconditions for equal and sustainable access to quality health services are in place. Through the area of Quality Health Services the No Baby Left Out initiative has been established to accelerate the reduction of maternal, newborn and child deaths in TanzaniaWhere do Newborns die?Southern Tanzania Especially in the rural remote area of the regionsHigh rate of low birth weight infants in southern Tanzania

Page Nr.Introduction(UNICEF 2013)Despite successful reduction of < 5 mortality, reduction in neonatal mortality is still very small by comparisonNeonatal mortality counts 44% of the < 5 mortalityGlobally around 3 million neonatal death yearly and 2/3 in South-East-Asia and sub-Saharan Africa (NMR: 34/1000)75% of neonatal death occur in the first week of lifeCauses of death:Infection26%Birth Asphyxia24%Low birth weight (LBW)/prematurity34%Page Nr.3Aims of newborn care25/01/2014Establishment of respiration at deliveryPrevention of hypothermiaEstablishment of breastfeeding Prevention of infectionIdentification of newborns at risk and early treatment

Page Nr.4Aims of newborn care25/01/2014Establishment of respiration at deliveryPrevention of hypothermiaEstablishment of breastfeeding Prevention of infectionIdentification of newborns at risk and early treatmentPage Nr.5Immediate care after delivery25/01/2014Keep dry and warm (dry towels and cover the head)Assess breathing and crying Clear airway only if mouth and nose are full of secretionsIf needed give respiratory support in the first minute of lifeThink back to 1, 5, and 10 minutes for APGARInitiate breastfeeding within 1 hour after deliveryGive Vitamin K as prophylaxis

PretermWeight under 2,5 kgMalformationInfection

Supportive care:e.g. KMC

Continueroutine Care

YESNOPage Nr.625/01/2014KMC = Kangaroo Mother CarePage Nr.Position: continuous and prolonged skin-to-skin contact between mother and babyNutrition: exclusive breastfeeding (ideally)Discharge with adequate support and follow upSupportive environment in the health care facility and home

7Indication for KMC25/01/2014Low birth weight (LBW) = BW < 2500gPrematurity = < 37 + 0 gestational weeks

Acute infections (e.g. malaria, UTI, asc. GTI)Chronic infections (e.g. TB, HIV/AIDS)Premature rupture of membraneTraumaCongenital malformation of the fetus (e.g. polyhydramion)Disease which induce labour (e.g. pre-eclampsia)Causes of LBW / prematurity

Page Nr.8Problems of prematurity / LBW25/01/2014Hypothermia Feeding difficulties Breathing difficulties Apnoe attacks Necrotizing enterocolitis Prone to sepsis Jaundice Intraventricular bleeding

HypoglycaemiaPage Nr.Hypothermia (small body weight, less brown fat tissue)Feeding difficulties (inability to suck, immature guts)Breathing difficulties (immature lungs)Apnoe attacks (immature brain)Necrotizing enterocolitis (immature intestine)Intraventricular bleeding (immature brain vessels)Jaundice (immature metabolic system)Prone to Sepsis (immature immunosystem)

9KMC covers the aims for preterm / LBW care25/01/2014Is a method of care of preterm infants carried skin-to-skin to Keep the temperature stable (36.5 37.5C)Stimulate babys breathingEnables breastfeedingPromote mother and baby bondingPromote physical growthDischarge with adequate support and follow up

It is a powerful and easy-to-use method!

Page Nr.10KMC positioning of the baby25/01/2014Start kangaroo position as soon as possible after delivery!

Page Nr.Placing the baby between the mothers breasts in an upright position, chest to chestSecuring baby with a binderHead turned to one side in a slight extended position. Top of binder just under the ear.The hips and arms should be flexed in frog positionA cloth should be tied firmly with the cloth over the baby, that the baby not slides outBabys abdomen should not be constricted and should be at the level of mothers epigastric region.

11KMC positioning of the baby25/01/2014

Head positionNappy, cap & socks

Father involvement

Page Nr.The Baby should wear nappy, cap and dray socks; change nappy immediately if wet!

12KMC positioning of the baby25/01/2014Interrupt skin-to-skin contact only for changing nappy, hygiene, cord care and clinical assessment when needed

Page Nr.Mothers should best sleep in kangaroo positionIf necessary mother can sleep as she wants but keeping skin-to-skin contact

The mother is relaxed an comfortable

13KMC - Feeding25/01/2014Breast milk is the BEST Start in the first hour of life with breastfeeding!Inform the mother about the special situation of breastfeeding preterm babies In breastfeeding somepoints for good attachment should be applied

Page Nr.Nutritious (high protein, low fat)Protective (immune protection, Vitamin A &E, zinc)Clean and safe, Available and affordableOnly when no breast milk available give formular feeding!

- suckle for shorter periods before resting- fall asleep during feeding- have long pauses after suckling and feeds longer- does not always wake up for feeds

The mother is relaxed an comfortableThe babys head and body are in a straight lineThe babys face is opposite the nipple and the breastThe babys upper lip or nose is opposite the mothers nippleThe baby is held or supported very close to the mothers bodyThe babys whole body is supported if the mother is in a sitting position, especially if her baby is newborn.

14KMC - Feeding25/01/2014Important for breastfeeding: good attachment

Page Nr.The mother is relaxed an comfortableThe babys head and body are in a straight lineThe babys face is opposite the nipple and the breastThe babys upper lip or nose is opposite the mothers nippleThe baby is held or supported very close to the mothers bodyThe babys whole body is supported if the mother is in a sitting position, especially if her baby is newborn.

15KMC - Feeding25/01/2014Important for breastfeeding: good attachment

Page Nr.The mother is relaxed an comfortableThe babys head and body are in a straight lineThe babys face is opposite the nipple and the breastThe babys upper lip or nose is opposite the mothers nippleThe baby is held or supported very close to the mothers bodyThe babys whole body is supported if the mother is in a sitting position, especially if her baby is newborn.

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KMC - Feeding25/01/2014Even though the mother states that the baby is breastfeeding well, but the baby is loosing weight there is a problem of breastfeedingPoor breastfeeding techniqueMother has not enough milkThe baby is to weak to suck properlyIf breastfeeding technique is improved but still no weight gain start cup feeding with expressed breast milk (EBM)

Page Nr.Hand expression of breast milk: EBM (expressed breast milk) Tell the mother to:Wash her hands thoroughlyMake herself comfortableHold a wide necked container under her nipple and areolaPlace her thumb and first fingerbehind the nipple (at least 4 cm from the tip of the nipple)

17KMC - Feeding25/01/2014Cup feeding

Page Nr.18KMC - Feeding25/01/2014> 1500g:exclusively oral feeding< 1500g:combination of oral feeding and IV-fluids

< 1500g: start EBM by naso-gastric-tube (NGT)1500 1800g: start EBM by cup feeding> 1800g:start directly with breastfeeding

Page Nr.- To weak to suck and still discordination in swallowing

19KMC - Feeding25/01/2014Naso-gastric-tube (NGT)Start immediately in LBW / preterm babies < 1500gIf cup feeding fails (e.g. severe birth asphyxia)

Page Nr.- To weak to suck and still discordination in swallowing

20KMC - Monitoring25/01/2014Bodyweight once dailyIn the first week of life weight loss of up to 15% of the birth weight is acceptableBirth weight should be regained between 7 to 14 days after birthThereafter weight gain should be not less than 15g/kg/d

Page Nr.21KMC - Monitoring25/01/2014Temperature 3x /day Normal range: 36,5 37,5CWhen starting KMC axillary temperature should be measured every 6 hours until it becomes stable for three consecutive days then 3x /dayNo rectal temperature (risk of rectal perforation)

Page Nr.22KMC - Monitoring25/01/2014Respiration rate 3x /dayNormal range: 30 60/min Check for difficulties in breathing (nasal flaring, chest indrawings)

Page Nr.23KMC Prevent infection25/01/2014Keep to general hygieneEye-, cord- & skin care

Page Nr.Examples:Clean eyes after delivery with sterile normale saline swab for each eye if prophylaxis for gonococcal opthalmia is needed use tretracycline or erythormycine ointmentUmbilical cord shoud tied by usin sterile ligature or disposable clamp. Use sterile blade, do not apply anything to the cordKeep the cord dry and cleanClea the baby off blodd, mucus and meconium but do not clean all the vernix caseosa because it is protectiveDo not bath the baby soon after birth24KMC - Discharge25/01/2014Baby is ready for Discharge if the following have been met:1) Baby factors:Continuous weight gain of at least 15g/kg/d for 3 consecutive days (after birth weight regained)Regained birth weight and has a minimum weight of 1500g (lower weight if near to follow up facility)Able to breastfeed and/or feed by cup wellOverall condition is stable for at least three consecutive days (temperature, respiration, feeding, no signs of infection)Page Nr.25KMC - Discharge25/01/20142) Mother factors:Accepts the KMC method and observed to be confident about caring of the baby with KMC (e.g. feeding and kangarooing)Able to breastfeed or express breast milk for feedingWilling to continue KMC at homeHas support from family to continue KMC including spouse/partner or close relativesPage Nr.26KMC - Discharge25/01/2014Information on Discharge:How to maintain KMC at homeCleanliness and hygieneFeeding When to return immediately to health facility (danger signs)Follow up visit: 3 days / 1 week after discharge then 1-2-3 weekly until weight is 2,5 kg (termination of KMC)

Page Nr.Return immediately to health facility if the baby:stops feeding, is not feeding well, or vomitsbecomes restless and irritable, lethargic or unconscioushas fever is cold despite rewarminghas convulsionshas diarrheashows any other worrying signs

1-2-3 weekly depends on the clinical picture

27Problems of LBW and the answer is KMC25/01/2014Hypothermia- kangarooingFeeding difficulties- special feeding (cup, NGT)Breathing difficulties - kangarooingApnoe attacks- kangarooingNecrotizing enterocolitis- only breast milkIntraventricular bleeding- gentle careJaundice- close observationAnemia- iron supplementationHypoglycaemia- special feedingProne to sepsis- close observationPage Nr.- To weak to suck and still discordination in swallowing

28Asanteni sana!25/01/2014

For more information visit www.tgpsh.or.tzPage Nr.- To weak to suck and still discordination in swallowing

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