|Year : 2019 | Volume
| Issue : 2 | Page : 85-89
Study of feeding practice and factors influencing it among preterm babies getting Kangaroo mother care in a Tertiary Care Hospital
Gargi Gayen1, Arijit Bhowmik1, Mausumi Nandy2
1 Department of Pediatric Medicine, Division of Neonatology, Medical College, Kolkata, West Bengal, India
2 Department of Pediatric Medicine, Medical College, Kolkata, West Bengal, India
|Date of Web Publication||25-Apr-2019|
Dr. Arijit Bhowmik
6, Kulada Roy Lane, PO Khagra, Murshidabad - 742 103, West Bengal
Source of Support: None, Conflict of Interest: None
Background: Kangaroo mother care (KMC) is an effective way to reduce mortality and morbidity of low-birth-weight babies. KMC feeding aims at the establishment of exclusive breastfeeding (EBF) for every baby. This study was conducted to analyze the actual feeding pattern and factors influencing it. Methods: Babies getting KMC were prospectively observed and the data related to feeding practice were collected. At discharge, the babies were divided into two groups: EBF and non-EBF. Different factors were compared between these groups. Results: Among 387 babies, 63.56% were on EBF. Postnatal counseling, early contact and initiation of feeding, early expression of breast milk, and first feeding with EBM played a pivotal role behind the establishment of EBF (P < 0.0001). Longer duration of KMC marginally helped in EBF (P = 0.0445). Conclusion: To establish EBF in KMC, the promotional measures should be taken since birth even when the baby was critically sick and separated from the mother and KMC was not initiated yet.
Keywords: Exclusive breastfeeding, kangaroo mother care, kangaroo nutrition
|How to cite this article:|
Gayen G, Bhowmik A, Nandy M. Study of feeding practice and factors influencing it among preterm babies getting Kangaroo mother care in a Tertiary Care Hospital. J Clin Neonatol 2019;8:85-9
|How to cite this URL:|
Gayen G, Bhowmik A, Nandy M. Study of feeding practice and factors influencing it among preterm babies getting Kangaroo mother care in a Tertiary Care Hospital. J Clin Neonatol [serial online] 2019 [cited 2019 May 22];8:85-9. Available from: http://www.jcnonweb.com/text.asp?2019/8/2/85/257128
| Introduction|| |
Kangaroo mother care (KMC) is now an accepted mode of care for preterm low-birth-weight (LBW) babies. “KMC is early, continuous, and prolonged skin-to-skin contact (SSC) between the mother and preterm babies; exclusive breastfeeding (EBF) or breast milk feeding; early discharge after hospital-initiated KMC with continuation at home; and adequate support and follow-up for mothers at home.” It was first started at Bogota in Columbia by Edgar Rey and Martinez in 1978. Since then, multiple studies proved that KMC reduces hypothermia and hospital-acquired infection and increases growth, EBF rate, neurodevelopmental outcome, and overall mortality in these babies., According to the guidelines, KMC has two major components before discharge: KMC position to provide SSC and KMC feeding or nutrition which implies EBF with additional support as required, but with the aim of achieving ultimately EBF., To get the benefits of KMC, both components are equally needed to be fulfilled. In our tertiary care hospital, KMC is well practiced for stable LBW babies and breastfeeding is promoted during KMC practice for all babies. In this study, we tried to find out how much we achieved to establish EBF among every baby getting KMC in our institution and if not fully achieved, then what were the factors hindering the process of establishment of EBF as KMC feeding.
| Methods|| |
A prospective study was done in sick newborn care unit (SNCU), KMC ward, and postnatal wards of Medical College, Kolkata, a tertiary care hospital in Eastern India, from May 2017 to April 2018. Institution's ethical clearance was obtained. Written informed consent was taken from all caregivers before inclusion in the study.
In this institution, KMC is advised and assisted for LBW babies when they were hemodynamically stable and not requiring O2 therapy. In our study, we included only those babies who were getting KMC for more than 24 h and full enteral feeding was established. Babies with congenital anomalies were excluded from the study. If mothers were unavailable due to sickness or any other reason and if there were any contraindication of human milk, they were excluded from the study. Mothers with minor morbidities which did not prevent them to provide KMC were kept in the study.
After initiation of KMC, all the mothers were counseled and assisted daily for the expression of milk and feeding of these babies. Even after these, for those babies who not getting required/prescribed amount of EBM from their mothers, preterm formula were allowed to be given for the deficient volume. These mothers and babies were prospectively observed up to the end of hospital stay. Any discontinuation of KMC due to maternal or neonatal sickness led to exclusion from the study.
We kept data regarding the feeding status and all other relevant information for every LBW baby admitted in SNCU from the admission time to discharge. At the end of the study, we only included those babies who fulfilled the inclusion criteria and analyzed their data [Table 1] and [Table 2]. According to the feeding status at the end of hospital stay, these babies were categorized into two groups. Those babies feeding only human milk either directly or by spoon katori or by orogastric tube, in each feed over the last 24 h, were taken as exclusive breastfed (Group 1). Babies taking even a single number of formula feed in the last 24 h were classified as non-exclusive breastfed (Group 2).
The data were taken about the postnatal day when the mother first met the baby after separation. It may be that at that time the baby was not fed or EBM not given. Similarly, timing of the first expression of EBM and its place (whether at home or postnatal ward or SNCU) was noted, irrespective of the feeding status of the baby at that time. All other possible demographic and clinical data were collected.
| Results|| |
Among the total of 387 babies, 246 (63.56%) babies were exclusively fed with human milk at the time of release from the hospital. There was no significant difference in various demographic parameters such as maternal age, religion, education, and socioeconomic status in these two groups. Mode of delivery did not have a significant influence on feeding outcome. Babies of multipara mothers were more in number (66.26%) in Group 1 in comparison to Group 2 (57.45%), but it was not statistically significant (P = 0.0844). Inborn babies were more in Group 1 (67.07% vs. 59.57%), but it was not statistically significant (P = 0.1388). There was no statistically significant difference in babies' birth weight, sex, and gestational periods among these two groups [Table 1]. Initiation time of KMC also did not have any influence over feeding outcome.
Most of the mothers in both the groups were counseled in antenatal period, but only 13.17% of mothers got postnatal counseling (PNC). In Group 1, significantly higher number of mothers received PNC. Babies in Group 1, after initial separation, had second-time contact with their mothers in an average 4 days earlier and among them feeding was also started in an average 3 days earlier. In the first group, more number of mothers started expression of milk from breast within 5 days (54.88% vs. 18.44%), irrespective of babies' feeding status, and around 30% of them expressed milk at home or postnatal ward, well before coming to SNCU. In the first group, more number of babies received their first feeding with EBM (53.25% vs. 26.24%). The mean duration of getting KMC in hospital was around 3 days more in babies in Group 1 than Group 2, and duration of KMC per day was little higher in Group 1. Babies who were exclusively on breast feeding at the time of discharge, most of them were on mother's milk at the time when KMC was initiated (82.11%). All these results were statistically significant (P < 0.05) [Table 2].
| Discussion|| |
In the present study, 63.56% of babies who were getting KMC in SNCU were exclusively fed with human milk and the rest got either full human milk substitute or mixed feeding. It is comparable to the study done by Heidarzadeh et al., where 62.5% babies of NICU with KMC got EBF. Our study showed that maternal age, birth weight, and mode of delivery had no influence on feeding outcome, which was same as the previous study.
A sick or premature baby, when got admitted in SNCU, became separated from his/her mother and breastfeeding may not be possible for several days or weeks depending on the baby's medical condition. Sometimes, it occurs that mothers are allowed to meet or hold the babies in SNCU after a long duration. This separation affects in establishing human milk feeding later on. During this long gap due to nonavailability of stimulation, mothers' normal milk flow reflexes are interrupted, and milk secretion stops. Once the production stops, later, when the baby becomes fit for feeding, the establishment of effective milk production and secretion in adequate amount becomes very difficult. Callen et al. showed that, at NICU discharge, low milk volume was the greatest breastfeeding barrier. In our study, this fact was established that early initiation and maintenance of expression of milk irrespective of the feeding status of the baby help in successful human milk feeding practice at the end of hospital stay. Jaeger et al. also proved that timely pumping for those mothers who are unable to put the baby to breast is an important predictor of sustained breastfeeding in the premature baby. In addition, this process establishes and maintains a milk supply, so that the mother will not have diminished or absent milk supply, when the baby is stable enough to start the breastfeeding process. On the contrary, delayed expression of breast milk and long separation of baby and mother after birth lead to more failure of milk production and ultimately human milk substitute feeding increases in this group. In our study, babies with delayed initiation of feeding and first feeding with human milk substitute resulted more formula-fed babies, and the babies who were initiated feeding early resulted in more human milk feeding. Initiation with human milk as first feeding also resulted more in human milk at discharge when compared. This is similar with previous studies., In studies done earlier, it was shown that starting of oral nutrition as early as possible is thought to be crucial for introducing EBF in LBW infants.
PNC plays a vital role behind this early initiation and continuation of expression of breast milk. It has been observed that most of the mothers are confused about their role after birth of a premature baby, and not having any idea about the expression of milk, its time, procedure, and need. In our study, mothers counseled in postnatal period had higher EBF babies. Sisk et al. proved that counseling mothers of very LBW infants increases the incidence of lactation initiation and breast milk feeding without increasing maternal stress and anxiety. Hence, counseling and support are needed to avoid suboptimal expression practices for mothers with preterm infants. Like the previous studies,, in our study also, long duration of KMC helps in promotion of EBF among our babies. Both the number of days and the average hours/day have a positive association between KMC and breastfeeding.
Although we are trying to promote and support breastfeeding in the SNCU babies during KMC, actually, the story starts at very earlier time when even KMC is not started. Often, we miss the initial days, when the baby is not stable for feed or KMC and at that time we concentrate on baby's survival only. We forget the mother completely and become reluctant to counsel or help them to maintain the milk flow. And then, when the baby becomes stable, again we recall her for milk. However, by that time, she eventually becomes helpless with lactation failure for this long gap of stimulation and motivation.
| Conclusion|| |
To establish EBF in KMC, the promotional measures should be taken since birth even when the baby was critically sick and separated from the mother and KMC was not initiated yet.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Charpak N, Ruiz-Peláez JG, Figueroa de CZ, Charpak Y. Kangaroo mother versus traditional care for newborn infants <=2000 grams: A randomized, controlled trial. Pediatrics 1997;100:682-8.
World Health Organization. Kangaroo Mother Care – A Practical Guide. Geneva, Switzerland: World Health Organization; 2003.
Charpak N, Ruiz-Peláez JG, Charpak Y. Rey-martinez kangaroo mother program: An alternative way of caring for low birth weight infants? One year mortality in a two cohort study. Pediatrics 1994;94:804-10.
Conde-Agudelo A, Belizán JM. Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Database Syst Rev 2003;(2):CD002771.
Charpak N, Ruiz-Pelaez JG, Figueroa de CZ, Charpak Y. A randomized, controlled trial of kangaroo mother care: Results of follow-up at 1 year of corrected age. Pediatrics 2001;108:1072-9.
National Health Mission. Kangaroo Mother Care and Optimal Feeding of Low Birth Weight Infants – Operational Guidelines. National Health Mission, Ministry of Health Family Welfare; 2014.
Heidarzadeh M, Hosseini MB, Ershadmanesh M, Gholamitabar Tabari M, Khazaee S. The effect of kangaroo mother care (KMC) on breast feeding at the time of NICU discharge. Iran Red Crescent Med J 2013;15:302-6.
Black KA, Hylander MA. Breastfeeding the high risk infant: Implications for midwifery management. J Midwifery Womens Health 2000;45:238-45.
Callen J, Pinelli J, Atkinson S, Saigal S. Qualitative analysis of barriers to breastfeeding in very-low-birthweight infants in the hospital and postdischarge. Adv Neonatal Care 2005;5:93-103.
Jaeger MC, Lawson M, Filteau S. The impact of prematurity and neonatal illness on the decision to breast-feed. J Adv Nurs 1997;25:729-37.
Wheeler J, Chapman C, Johnson M, Langdon R. Feeding outcomes and influences within the neonatal unit. Int J Nurs Pract 2000;6:196-206.
Walker TC, Keene SD, Patel RM. Early feeding factors associated with exclusive versus partial human milk feeding in neonates receiving intensive care. J Perinatol 2014;34:606-10.
Mamemoto K, Kubota M, Nagai A, Takahashi Y, Kamamoto T, Minowa H, et al.
Factors associated with exclusive breastfeeding in low birth weight infants at NICU discharge and the start of complementary feeding. Asia Pac J Clin Nutr 2013;22:270-5.
Byrne B, Hull D. Breast milk for preterm infants. Prof Care Mother Child 1996;6:39, 42-5.
Sisk PM, Lovelady CA, Dillard RG, Gruber KJ. Lactation counseling for mothers of very low birth weight infants: Effect on maternal anxiety and infant intake of human milk. Pediatrics 2006;117:e67-75.
Ikonen R, Paavilainen E, Helminen M, Kaunonen M. Preterm infants' mothers' initiation and frequency of breast milk expression and exclusive use of mother's breast milk in neonatal intensive care units. J Clin Nurs 2018;27:e551-8.
Almeida HD, Venancio SI, Sanches MT, Onuki D. The impact of kangaroo care on exclusive breastfeeding in low birth weight newborns. J Pediatr (Rio J) 2010;86:250-3.
[Table 1], [Table 2]