Kenguru módszer (KMC), bőrkontaktus

„A kenguruzó babák nyugodtabbak, egészségesebbek és jobban fejlődnek” – beszélgetés dr. Schill Beáta neonatológussal

Létezik egy módszer, amelyet a természet adott. Létezik egy orvos, akinek nem is életcélja, hanem inkább az élete, hogy minél több koraszülöttnek legyen esélye az egészséges életre. Egy tudományosan igazolt módszerről van szó, amelyet egyre több magyarországi koraszülött intenzív osztályon is használnak. De még mindig nem mindenütt. Dr. Schill Beáta, tavaly Aranyanyu-díat is nyert a munkájával, bátor nő, az elvei mellett kiálló ember, aki oroszlánként harcol azért, hogy a keze alatt cseperedő babák a lehető legjobb ellátásban részesüljenek. Jelenléte nyugalmat sugároz, hitet ad, és lássuk be, ez nem könnyű feladat a mai magyar egészségügyben. Rohr Linda beszélgetett vele a kenguruzás világnapja és a „kenguruverseny” alkalmából.

Does skin-to-skin contact and breast feeding at birth affect the rate of primary postpartum haemorrhage: Results of a cohort study.

Saxton A et al.
Midwifery. 2015 Jul 29. [Epub ahead of print]

Abstract

OBJECTIVE: to examine the effect of skin-to-skin contact and breast feeding within 30 minutes of birth, on the rate of primary postpartum haemorrhage (PPH) in a sample of women who were at mixed-risk of PPH.

DESIGN: retrospective cohort study.

SETTING: two obstetric units plus a freestanding birth centre in New South Wales (NSW) Australia.

PARTICIPANTS: after excluding women (n=3671) who did not have opportunity for skin to skin and breast feeding, I analysed birth records (n=7548) for the calendar years 2009 and 2010. Records were accessed via the electronic data base ObstetriX.

INTERVENTION: skin to skin contact and breast feeding within 30 minutes of birth.

A korai bőrkontaktus támogatása 10 lépésben - gyakorlati útmutató családoknak, szakembereknek

A korai kötődés, azaz bonding – már a születés, szülés előtt, illetve a szül(et)és pillanatában megkezdődik. Elengedhetetlen, hogy a gyermek és az anya elválasztását meggátoljuk az élet első pillanataiban, óráiban, napjaiban. A korai kapcsolat támogatása alapvető fontosságú minden gyermeknél, de ennél is lényegesebb a koraszülötteknél és császármetszéssel világrajötteknél, traumatizált anyáknál. A szül(et)éssel egyaránt megváltoznak mind a gyermek, mind az anya neuropszichológiai mechanizmusai. A bőrkontaktus elősegíti a szülővé válást, az újszülött adaptálódását, a természetes, egészséges bio-pszicho-szociális, spirituális folyamatok kibontakozását, megvalósul a kolonizáció, immunológiai, fiziológiai szempontból is az ideális kezdetet kapja meg a kisbaba.

Midwives׳ experiences with mother-infant skin-to-skin contact after a caesarean section: 'Fighting an uphill battle'.

Zwedberg S, Blomquist J, Sigerstad E.
Midwifery. 2015 Jan;31(1):215-20.

Abstract

OBJECTIVE: to explore midwives׳ experiences and perceptions of skin-to-skin contact between mothers and their healthy full-term infants immediately and during the first day after caesarean section.

DESIGN: qualitative interviews with semi-structured questions.

SETTING AND PARTICIPANTS: eight midwives at three different hospitals in Stockholm participated in the study. All participants provided care for mothers and their newborn infants after caesarean birth.

Immediate or early skin-to-skin contact after a Caesarean section: a review of the literature

Stevens J, Schmied V, Burns E, Dahlen H.
Maternal & Child Nutrition. doi: 10.1111/mcn.12128

Abstract

The World Health Organization and the United Nations International Children's Emergency Fund recommends that mothers and newborns have skin-to-skin contact immediately after a vaginal birth, and as soon as the mother is alert and responsive after a Caesarean section. Skin-to-skin contact can be defined as placing a naked infant onto the bare chest of the mother. Caesarean birth is known to reduce initiation of breastfeeding, increase the length of time before the first breastfeed, reduce the incidence of exclusive breastfeeding, significantly delay the onset of lactation and increase the likelihood of supplementation. The aim of this review is to evaluate evidence on the facilitation of immediate (within minutes) or early (within 1 h) skin-to-skin contact following Caesarean section for healthy mothers and their healthy term newborns, and identify facilitators, barriers and associated maternal and newborn outcomes.

Kangaroo mother care to reduce morbidity and mortality in low-birth-weight infants

Conde-Agudelo A, Belizán JM, Diaz-Rossello J.
Cochrane Database Syst Rev. 2011 Mar 16;(3):CD002771.

Abstract

BACKGROUND: Kangaroo mother care (KMC), originally defined as skin-to-skin contact between a mother and her newborn, frequent and exclusive or nearly exclusive breastfeeding, and early discharge from hospital, has been proposed as an alternative to conventional neonatal care for low birthweight (LBW) infants.

OBJECTIVES: To determine whether there is evidence to support the use of KMC in LBW infants as an alternative to conventional neonatal care.

Early skin-to-skin contact for mothers and their healthy newborn infants (2012)

Moore ER, Anderson GC, Bergman N, Dowswell T.
Cochrane Database Syst Rev. 2012 May

Abstract

BACKGROUND: Mother-infant separation postbirth is common in Western culture. Early skin-to-skin contact (SSC) begins ideally at birth and involves placing the naked baby, head covered with a dry cap and a warm blanket across the back, prone on the mother's bare chest. According to mammalian neuroscience, the intimate contact inherent in this place (habitat) evokes neurobehaviors ensuring fulfillment of basic biological needs. This time may represent a psychophysiologically 'sensitive period' for programming future physiology and behavior.

OBJECTIVES: To assess the effects of early SSC on breastfeeding, physiological adaptation, and behavior in healthy mother-newborn dyads.

Expansion of the baby-friendly hospital initiative ten steps to successful breastfeeding into neonatal intensive care: expert group recommendations.

Nyqvist KH et al.
J Hum Lact. 2013 Aug;29(3):300-9.

Abstract

In the World Health Organization/United Nations Children's Fund document Baby-Friendly Hospital Initiative: Revised, Updated and Expanded for Integrated Care, neonatal care is mentioned as 1 area that would benefit from expansion of the original Ten Steps to Successful Breastfeeding. The different situations faced by preterm and sick infants and their mothers, compared to healthy infants and their mothers, necessitate a specific breastfeeding policy for neonatal intensive care and require that health care professionals have knowledge and skills in lactation and breastfeeding support, including provision of antenatal information, that are specific to neonatal care.

Infant Calming Responses during Maternal Carrying in Humans and Mice

Esposito G, Yoshida S, Ohnishi R, Tsuneoka Y, Rostagno Mdel C, Yokota S, Okabe S, Kamiya K, Hoshino M, Shimizu M, Venuti P, Kikusui T, Kato T, Kuroda KO.
Curr Biol. 2013 May 6;23(9):739-45.

Abstract

BACKGROUND: Mother-infant bonding is the earliest and most critical social relationship of mammalian infants. To promote this bond, infants have innate behaviors to seek maternal proximity and protest upon separation via communication with the mother vocally and through body movement. However, the physiological mechanisms regulating these infant behaviors remain largely undefined.

Császár után

Egy éve dolgozom az egészségügyben. Egy év alatt annyit tanultam, mint azelőtt összesen. Többek között azt, milyen fontos néha csak ülni valahol, és nem csinálni semmit. Ilyen helyzet, amikor anya és baba először találkoznak.

Eddig bába és szülész ismerőseimtől hallottam arról, mekkora művészet valahol csak ott lenni, nem is szólni, szinte észrevétlenül belesimulni a környezetbe, csak annyira látszani, hogy az anya biztonságérzete meglegyen. Sokan erre képtelenek, úgy érzik, tenni kell valamit, különben miért is lennének ott. Vagy tenni kell valamit a fizetésükért/fizetségükért. Vagy azért, hogy bebizonyítsák: itt szükség van a szaktudásukra. Vagy azért, hogy végre történjen már valami. Pedig néha fontos, hogy úgy legyünk az anya mellett, mintha ott sem lennénk.

Newborn behaviour to locate the breast when skin-to-skin: a possible method for enabling early self-regulation.

Widström AM, Lilja G, Aaltomaa-Michalias P, Dahllöf A, Lintula M, Nissen E.
Acta Paediatr. 2011 Jan;100(1):79-85.

Abstract

Aim: The aim of this study was to provide a more detailed analysis of the infant’s behavioural sequence that begins immediately after birth and terminates with grasping the nipple, suckling and then falling asleep.

Early Skin-to-Skin After Cesarean to Improve Breastfeeding

Hung KJ, Berg O.
MCN Am J Matern Child Nurs. 2011 Sep-Oct;36(5):318-24.

Abstract

This article describes a quality improvement project in which early skin-to-skin (STS) contact, in the operating room (OR) and during recovery, was used as an intervention to increase the success of breastfeeding initiation among healthy infants after cesarean, at a large, urban, acute care teaching hospital. The nursing role is key for the intervention, but the program involves the entire perinatal team, including the obstetricians, pediatricians, and anesthesiologists.

‘Kangaroo mother care’ to prevent neonatal deaths due to preterm birth complications

Lawn JE, Mwansa-Kambafwile J, Horta BL, Barros FC, Cousens S.
Int J Epidemiol. 2010 Apr;39 Suppl 1:i144-54.

Abstract

Background ‘Kangaroo mother care’ (KMC) includes thermal care through continuous skin-to-skin contact, support for exclusive breastfeeding or other appropriate feeding, and early recognition/response to illness. Whilst increasingly accepted in both high- and low-income countries, a Cochrane review (2003) did not find evidence of KMC’s mortality benefit, and did not report neonatal-specific data.

Towards Universal Kangaroo Mother Care: Recommendations and report from the 1 European Conference and 7 International Workshop on Kangaroo Mother Care.

Nyqvist KH, Anderson GC, Bergman N, Cattaneo A, Charpak N, Davanzo R, Ewald U, Ibe O, Ludington-Hoe S, Mendoza S, Pallás-Allonso C, Peláez JG, Sizun J, Widström AM.

Acta Paediatr. 2010 Mar 6. [Epub ahead of print]

Breastfeeding promotion for infants in neonatal units: a systematic review and economic analysis

Renfrew MJ, Craig D, Dyson L, McCormick F, Rice S, King SE, et al.

Health Technol Assess 2009;13(40).

Objectives: To evaluate the effectiveness and costeffectiveness of interventions that promote or inhibit breastfeeding or feeding with breastmilk for infants admitted to neonatal units, and to identify an agenda for future research.

Early contact versus separation: effects on mother-infant interaction one year later.

Bystrova K et al.
Birth. 2009 Jun;36(2):97-109.

Abstract

BACKGROUND: A tradition of separation of the mother and baby after birth still persists in many parts of the world, including some parts of Russia, and often is combined with swaddling of the baby. The aim of this study was to evaluate and compare possible long-term effects on mother-infant interaction of practices used in the delivery and maternity wards, including practices relating to mother-infant closeness versus separation.

Enhanced kangaroo mother care for heel lance in preterm neonates: a crossover trial

C C Johnston, F Filion, M Campbell-Yeo, C Goulet, L Bell, K McNaughton and J Byron

Journal of Perinatology (2009) 29, 51–56

Objective: To test if enhancing maternal skin-to-skin contact, or kangaroo mother care (KMC) by adding rocking, singing and sucking is more efficacious than simple KMC for procedural pain in preterm neonates.

Conclusion: The sensorial stimulations from skin-to-skin contact that include tactile, olfactory sensations from the mother are sufficient to decrease pain response in premature neonates.

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