A Pilot Study to Examine the Feasibility and Acceptability of Researching the Effectiveness of Kangaroo Mother Care on Low Birth Weight Infants in Neonatal Intensive Care Units

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Abstract

Background: Kangaroo Mother Care (KMC) is defined as skin-to-skin contact between a mother and her newborn baby, frequent and exclusive or nearly exclusive breastfeeding and early discharge from hospital. This concept was proposed as an alternative to conventional methods of care for low birth weight (LBW) infants, and in response to problems of serious overcrowding in neonatal intensive care units (NICUs). KMC essentially uses the mother as a natural incubator. According to this principle, LBW babies are placed to the mother’s chest in an upright position, where maternal body heat can help control the baby’s body temperature. Although widely used in some parts of the world, this practice is not the norm in the Kingdom of Saudi Arabia (KSA). Aim: The aim was to assess the feasibility and acceptability of running a randomised controlled trial (RCT) to evaluate the effectiveness of KMC in LBW infants in KSA.Study Design: A pilot RCT with supportive qualitative interviews was conducted, underpinned by a post-positivist approach.Methods: This was a mixed methods study. Quantitative methods were used to measure the effectiveness of KMC, and qualitative methods were used to explore women’s and nurses’ experiences of a) KMC and b) trial processes. The study took place in two urban hospitals in Jeddah, KSA. Ethical approval was gained, and data were collected between March and May 2011.The quantitative element comprised a two-group, individually randomised controlled pilot trial with 20 mothers-and-babies per group. The randomisation sequence was computer-generated, and participants were randomised using consecutively numbered, sealed, opaque envelopes. Data were collected using routinely collected case records, specifically designed clinical data sheets and two questionnaires (validated maternal bonding scale and maternal breastfeeding experience questionnaire). For the latter questionnaire, the design was informed by an expectation-fulfilment model. The qualitative element comprised semi-structured interviews, within 48 hours of birth, with a sample of 20 mothers who participated in the pilot RCT and 12 nurses who were attending these mothers. All 40 mothers were also telephoned when their babies were 6 months old to ascertain their feeding method and exclusivity of feeding.Quantitative data were managed using SPSS and analysed descriptively to estimate confidence intervals and effect sizes. Statistical tests and regression models were used to explore associations with potential outcome measures, with findings interpreted with caution as hypothesis-generating rather than hypothesis-confirming, given the small sample size. Qualitative data were analysed manually, using the Framework Approach.Results: The pilot study confirmed that trial processes were efficient, the intervention was acceptable (to mothers and nurses) and that the outcome measures were appropriate; the percentage of women exclusively breastfeeding at 6 months was identified as the most appropriate primary outcome. A large scale trial of KMC would be feasible and acceptable in KSA. However, issues relating to religious and organisational culture would need to be resolved, including improving privacy in the NICU, addressing language issues arising from transcultural nursing and engaging with male partners. A unique finding was the effect of KSA culture on women’s mobility and the impact that this had on their ability to carry out KMC if they were personally discharged but their baby remained in the NICU. Conclusion: A large scale RCT comparing KMC with standard care in KSA is feasible, acceptable and recommended. However, prior to progressing to a large scale study, a thorough planning stage is necessary which considers cultural practices and ward environment. The understandings gained from this research will be transferable to other research within similar settings

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Kangaroo mother care

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