Effectiveness of Kangaroo Mother Care in Weight Gain among Newborn Babies in AVBRH Hospitals of Wardha

Introduction: Kangaroo Mother Care is a simple and feasible intervention; acceptable to most mothers admitted in hospitals. There may be benefits in terms of reducing the incidence of hypothermia with no adverse effects of Kangaroo Mother Care. Kangaroo Care infants showed improvement in regular breathing patterns and virtually no periodic breathing, weight gain in low birth babies, suggesting that Kangaroo Mother Care is safe for these infants. Materials and Methods: Randomized control trai, l experimental and control group design was used in study this study was conducted in post natal wards of AVBR Hospital. In this study samples were newborns that were fulfilling the inclusion and exclusion criteria. 500 newborns were selected Original Research Article Maurya et al.; JPRI, 33(46B): 532-537, 2021; Article no.JPRI.73855 533 and it was equally divided into two groups as control 250 and experimental 250. Random sampling technique was used in this study. A checklist regarding the frequency and duration of KMC was prepared for the experimental group. Results: The mean weight gain in the control group at birth is 2.71, on discharge it is 2.53 and on follow up it is 3.07. The mean weight gain in the experimental group at birth is 2.74, on discharge it is 2.67 and on follow up it is 3.31. Conclusion: Significant difference was found in the mean weight gain between experimental and control group. Thus it is concluded that KMC is effective in increasing the weight of the newborn babies.


INTRODUCTION
Background Kangaroo mother care (KMC), originally defined as skintoskin 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 birth weight (LBW) infants [1]. Lawn JE, Mwansa-Kambafwile J, Barros FC, Horta BL, Cousens S conducted study (2010) Kangaroo mother care to prevent neonatal deaths due to preterm birth complications [2]. The evidence that kangaroo mother care (KMC), when compared to conventional neonatal care in resource-limited settings, significantly reduces the risk of mortality in infants born in facilities who are clinically stable and weighing less than 2000 gms [3].
There is strong evidence of mortality and morbidity reduction in low-and middle-income settings and KMC has been endorsed by the World Health Organization (WHO). However, adoption and implementation of KMC has been limited at the national level. A systematic assessment of health system bottlenecks among countries with a high rate of neonatal deaths identified KMC as an intervention with significant barriers to scaling up, including leadership and governance, health financing, health workforce, health information systems, and community ownership and partnership [4]. Based on criteria such as mortality benefit and equity, health intervention priority-setting tools, such as the Lives Saved Tool and Child Health and Nutrition Research Initiative methodology, have identified KMC as a high priority intervention.
The lack of a clear definition of KMC has made it difficult to achieve effective coverage at scale of KMC in addition to implementation barriers. A multi-country study in Africa found that KMC implementation varied across facilities in countries committed to KMC1. Developing and adopting a global definition of KMC is challenging due to regional, country, and facility differences in health worker capacity, financial resources, leadership, health information systems, and cultural and community structures.
Kangaroo Mother Care combines skin-to-skin contact between mother and infant, frequent breast feeding, and early discharge from the hospital. Skin-to-skin contact has been shown to significantly increase and stabilize infant temperature, breathing, increase blood glucose, and improve breastfeeding duration and aid to lasting maternal infant bonding. Babies in Kangaroo Mother Care are secured between their mother's breasts in an upright position, day and night.
Kangaroo Mother Care is a simple and feasible intervention; acceptable to most mothers admitted in hospitals. There may be benefits in terms of reducing the incidence of hypothermia with no adverse effects of Kangaroo Mother Care in the study. The present study has important implications in the care of low birth weight infants in the developing countries; where expensive facilities for conventional care may not be available at all place.
The physiologic parameters for Kangaroo Care infants remained within clinically acceptable ranges and the infants did not experience any adverse physiological events.
Additionally, Kangaroo Care infants showed improvement in regular breathing patterns and virtually no periodic breathing, suggesting that Kangaroo Mother Care is safe for these infants. Using skinto-skin contact, it is possible to create a neutral thermal environment, a radiant warmer…" and that "the use of this technique has several advantages, including stabilizing vital signs and temperature, promoting bonding between infant and parent, and improving lactation. Kangaroo mother care improves growth and reduces morbidities in low birth weight infants. It is simple, acceptable to mothers and can be continued at home. As soon as the baby is stable, KMC can begin. Baby's requiring special treatment or suffering from severe illnesses should be managed according to the unit protocol: short KMC sessions can be initiated during recovery with ongoing medical treatment (intravenous fluids, oxygen therapy). The KMC can be provided while the baby is being fed via orogastric tube or while on oxygen therapy [5]. The institution and then at home, KMC continues for as long as possible when the mother and baby are comfortable. This is often preferred until the baby's gestation reaches term, or until its weight reaches 2500 grams. This is the time to wean the baby from KMC. Mothers can provide skin to skin contact occasionally after giving the baby a bath and during cold nights [6].

Need of the Study
KMC improved breastfeeding rates and physical growth rates because it was well-received by both the mothers and nursing staff. This study is performed to see the effect of structured kangaroo care on the growth and morbidity pattern of newborns. Most of the studies have been done showing the effect of KMC on weight gain in low birth weight babies.

Aims
The effect of kangaroo mother care in weight gain among newborn babies.

Objectives
Following are the objectives of the study: 1) To assess weight gain in newborn babies without receiving KMC in control group. 1) To assess weight gain in newborn babies receiving KMC in experimental group.
3) To compare weight gain in control group and experiment group.

Research Design
Research design Randomized control trail was used in.

Study Groups
Interventional Group and control group was used in the study.

Setting
The study was post natal wards of AVBR Hospital.

Sample
Normal Newborn

Sampling Technique
Researcher was used computerized randomized sampling technique for the group formation of intervention group and control group.

Section of the Sample
Random sampling technique.

Sample size
500 normal newborn 250 newborn each group.

Inclusion criteria
• Normal Healthy and stable newborn after birth within 7days • Newborn weight 2500gms or more than • Mother who are healthy during postnatal period • Normal delivery and cesarean section

Exclusion criteria
• Major congenital anomalies • Mothers have fever, or any communicable disease

Data Collection
This study was conducted between the years 2016 and 2018. In the study, the researcher used a randomized control trail research design. A computerized random sampling technique was used to select 500 newborn from postnatal wards at AVBRH Sawangi Wardha, Maharashtra, India.
An Observation approach was used in this study. This study was conducted in the postnatal wards of AVBR Hospital. In this study samples were normal newborns that were fulfilling the inclusion and exclusion criteria. Newborns were selected and it was equally divided into two groups as control and experimental. A random sampling technique was used in this study. A checklist regarding the frequency and duration of KMC was prepared for the experimental group up to discharge researcher trained the mother about KMC. Three observations were taken by researcher weight at birth, at discharge, and after one month at the time of follow up and for the control group with routine care three observation weights at birth at discharge and after one month at the time of follow up.
Before giving KMC, weight of the baby would be recorded. Then KMC would be given to newborn babies for two hour every four-hour interval. (8am, 12pm, 4pm, 8pm) Before discharge of baby again weight was recorded. Mother has been advised to continue KMC up to one month at home and weight had reassessed after 1month of age in paediatric OPD at AVBRH.

RESULTS
The mean weight gain in the experimental group at birth is 2.73, on discharge it is 2.68 and on follow up it is 3.31. The mean weight gain in the control group at birth is 2.71, on discharge it is 2.53 and on follow up it is 3.07.   A study revealed that 62 low birth weight babies were given KMC. 19 (31%) of these were *1000gm, 32 (52%) 1001-1500gm, and the rest were between 1500gm and 2500gm. (Smallest 548 grams). KMC was initiated within the first week in 50.4% and by the second week in 27.4%. KMC lasted an average of 7 days (range 1-48). No significant variation in heart rate, respiratory rate was noticed. Babies who received KMC had fewer complications and a higher survival rate. The number of mothers expressing breast milk increased. Mothers accepted KMC well, and were more confident in handling their LBW babies. Their milk yield increased and they felt as if they were contributing positively to the care of their precious babies [7].
The KMC babies had better average weight growth per day (KMC: 23.99g vs. CMC: 15.58g, P<.0001). There was no effect on time to discharge. More KMC babies were exclusively breastfed at the end of the study (98% vs. 76%). KMC was acceptable to most mother and families at home [8].

CONCLUSION
The present there are significant difference was found in the mean weight gain between experimental and control group. Thus it is concluded that KMC is effective in increasing the weight of the normal newborn babies. KMC with increased breastfeeding opportunities was shown to improve weight gain in normal neonates with delayed weight gain regardless of birth weight. Based on our findings as well as those of others, KMC can be considered an effective strategy for increasing weight gain in neonates with delayed weight gain. The effect of KMC needs to be explored on other neonatal problems and has to be examined in different clinical settings.

CONSENT
Researcher obtained permission from the CMS of the hospital and the head of the department and then obtained written informed consent from the parents before the study.

ETHICAL APPROVAL
Institutional Ethical Committee Board, Datta Meghe Institute of Medical Sciences (Deemed to be University), and India provided ethical approval.