Health: Kangaroos know that cuddles work best: Danny weighed just 3lb 3oz, but instead of being isolated in an incubator he thrived on the body heat of his parents. Angela Smyth looks at a new way to save premature infants

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Indy Lifestyle Online
DANNY CLARK was born prematurely, weighing only 3lb 3oz (1,500g). In normal circumstances he would have been whisked away from his mother to struggle alone for the first two months of his life in the isolation of an incubator. Yet with the help of 'kangaroo care', a method of treating premature babies which began in South America and is spreading to the United States and Europe, Danny was able to snuggle up to his parents soon after birth. His parents took over from the incubator in the hospital at St Paul, Minnesota.

At such a low weight, Danny was unable to regulate his own body heat. He had blood in his lungs and stomach and was hooked up to intravenous lines providing nutrition, a ventilator to help him to breathe, and monitors to check his progress. He received seven blood transfusions in his first month.

Like most premature babies, he suffered apnoea - periods when he would stop breathing altogether. His parents were terrified not only that he might not survive, but that if he did he would suffer developmental problems, including brain damage and severe lung disorders.

Most neonatal specialists would have advised minimum handling of Danny to preserve his fragile energy. The risk of hypothermia would have confined him to his incubator and his parents' only contact would have been the occasional hand poked through the porthole, or a brief cuddle once a week surrounded by the technology of an intensive-care unit.

But Danny's mother, Chris Clark, from Cushing, Minnesota, had read about kangaroo care and persuaded the staff at the hospital to allow her to try it. For increasing periods each day, starting with about 20 minutes, she sat in a rocking chair, opened her blouse and slipped her tiny naked baby between her breasts.

'At first it was difficult to find a place on his body to hold him, he was hooked up to so many lines, but once he was there I was able to shut out all the flashing lights and beeps of the monitors and connect with him,' she says.

Danny's father, Steve, also took his turn: 'His body just about fitted into my hand as I held him on my chest. I'd look down at him and maybe hum a little and sometimes stroke his head with my finger. It made me realise he was a human being, and the whole intensive-care experience became much more tolerable.'

It is a far cry from the hi-tech norm of Western medicine. Kangaroo care originated in Colombia, where doctors in Bogota, desperately short of incubators and faced with high mortality rates among the newborn, advised mothers to hold and breast-feed their premature babies.

Inspired by kangaroos and other marsupials, which nurture their young in pouches, they told the mothers to tuck their babies, naked except for nappies, under their clothing and hold them upright, skin-to-skin, between their breasts.

The babies would often spontaneously start to suckle and were encouraged to feed on demand. To the doctors' surprise, high-risk babies weighing less than 2lb 2oz (1,000g) thrived, and their parents were soon able to take them home. Survival rates soared.

The experiment was so successful that Unicef, the United Nations children's fund, has promoted kangaroo care throughout the Third World, and many doctors and nurses from the West have gone to Colombia to see it in action.

The method has been introduced to Britain, Scandinavia and the US and subjected to scrutiny by medical researchers. Kathy Sleath, a neonatal nurse specialising in community care at Hammersmith Hospital, London, was one of the first to recognise the advantages. Despite resistance from paediatricians, she started a project in which staff suggested to parents that they hold their babies skin-to-skin.

'We could see the benefits of this treatment because it provided contact between the parent and child, which is lost in intensive care,' she says. 'We found a very positive response: the babies' oxygen levels, heart rate and temperature were maintained.' Follow-up studies have shown that women who give kangaroo care tend to produce more breast milk and can feed for longer - and their babies cry less at six months.

But kangaroo care does not fit easily into the structure of a special-care baby unit. It provokes anxiety among staff, and provision must be made for the parents in often quite confined spaces. Ms Sleath hopes to restart the project when the Hammersmith unit moves to new premises next year.

In Britain and America, kangaroo care tends to be nurse-led, and studies by nurses in the US indicate its advantages over intensive care. Susan Ludington, a research nurse at the University of California Los Angeles School of Nursing, has observed that the mother's temperature alters to suit the baby when the two are skin-to-skin: 'The mother's temperature rises to warm her cool baby, the baby's temperature goes up, then the mother's temperature drops back a little. Her temperature is constantly rising and falling in tandem with the baby's needs to provide an optimum environment. Mothers are more efficient than incubators at keeping babies warm.'

Fathers also keep their babies warm, though their skin temperature does not adjust as accurately as mothers'. Studies in Colombia and the US show that premature babies held by their fathers during the first 24 hours after birth keep warm, sleep most of the time and suffer no lapses in breathing. To many fathers' surprise, their babies even start to move towards the breast, attempting to suck.

Gene Anderson, of the University of Florida School of Nursing, has observed psychological as well as physiological benefits from kangaroo care for both parents and children: 'When we went to Bogota we were impressed by the serenity of the babies, and the mothers' obvious happiness and attachment.'

Babies kept in the stressful environment of an intensive-care unit tend to lose valuable energy through restless fidgeting and crying, and this hinders their growth. Ms Anderson's studies reveal that a baby receiving kangaroo care shows signs of recognising its mother or father soon after it is placed on a parent's chest. Such babies settle quickly and rarely cry. They also sleep twice as much as they do in an incubator, she says, which helps brain development.

A recent trial showed that babies born four to six weeks prematurely who were given kangaroo care from birth were fully breast-feeding and well enough to be discharged at four days. Those receiving traditional intensive care were not able to leave the hospital until nine days later. 'Not only are the babies fitter,' says Ms Anderson, 'but the cost containment is significant.'

Having seen the benefits of skin-to- skin treatment on premature babies, she is keen to see it used in standard postnatal care: 'It is ironical that in modern medicine it is common practice to take the baby away from the mother at birth to ensure he is kept warm, yet the mother can adequately heat her baby providing he is kept skin-to-skin.'

Ms Ludington has plans more studies. 'Many of the signs and conditions which precede sudden infant death syndrome (Sids), such as lapses in breathing, sleep disorganisation, a drop in body temperature, and having the baby lying flat, seem to be corrected through kangaroo care where the baby is kept warm and upright and breathes and sleeps well,' she says. Her next project is to follow two large groups of babies at home, one receiving regular kangaroo care from birth, and the other traditional care, and comparing the incidence of Sids.

Danny Clark is now two years old and a healthy and affectionate toddler. While researchers work to give kangaroo care respectable Western credentials, there is no doubt in his parents' minds of the benefits of the treatment.

For them, one of the greatest advantages was the opportunity to establish their relationship with their son at once and take part in his treatment. 'In the intensive-care environment we had no control over Danny's future, the machines took over,' says Mr Clark. 'Kangaroo care transformed my relationship from seeing Danny as an 'it' in an incubator to my son whom I love.'

(Photograph omitted)

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