Parenting in the NICU - a quick look

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Learning about the NICU and ways of helping and bonding with your preemie can help you manage some of the stress and uncertainty associated with a preterm birth.


Finding special ways to connect & understand preterm birth

The joy of childbirth is often short-lived for parents of preterm babies. Isolation from your newborn, extended hospital stays, and the uncertainty associated with medical procedures, takes a massive emotional and physical toll. This section has been created to help you navigate your way through some tough times. It covers everything from family-centred care, tips on how to bond with your preemie, helping out in the NICU, what to bring, to learning to read your prem's body language


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Kangaroo Mother Care

Kangaroo Mother Care is care of low birth weight and preterm infants carried skin-to-skin with the mother. This technique is easy to use and is a powerful way to ensure physiological and psychological warmth and bonding.

Main areas covered in this article:

Key Features of Kangaroo Mother Care

  • Early, continuous and prolonged skin-to-skin contact between the mother and the baby.
  • Exclusive breastfeeding (ideally)
  • Initiated in the hospital and can be continued at home
  • It is a gentle and effective method that avoids the agitation routinely experienced in a busy hospital setting with preterm infants

Evidence of Effectiveness of Kangaroo Mother Care

  • Kangaroo care is at least equivalent to conventional care (incubators), in terms of safety and thermal protection, if measured by mortality.
  • Kangaroo Mother Care contributes to the humanisation of neonatal care and to increase bonding between mother and baby in both low and high income countries
(Organization, 2003)

Benefit of Kangaroo Mother Care

  • Kangaroo Mother Care has been shown to increase the prevalence and duration of breastfeeding.
  • Research in low income countries has found that Kangaroo Mother Care for preterm infants and low birth weight provides effective thermal control and may be associated with a reduced risk for hypothermia.
  • Heart and respiratory rates, respiration, oxygenation, oxygen consumption, blood glucose, sleep patterns, and behaviour seen in preterm and low birth weight babies given Kangaroo Mother Care are similar or better than those seen in infants separated from their mothers.
  • Salivary cortisol, an indicator of stress, is lower in newborn infants given Kangaroo Mother Care.
  • Improves bonding
  • Easy access to breast feeding
  • Lower levels of infant stress
  • Lower levels of maternal stress
  • Mothers report greater confidence, self-esteem, and feelings of fulfilment
  • Fathers report feeling more relaxed, comfortable, and contented
  • Low cost and easy to do

Resources Required for Kangaroo Mother Care

It is best for preterm babies who are very or extremely low birth weight and those with complications to be cared for in incubators where they will receive the necessary specialist care and attention. When their condition improves and intensive care is no longer required Kangaroo Mother Care can be an ideal method of care.

Kangaroo Mother Care does not require special facilities but following are some simple suggestions on maintaining comfort for mother and baby.

Clothing For Mother


  • Ideally mothers will have access to comfortable chairs and beds that are adjustable and/or adequate pillows to maintain a good position for rest and sleep.
  • Mother should wear whatever she finds comfortable and warm so long as it accommodates the baby. That is, keeps the baby firm and comfortable against mother’s skin.

Support Binder

The support binder is the only specific piece of equipment needed for Kangaroo Mother Care. It is used to help mothers hold their preemies safely close to their chest.

  • A soft piece of fabric can be used for this; approx a metre square, folded diagonally in two and secured with a safe knot or tucked under the mother’s armpit.
  • A number of commercial carrying pouch’s are available for mothers to choose from.
  • Some institutions provide their own type of pouch.
  • ,

Clothing for Preemie

Preemie will not require any more clothing than an infant in conventional care.

  • If the ambient temperature is 22-24 degrees Celsius, preemie should be carried in the kangaroo position naked, except for the diaper, a warm hat, and socks.
  • When the temperature is below 22 degrees Celsius preemie should wear a cotton sleeveless shirt, open at the front to allow the face, chest, abdomen, arms, and legs to maintain skin-to-skin contact with the mother’s chest and abdomen
  • Mother will cover herself and preemie with her usual dress.

When to Start Kangaroo Mother Care

The exact time Kangaroo Mother Care should begin will depend on each preemie baby’s unique needs and situation, the following birth weight ranges is a general guide;

  • Preterm infants weighing 1,800 g or more at birth or gestational age 30 – 34 weeks or more: most babies at this range will be healthy enough for Kangaroo Mother Care and can start soon after birth.
  • Preterm infants weighing between 1,200 and 1,799 g at birth or gestational age 28 – 32 weeks are at risk for respiratory difficulties and other complications, so it may take a week or more before Kangaroo Mother Care can be started.
  • Preterm infants weighing less than 1,200 g at birth or gestational age below 30 weeks are at greater risk for complications and therefore it may take weeks before their condition improves well enough for Kangaroo Mother Care
  • Initial care for preterm infants with complications is provided according to national or institutional guidelines.
  • For continuous Kangaroo Mother Care preemies must be stable, they must be able to breath spontaneously without need for additional oxygen.
  • All mothers can provide Kangaroo Mother Care irrespective of age, education, culture, and religion.

Kangaroo Position

Mother’s or parents interested in starting Kangaroo Mother Care should discuss it with their nurse and receive adequate instruction and practice before starting with their preemie baby. The following provides some general guidelines, as suggested by the World Health Organization;

  • Preemie baby is placed between the mother’s breasts in an upright position, chest to chest.
  • Preemie should be secured with the binder
  • Preemie’s head should be turned to one side in a slightly extended position. The slightly extended head position keeps the airway open and allows eye-to-eye contact between mother and prem.
  • Avoid letting preemie’s head from forward flexion and hyperextension of the head.
  • The top of the binder should be just under preemies ears.
  • Preemie’ hips should be flexed and extended like a “frog-type” position.
  • Arms should be flexed.
  • Tie the binder firmly enough so when mother stands up, preemie won’t slide out.
  • Ensure that the tight part of the binder is over prem’s chest.
  • Preemie’s abdomen should not be constricted; they need enough room for abdominal breathing, which is stimulated by mother’s breathing.

Duration of Kangaroo Mother Care

  • If mother and preemie are comfortable, Kangaroo Mother Care, can continue for as long as possible.
  • Kangaroo Mother Care is typically used until preemie reaches term age, gestational age around 40 weeks, or 2,500 g.
  • Around this time preemie outgrows the need for this type of care, take note of baby’s language for signs of discomfort.

Where to Find More Information

The World Health Organization has a comprehensive guide to Kangaroo Mother Care, which can be purchased or downloaded from their website at


Technical Reference List

Acolet, D., Sleath, K., & Whitelaw, A. (1989). Oxygenation, heart rate and temperature in very low birthweight infants during skin-to-skin contact with their mothers. Acta Paediatr Scand, 78(2), 189-193. Affonso, D., Bosque, E., Wahlberg, V., & Brady, J. P. (1993). Reconciliation and healing for mothers through skin-to-skin contact provided in an American tertiary level intensive care nursery. Neonatal Netw, 12(3), 25-32. Affonso, D., Wahlberg, V., & Perrson, B. (1989). exploration of mother's reactions to the kangaroo method of prematurity care. Neonatal Netw, 7, 43-51. Anderson, G. C., Wood, C. E., & Chang, H. P. (1998). Self-regulatory mothering vs. nursery routine care postbirth: effect on salivary cortisol and interactions with gender, feeding, and smoking. Infant Behav Dev, 21, 264. Bell, E. H., Geyer, J., & Jones, L. (1995). A structured intervention improves breastfeeding success for ill or preterm infants. MCN Am J Matern Child Nurs, 20(6), 309-314. Cattaneo, A., Davanzo, R., Bergman, N., & Charpak, N. (1998). Kangaroo mother care in low-income countries. International Network in Kangaroo Mother Care. J Trop Pediatr, 44(5), 279-282. Cattaneo, A., Davanzo, R., Uxa, F., & Tamburlini, G. (1998). Recommendations for the implementation of Kangaroo Mother Care for low birthweight infants. International Network on Kangaroo Mother Care. Acta Paediatr, 87(4), 440-445. Cattaneo, A., Davanzo, R., Worku, B., Surjono, A., Echeverria, M., Bedri, A., et al. (1998). Kangaroo mother care for low birthweight infants: a randomized controlled trial in different settings. Acta Paediatr, 87(9), 976-985. Charpak, N., Ruiz-Pelaez, J. G., & Charpak, Y. (1994). Rey-Martinez Kangaroo Mother Program: an alternative way of caring for low birth weight infants? One year mortality in a two cohort study. Pediatrics, 94(6 Pt 1), 804-810. Charpak, N., Ruiz-Pelaez, J. G., Figueroa de C, Z., & Charpak, Y. (1997). Kangaroo mother versus traditional care for newborn infants 2000 grams: a randomized, controlled trial. Pediatrics, 100(4), 682-688. Christensson, K. (1996). Fathers can effectively achieve heat conservation in healthy newborn infants. Acta Paediatr, 85(11), 1354-1360. Fischer, C. B., Sontheimer, D., Scheffer, F., Bauer, J., & Linderkamp, O. (1998). Cardiorespiratory stability of premature boys and girls during kangaroo care. Early Hum Dev, 52(2), 145-153. Ludington-Hoe, S. M., Hashemi, M. S., Argote, L. A., Medellin, G., & Rey, H. (1992). Selected physiologic measures and behavior during paternal skin contact with Colombian preterm infants. J Dev Physiol, 18(5), 223-232. Nyqvist, K. H., Anderson, G. C., Bergman, N., Cattaneo, A., Charpak, N., Davanzo, R., et al. (2010). Towards universal Kangaroo Mother Care: recommendations and report from the First European conference and Seventh International Workshop on Kangaroo Mother Care. Acta Paediatr, 99(6), 820-826. Organization, W. H. (2003). Kangaroo Mother Care: A practical guide. Geneva: WHO. Rey, E. S., & Martinez, H. G. (1983). Manejo racional del nino prematuro Universidad Nacional, Curso de Medicina Fetal. Bogota: Universidad Nacional. Tessier, R., Cristo, M., Velez, S., Giron, M., de Calume, Z. F., Ruiz-Palaez, J. G., et al. (1998). Kangaroo mother care and the bonding hypothesis. Pediatrics, 102(2), e17. Whitelaw, A., Heisterkamp, G., Sleath, K., Acolet, D., & Richards, M. (1988). Skin to skin contact for very low birthweight infants and their mothers. Arch Dis Child, 63(11), 1377-1381.



AlbertEinstein_iconOne of the greatest minds in history, Albert Einstein was born preterm.

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Preemie, Premmie, or Prem?

Most babies spend between 38 and 42 weeks in their mother’s uterus. So, technically a preterm birth, preemie, premmie, or prem, is an infant who is born less than 37 completed gestational weeks. 

Read More: Defining Preterm birth



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