Article

The Kangaroo Foundation

Fundación Canguro is the recipient of the 2006 Award for Best Practices in Global Health. The Global Health Council presents the award annually to celebrate and highlight efforts of individuals in the field dedicated to improving the health of disadvantaged and disenfranchised populations. Recipients of the award are selected for their ability to exhibit measureable results in the field, as well as the capacity and expertise to share, inspire and extend best practices for improving health.

Each year, 5 million infants die during the first month of life. Of these deaths, two-thirds are correlated to the infant's prematurity and/or low and support provided during the kangaroo adaptation, breastfeeding is birth weight.

Kangaroo Mother Care (KMC) is an evidence-based technology, centered on the mother as the main provider of heat and stimulation (skin-to-skin contact, i.e. the "kangaroo" position), nutrition (maternal milk) and close monitoring at home. Devised by a pediatrician in Colombia more than 20 years ago, KMC has emerged as a unique, readily available tool to enhance the health care of low birth weight children around the world. Major components of the method include the kangaroo position, feeding, and early discharge and follow-up practices. KMC is an efficacious and safe option, particularly in developing countries with limited human and technical resources. It is a powerful, easy-to-use method that relies on human resources that are, at least theoretically, always available to mothers, families and basic skilled health-care providers.

The components of the strategy are simple:

Kangaroo Position
Skin-to-skin contact between the mother and the child, 24 hours a day, in a vertical position, between the breast of the mother and under her clothes. Mothers act as incubators as well as the main source of nutrition and stimulation. The infant's temperature stays within normal range, because of the heat of their mother's body. A number of studies have been conducted to assess the behavior of physiological variables while in kangaroo position. They have shown that temperature, oxygenation, cardiac frequency and other physiological parameters are maintained within normal values while in kangaroo position. In addition, the infant can be fed during skin-to-skin contact. Other people can share the role of the mother as a kangaroo position provider.

While sleeping, the position provider must lay in a semi-seating position. Kangaroo position is maintained until the infant does not tolerate it anymore, meaning that appropriate temperature regulation has been achieved. Kangaroo position should be initiated as soon as possible after birth, provided the infant is stable enough to tolerate it.

Kangaroo Feeding Policy
Exclusive breastfeeding, whenever possible must be the rule. Initially, a strict schedule for feeding is followed. When the infant's growth is shown to be adequate, the schedule is relaxed to accommodate to the infant's demands. The goal is to obtain a weight gain rate that approaches the intrauterine growth rate of the third trimester of pregnancy (15g/kg/day until 40 weeks postconceptional age). If the infant's growth is not satisfactory with exclusive breastfeeding, and after receiving training and support provided during the kangaroo adaptation, breastfeeding is complemented with formula.

Kangaroo Discharge and Follow Up Policies
KMC can be offered to low birth weight infants as soon as they are clinically stable, are regulating their temperature in a neutral thermal environment (incubator), and are able to suck, swallow and breathe. Infants are discharged from the hospital independently of their weight or postconceptional age, after having completed a successful in-hospital adaptation to KMC. This adaptation process lasts one to several days. Once at home, the children are maintained in kangaroo position, until they reject it (generally toward 37 weeks of postconceptional age). After discharge, infants' weights are monitored during daily visits until they recover their birth weight and are gaining 15 g/kg/day. Afterwards, visits are conducted weekly until they reach term (40 weeks of postconceptional age). These discharge and follow-up protocols constitute minimal neonatal ambulatory care, including prophylactic drugs, vitamins, iron etc, according to the needs of each child. In cases where direct discharge to the home is not feasible, (living far from hospital, extreme poverty, etc.) mother and baby are transferred to a KMC ward until very close monitoring is no longer needed.

KMC: Moving Forward
The original components of the intervention have been scientifically tested in observational and experimental studies conducted in Colombia and in other countries, both developing and developed. There is a sound body of evidence that supports KMC, with all its components, including early discharge, in an effective and safe method for the care of clinically stable low birth weight infants. Multiple health programs now provide Kangaroo Mother Care, and in 2003, the World Health Organization produced guidelines to generalize the use of the method.

Recently, developed countries have rediscovered KMC as a physiologically sound and emotionally appropriate intervention that can provide distinct benefits when integrated as part of the standard care of more fragile newborn infants. It has been noted in a number of publications for the physiological and some psychological aspects of the skin-to-skin contact between the mother and a fragile newborn infant. Nevertheless, most researchers and practitioners in high-income countries do not realize that KMC, as it has been conceptualized by its developers in the South, is a far more sophisticated and complex intervention than incidental skin-to-skin contact between the mother and the infant.

KMC also promotes a culture for the systematic use of scientifically sound interventions in neonatal care in developing countries. Furthermore, health-care providers often become familiar with standard method for good quality data collection as it is an integral part of providing KMC. The necessary next step is to provide them with both monitoring tools and clinical research tools. Strengthening research and self-evaluation capacity in developing countries is one of the most powerful, costeffective and sustainable means of enhancing health and development.

Fundación Canguro
One of the major contributors to the so-called 90-10 gap between affluent and less developed countries is the inadequate access to knowledge (knowledge transfer) and when accessible, the insufficient translation of that knowledge into action.

In 1994 a group of researchers and health-care professionals decided to tackle this double challenge by creating a non-governmental not-forprofit organization called the Fundación Canguro (Kangaroo Foundation) in Bogota, Colombia. Major goals of the Kangaroo Foundation are:

1. To establish the safety and efficacy of KMC. This is been accomplished by a set of clinical studies that have been completed and published.


2. To disseminate KMC to other institutions of developing countries by training health-care teams not only in KMC, but also in the recording and monitoring of key-quality indicators.


3. To coach those new KMC teams during the implementation and adaptation phases of their KMC programs.


4. To design and implement a quality assurance program to support continuous performance evaluation (KMC database), including the identification and analysis of difficulties encountered in other settings for the implementation and successful performance of KMC.