Kangaroo Care Counterpoint: What About the Term Infant?

After releasing yesterdays post Skin to Skin Fad Blamed For Death of Babies I entered into a very interesting discussion on Twitter with Clay Jones of Science Based Medicine.org.  Emily Hahn (@TexasKidDoc) was also instrumental for setting up the discussion so I thank her for connecting Clay and I once again.  At issue was whether the “Fad” of Skin to Skin Care was indeed to blame for the observations in Australia.

Clay in fact his written on this topic as well but from KC in the term infant perspective and I would encourage you to read his piece as a “counterpoint” below.

Kangaroo Mother Care, Skin-To-Skin Contact, and the Risk of Sudden Unexpected Postnatal Collapse

My gut reaction given that I am immersed in a culture of Kangaroo Care was to defend the usage but he raises a very important point that I think is worth addressing.

No one is disputing the benefits of Kangaroo Care for preterm infants which I won’t go into here as I have done so yesterday.  The question being posed is whether such benefits extend to the term infant and whether it can be done safely.  The preterm infant experiencing KC in a prone position is of course monitored with a nurse close by.  The patient in the room alone with a mother who has recently delivered is not necessarily supervised to the same degree.  Also if the baby is unmonitored then is it safe?

Still A Big Supporter of Kangaroo Care

I am not changing my tune so to speak as there are many benefits in terms of breastfeeding, maternal-infant bonding, thermoregulation etc that will be achieved through KC.  What I do mean to at least raise some awareness of though is the concern that without a proper preventative strategy in the term infant population falls and or asphyxiation from a mother who falls asleep with the infant in between her breasts is possible.  Readers of this blog on Facebook yesterday acknowledged they have seen such events happen and I can say myself that I have as well.

Let’s practice KC and endorse it but in the end let’s all be safe.  In the end the question then is was the title of the Yahoo post truly that inflammatory?!  What it inferred I think was but as it pertained to the hospital experience perhaps there was something there.

What do you think?

Addendum: From Keith Barrington

There are now several publications about this happening, (including our case report, Schrewe B, et al. Life-threatening event during skin-to-skin contact in the delivery room. BMJ Case Rep. 2010;2010(dec21 1):bcr1120103475-bcr.) At the time we wrote our report we found 59 cases in the literature, and 56 of them had been in skin to skin with the mother.
A French group published a number of risk factors for sudden unexpected life-threatening events after an uneventful delivery at term, which included skin to skin position and maternal obesity.
It is clear that this is very rare ( German group calculated the incidence as 2.6 per 100,000 deliveries), but it is potentially devastating, mortality is high, and neurologic compromise also.
Our take on this was that given the benefit in terms of breast feeding initiation etc, and the rarity of problems, that we should not discourage the practice, but never leave a new mother alone with the baby in skin to skin, someone else should be in the room to keep an unobtrusive eye on the baby, it could be the father (if he had some idea what to watch for) or a health care worker. As the mechanism is probably simple suffocation, a pulse oximeter could be a potential way of surveying for teh occurrence, if something more natural was not available.

 

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3 thoughts on “Kangaroo Care Counterpoint: What About the Term Infant?

  1. There are now several publications about this happening, (including our case report, Schrewe B, et al. Life-threatening event during skin-to-skin contact in the delivery room. BMJ Case Rep. 2010;2010(dec21 1):bcr1120103475-bcr.) At the time we wrote our report we found 59 cases in the literature, and 56 of them had been in skin to skin with the mother.
    A French group published a number of risk factors for sudden unexpected life-threatening events after an uneventful delivery at term, which included skin to skin position and maternal obesity.
    It is clear that this is very rare ( German group calculated the incidence as 2.6 per 100,000 deliveries), but it is potentially devastating, mortality is high, and neurologic compromise also.
    Our take on this was that given the benefit in terms of breast feeding initiation etc, and the rarity of problems, that we should not discourage the practice, but never leave a new mother alone with the baby in skin to skin, someone else should be in the room to keep an unobtrusive eye on the baby, it could be the father (if he had some idea what to watch for) or a health care worker. As the mechanism is probably simple suffocation, a pulse oximeter could be a potential way of surveying for teh occurrence, if something more natural was not available.

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