THE KANGAROO METHOD IS SAFE FOR PREMATURE INFANTS UNDER 30 WEEKS OF GESTATION DURING VENTILATORY SUPPORT
Van Zanten HA, Havenaar AJ, Stigt HJH, Ligthart PAH, Walther FJ. J Neonat Nurs. 2007;1:186-190.
A case control study was conducted with mechanically ventilated infants in a neonatal intensive care unit in Leiden, The Netherlands, to investigate the safety of the kangaroo method.
The kangaroo method is named after the manner in which a kangaroo carries newborns in its pouch. Kangaroo care promotes bonding between the infant and parents. In this study, parents held infants against their skin while various parameters (heart rate, oxygen saturation, respiratory rate, skin temperature, and mean arterial blood pressure) were measured. There were 34 premature infants with gestational age less than 30 weeks participating in the study. Using a repeated-measures design, infants formed their own control group.
Safe parameters were maintained during kangaroo care. In fact, heart rate, respiratory rate, and oxygen saturation were improved. However, blood pressure increased and temperature decreased during kangaroo care. After kangaroo care, blood pressure normalized and temperature declined. Researchers expected the temperature change and recommend monitoring infants carefully for needed interventions in case of a drop in skin temperature. They conclude that kangaroo care is safe in mechanically ventilated infants less than 30 weeks gestation as long as skin temperature is monitored and warmth is provided, if needed.
NUTRITIONAL GOALS, PRESCRIPTION, AND DELIVERY IN A PEDIATRIC INTENSIVE CARE UNIT
De Neef M, Geukers VGM, Dral A, Lindeboom R, Sauerwien HP, Bos AP. Clin Nutr. 2008;27:65-71.
This observational study was conducted in Amsterdam in a pediatric intensive care unit (PICU) to compare prescribed and delivered nutritional therapy to predefined nutritional requirements, as well as the extent that intake was disturbed by admission to the PICU.
Intake was calculated from enteral nutrition, parenteral nutrition, and glucose infusions. Over a period of 10 months, complete data were collected on 84 mechanically ventilated infants in the PICU.
On the first day of admission to the PICU, about 40% of the patients were started on some form of nutritional therapy. This increased to more than 90% on the third day and was primarily enteral nutrition. Underfeeding occurred most during the initial 4 days of admission, with the predefined nutritional goal reached as late as day 5 of admission.
The researchers report underfeeding infants in about 50% of patient days, with 25% overfed. They concluded that malnutrition was a result of inadequate prescription rather than insufficient delivery and noted that they believed that the main finding was occurrence of protein undernutrition. This is because protein-energy malnutrition is associated with increased morbidity, mortality, number of ventilator days, and length of stay. Researchers suggest that attention should be given to protein intake, preferably by a nutritional support team through implementation of algorithms.