10a. Skin-To-Skin Care S1

7/27/2019 10a. Skin-To-Skin Care S1

1/24

Module: Skin-to-Skin Care Session 1

Module Overview Visual 1

Module Overview: Purpose

The purpose of this module is to provide facilitators with

a sound, competency-based training (CBT)

methodology which if implemented as designed, willresult in physicians attaining mastery of the knowledge,

competencies, and skills required to identify and

manage neonates on skin-to-skin care.


2/24


Skin to Skin Care

Ayman El-Mohandes, MD, MPH, FAAP

The George Washington University


3/24



Module Overview: Story

Skin-to-skin care, also referred to as kangaroo care, is a form

of parent-neonate interaction in which the mother holds her

neonate skin-to-skin in a vertical, head-up position on or

between her breasts for twenty minutes or longer. This type of

contact provides an appropriate thermal environment while

conferring many physiological and emotional benefits to both

neonate and mother. Egyptian hospitals have not used skin-to-

skin care extensively.


4/24



Module Overview: Story (cont.)

Existing evidence suggests that mothers and infants inIndonesia, especially preterm/LBW infants, would

benefit from increased use of skin-to-skin care, forinfants born in and outside facilities. Preliminaryevidence also exists that Indonesian mothers have adesire to learn and practice this type of care. It is

important that midwives, nurses and physicians areknowledgeable in promoting, selecting, and managingneonatal skin-to-skin care..


5/24


Task Analysis Visual 5

Task Analysis: Task

Complete a Newborn Assessment and Implement

Admission and Discharge Policies and Procedures

According to the Service Standards and Protocol toEnroll and Manage Neonates Suitable for Skin-to-Skin

Care.


6/24



Task Analysis: Competency 1

1. Competency: Promote Skin-to-Skin Care of the

Neonate

Skills1.1. Select neonates appropriate for skin-to-skin care.

1.2. Educate mothers about the advantages of skin-to-skin

care.

1.3. Prepare neonates for skin-to-skin care.


7/24



Task Analysis: Competency 1

1. Competency: Promote Skin-to-Skin Care of the

Neonate (cont.)

Skills1.4. Prepare parents for skin-to-skin care.

1.5. Monitor the vital signs and oxygenation of the neonate

during skin-to-skin care.

1.6. Identify any persistent signs of stress, and manageaccordingly.


8/24


Session Purpose Visual 8

Session 1: Purpose

The purpose of this session is to introduce participants

to the concepts, benefits, implementation, and

management of skin-to-skin care. Criteria for selection

of neonates appropriate for this kind of care, as well aspreparation of the neonate and parents for skin-to-skin

care, will be reviewed.


9/24


Session Story Visual 9

Session 1: Story

Skin-to-skin care, also referred to as kangaroo care, is

a form of parent-neonate interaction in which the

mother holds her neonate skin-to-skin in a vertical,head up position on or between her breasts for 20

minutes or longer.


10/24


Session Story Visual 10

Session 1: Story (cont.)

This type of contact: Provides an appropriate thermal environment.

Improves oxygenation.

Decreases apnea and bradycardia.

Facilitates early breastfeeding. Increases duration of lactation.

Lowers caloric expenditures.

Improves weight gain.

Increases time in optimal behavioral states. Promotes parental attachment and bonding.

Shortens hospitalization period.


11/24


Learning Objectives Visual 11

Learning Objectives1. Define skin-to-skin care and know the criteria used

to select neonates for this type of care.

2. Educate mothers about the advantages of skin-to-skin care.

3. Prepare neonates for skin-to-skin care.


12/24



Learning Objectives (cont.)4. Prepare parents for skin-to-skin care.

5. Monitor the vital signs and oxygenation of the

neonate during skin-to-skin care.6. Identify any persistent signs of stress and manage

accordingly.


13/24


Learning Objective 1 Visual 13

Skin-to-Skin Care

Definition

Skin-to-skin care, also referred to as "kangaroo care", is a

form of parent-baby interaction in which the mother holds

her infant skin-to-skin in a vertical, head up position on or

between her breasts for 20 minutes or longer.


14/24


15/24



Advantages of Skin-to-Skin Care

Mothers, fathers, and health care personnel need to

know the advantages of this type of therapy in order

to promote its adoption and use.


16/24



Advantages of Skin-to-Skin Care

Provides an appropriatethermal environment

Improves oxygenation.

Decreases apnea andbradycardia.

Facilitates earlybreastfeeding.

Increases duration oflactation

Lowers caloricexpenditures.

Improves weight gain.

Increases time in optimalbehavioral states.

Promotes parentalattachment and bonding.

Shortens hospitalizationperiod.


17/24


18/24



Management Guidelines for Skin-to-

Skin Care

Physicians and nurses should decide which infants

are appropriate for skin-to- skin care and provide

parents with sufficient information describing the

advantages of the technique. It is extremely

important to remember that everyone involved should

be comfortable and supportive of the decision to hold

the infant skin-to-skin.


19/24



Preparation of the Neonate for Skin-

to-Skin Care

Once the decision has been made, the infants temperature

should be assessed at 36 C or greater and documented on

the flow sheet.

A skin temperature probe can be left on and all other monitorwire, intravenous lines, and respiratory support tubes should

be secured.

The infant can be undressed except for a diaper. Hats are

generally not necessary unless the infant weighs less than1,000 grams.


20/24



Preparation of the Parents for Skin-

to-Skin Care

Carefully explain the advantages of this type of care

for their infant.

Demonstrate the type of holding they will do. Encourage the mother to wear a front-opening shirt

or cover gown so she can provide this care in a

modest manner.

Provide as much privacy and quietness as possible.

M d l Ski t Ski C S i 1


21/24



Monitoring the Neonate on Skin-to-

Skin Care

Once the infant has been successfully transferred to

the parent, the infants vital signs and oxygenation

status should be monitored, and adjustments made

based on the infant's status.

M d l Ski t Ski C S i 1


22/24



Signs of Stress during Skin-to-Skin

Care

The infant should be returned to the incubator if any

persisting signs of stress are identified, including

tachypnea, tachycardia, temperature instability, or

oxygen desaturation.

The length of time for holding is individually based

and depends on the neonates status and parental

comfort.

Module: Skin to Skin Care Session 1


23/24



Summary: Learning Objectives1. Define skin-to-skin care and know the criteria used

to select neonates for this type of care.

2. Educate mothers about the advantages of skin-to-skin care.

3. Prepare neonates for skin-to-skin care.

Module: Skin to Skin Care Session 1


24/24



Summary: Learning Objectives

(cont.)4. Prepare parents for skin-to-skin care.

5. Monitor the vital signs and oxygenation of the

neonate during skin-to-skin care.6. Identify any persistent signs of stress and manage

accordingly.

Documents

10a. Skin-To-Skin Care S1