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January 26, 2010

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'Kangaroo care' helps preemies

MOTHER kangaroos can teach human mothers how to help their premature babies in intensive care. Hold them skin-to-skin, heart-to-heart, snuggle, cuddle, whisper, and croon. Rasha Madkour reads her baby verses from the Koran. I never imagined I would spend my first weeks as a mother pretending to be a marsupial. But there I was, a month and a half before my due date, sitting in the neonatal intermediate care unit and hoping that a practice known as "kangaroo care" would help my premature baby.

Every morning I would put my almost 2kg son under my pouch-like sweater so that we were skin to skin, chest to chest, my body acting as a natural heat source instead of his incubator - with the added benefits of a human touch, soothing heart beat and familiar smell.

It did not start out this way. The first time I "visited" my baby in the unit, I was so excited that I got to hold him in my arms for more than a few minutes, which had been all the time we had had together before then. That feeling very quickly turned into intense guilt when I went back later and a nurse told me his temperature had dipped a bit because of how long we had him out of his incubator. I did not hold him for the rest of the day and felt discouraged from doing so the day after, too.

I knew I wanted to hold him, and felt I should, but I also did not want to do any harm.

Then I heard about kangaroo care. Finally, after days struggling to figure out how to handle this tiny baby who had surprised me by coming early, I had found a way to be useful.

Human touch

The benefits of kangaroo care were discovered accidentally. In Bogota, Colombia, in the late 1970s, doctors were grappling with a shortage of incubators, an overstretched staff and a high mortality rate. They decided to get help from mothers, who were instructed to keep their babies warm by holding them skin-to-skin and to feed them breast milk. The babies were found to be thriving in this new setup, and the practice has since spread across the globe. In 2003, the World Health Organization published a guide on it.

Studies have shown the closeness helps preemies sleep better, breathe better, and regulate their body temperature and heart rate better. All of this allows them to devote more energy to growing.

"Kangaroo care, to me, is the first gift you can give to your baby in the neonatal intensive care units and it's one of the greatest gifts the staff can give to parents in the NICU," says Liza Cooper, the US national director of a March of Dimes program that supports families in NICUs and promotes the practice among health care workers.

I first came across kangaroo care in a book about premature babies that I bought the day after I was discharged. It seemed like a good way to bond if nothing else, and a more appealing way to spend my time in the hospital. Sitting next to a plastic box with your kid inside isn't much fun.

Kangarooing, on the other hand, turned out to be quite lovely.

I loved feeling his scrawny body wriggling to get comfy, then the rise and fall of his steady breathing. I felt something tickling me once and realized his hand had made its way under my arm. I would talk to him, read comforting verses from the Koran and sing the few lullabies whose words I could remember.

The staff at Jackson Memorial Hospital were accommodating, and by midweek, as word of the "kangaroo mom" spread in the unit, a nurse pointed me to some foldable recliners hiding in a nook that were donated by a doctor who wanted to support kangaroo care. Big improvement on the metal and plastic chairs we had occupied previously. Thus began our truly marathon cuddling sessions: a few hours in the morning, then a few in the evening.

Other hospitals are more proactive in telling parents about kangaroo care and encouraging them to do it. At Mercy Medical Center in Baltimore, in the state of Maryland, the practice is described in the NICU parent handbook. Staffers also talk to families about it as one of the ways they can help care for their baby, along with the more typical duties of changing diapers and giving baths.

"It's wonderful in terms of moms and dads being able to get as close as they can to their hospitalized babe," says Dr Susan Dulkerian, the medical director at Mercy's NICU. "Babies snuggle in and get comfortable and calm down and seem very, very content."

On the whole, neonatologists recognize the benefits of kangaroo care, says Dr Jonathan Fanaroff, associate medical director of the NICU at Rainbow Babies and Children's Hospital in Cleveland, Ohio. "I think where the questions still lie is not to overstate the benefits - 'if you don't do kangaroo care, your kid won't go to Harvard' - and to make sure it's safe."

There is room for debate on when a premature baby is stable enough to be held; some doctors draw the line when the baby's on a breathing tube, for example.

And Dulkerian emphasizes that it is just one of the ways parents can help their child get better and that those who do not kangaroo should not feel guilty.

"Ultimately you're going to get that bonding and that closeness," Dulkerian says. "Even just being there, babies know."

I've learned quickly that no single parenting choice will make or break a child's development, and kangaroo care is no exception. But I am glad to have had it as a comforting experience during an uncertain and scary time. And if it helped my baby relax and pack on the pounds, all the better.

I cannot even imagine kangarooing with my little guy now; he's so energetic and squirrely I've taken to calling him McSquirmy. But that is just as I had hoped.


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