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Provide a summary of the study you selected. Include elements of the methodology such as population, sample size, instruments used, how the study was conducted, what the findings were. You can find this in the methods section of the article.
Kangaroo Mother Care (KMC) is widely accepted during newborn care and has demonstrated significant reductions in newborn health complications and mortality rates. Direct skin-to-skin contact (SSC) between a mother and her newborn is a huge component of KMC. Particularly those with low birth weight (LBW), SSC has been shown to effectively regulate the baby’s body temperature (Pujara et al., 2023). Despite its benefits, KMC may have its difficulties. One challenge is privacy during SSC. To address this privacy issue, researchers thought of an alternative method called cloth-to-cloth contact (CCC), where both mother and newborn remain clothed while maintaining KMC. Results indicated that over a two-hour period, infants experienced a steady increase in body temperature during both SSC and CCC (Pujara et al., 2023). “There were no significant differences in mean temperature readings between these two groups at various time points” (Pujara et al., 2023, “Lay summary” section). This suggests that CCC is just as beneficial as SSC in maintaining infant body temperature.
In the study done by Pujara et al. (2023), a randomized crossover trial was done to assess the effectiveness of CCC versus SSC in regulating body temperature for newborns weighing between 1500 and 2499 grams. During the time frame of July 2020 and June 2021, the trail included 23 mother-newborn pairs of stable newborns who fit the weight range and who were admitted for 5 days or more. Mothers were the only adults providing the KMC to the newborn and were required to be physically capable of providing the KMC. Temperature was taken by axillary mode. SSC was done by having the unclothed newborn placed on the mothers bare chest, only wearing a diaper, hat and socks . Both mother and baby were provided a warm blanket over them while the baby was supported with a binder around itself and the mother. CCC was done by the mother and newborn being clothed. Again, the newborn was supported with a binder. “One of the sequences of enrollment was SSC on day 1, CCC on day 2, SSC on day 3, CCC on day 4 and so on. The second possible sequence of enrollment was CCC on day 1, SSC on day 2, CCC on day 3, SSC on day 4 and so on” (Pujara et al., 2023, “Study intervention and procedure” section). Mothers endured KMC sessions lasting 2 hours each. They could participate in up to four sessions per day for a maximum of 8 hours, using the same KMC method. To prevent any conflict, a minimum 3-hour interval was required between sessions. “A crossover design was chosen for this study to get the benefit of less within-patient variation as compared to the between patient variation and few dropouts were expected because of the shorter study period” (Pujara et al., 2023, “Study intervention and procedure” section). The mothers alternated techniques, sticking with one technique per day and switching the next day. Each participant was expected to perform KMC (SSC or CCC) between 10 and 20 times during their enrollment. This range was established to ensure mothers gained sufficient data collection with both techniques, while also limiting an overabundance of data. This also allowed for a balanced comparison of the SSC and CCC methods, ensuring each mother had a proper amount of exposure to both techniques (Pujara et al., 2023).
What is the evidence saying based on the results and discussion sections? Is this an adequate article from an evidence standout (i.e. would you change your practice based on this article or would you need more research?)? Consider the sample population and size, and if findings were statistically significant as a part of this discussion.
The evidence from this trial indicates that SSC is not superior to CCC in maintaining thermoregulation in babies born with LBW (Pujara et al., 2023). The study did not find any adverse effects associated with CCC. When the mothers and nurses were interviewed during the study, it was determined that CCC may be easier to achieve because it’s easier to do when privacy is of concern (Pujara et al., 2023). KMC may not be utilized if SSC is thought to be the only option. KMC is more likely to occur when CCC is offered to women who express concerns with SSC (Pujara et al., 2023). This study may not change my practice per say, but it does make me realize that KMC in general is beneficial in helping the newborn (especially of LBW) thermoregulate. I’ve always believed that KMC is great for the newborn on so many levels. It has always been my thought that cloth-to-cloth contact would be better than no KMC at all so, if skin-to-skin is not feasible, it’s better to place the baby on the mother’s chest even if there’s a barrier. It’s nice to know that there’s evidence to support that it’s not required for the mother to get completely exposed to benefit from KMC, which is great when there may be hesitation from the mother. The one thing that could have increased the validity of this study is a greater population size. The 23 mother-newborn pairs is a small number. Being that there were no adverse effects of either method, I don’t think I’ll need more evidence to educate parents and integrate SSC and CCC into my practice to promote a low intervention means of optimizing newborn thermoregulation.
Did the research article address physiologic principles in their discussion? If yes, what principles or concepts were explained? If not, did they infer them in some way? Were there physiologic concepts that were not addressed that you think would improve the readers’ understanding of the study? Explain.
The research did not address physiological principles of how KMC (SSC or CCC) specifically affects thermoregulation, however, it did mention the health benefits KMC has on the newborn. “Early initiation and continuation of SSC augment thermoregulation and thus reduce hypothermia, improve exclusive breastfeeding rates and reduce pain while doing invasive procedures” (Pujara et al., 2023, “Introduction” section, para. 1). The study also mentions, “KMC also provides several other benefits to LBW newborns in the form of reducing neonatal sepsis, hypoglycemia, hospital readmission and length of hospital stay” (Pujara et al., 2023, “Introduction” section, para. 1). To help the readers better understand KMC and thermoregulation it would have been helpful to mention the concept of heat transfer by means of conduction. Conduction is a means by which heat can be transferred by direct contact, in this case, by mothers skin. By understanding this concept, it can help the parents recognize the importance of skin-to-skin and cloth-to-cloth contact. Some other physiological aspects to KMC that are interesting and further promote the intervention are: The mother’s release of oxytocin. This makes the mother feel good, helps her produce more breast milk, and encourages exclusive breastfeeding. It also improves the bond between mother and baby (European Foundation for the Care of Newborn Infants [EFCNI], 2021). The baby also produces oxytocin during skin-to-skin contact. This helps strengthen the baby’s immune system by increasing T-cell production. KMC helps lower stress levels in both mother and baby by decreasing cortisol levels. It also helps regulate the baby’s heart rate (EFCNI, 2021). Beneficial bacteria from the mother transfers to the baby during skin to skin contact, further facilitating the infant’s immune system. Dopamine is released during skin to skin contract which is used as the baby’s natural painkiller and feel-good chemicals (EFCNI, 2021).
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