1. Emily Forward, RN, Margaret Gerulski, RN, Mary Jacobs, RN, Michele Niles, RN, & Cheryl Rose, RN

3.  Evaluate the benefit of Kangaroo Care to the neonate  Providing evidence-based research to provide mothers and newborns a more natural birth experience  Minimize separation of the maternal-infant couplet to enhance birth experience  Provide cost effective care

4. “What does the literature say about kangaroo care (KC), also known as skin-to-skin care, in the regulation of the thermoregulatory system of the neonate?

5.  In term newborns born vaginally, will the axillary temperature remain within the normal range in infants placed skin-to-skin immediately after birth compared with infants placed within minutes of birth under a radiant warmer during the first hours of life?”

6. Literature Eliminated Literature Eliminated

7.  Critical evaluation of ten selected articles  Articles were examined for appropriateness to the purpose statement, reliability, and validity (Nieswiadomy, 2008, p. 63)  Qualifications of the researchers and the ethical content was also analyzed (Nieswiadomy, p. 29)  Articles not meeting criteria were eliminated

8.  A comparison of skin-to-skin contact and radiant heaters in promoting neonatal thermoregulation (Fardig, J., 1980). This was an outdated source  Keeping infants warm: Challenges of hypothermia (Mance, 2008). Involved preterm infants which did not meet the criteria set in the purpose statement  Temperature variation in newborn babies: Importance of physical contact with the mother (Fransson, Karlsson, & Nilsson, 2005). Article did not discuss skin-to-skin content and the research did not start until four to eight hours after birth

9.  The effect of skin-to-skin contact (kangaroo care) shortly after birth on the neurobehavioral responses of the term newborn: A randomized, controlled trial (Ferber & Makhoul, 2004). Focused on infants neurological behavior with minimal discussion regarding temperature  Kangaroo mother care: 25 years after (Charpak et al., 2005). Difficult to follow, and mainly pertained to the unhealthy newborn in underdeveloped countries with a minimal discussion regarding temperature  Early skin-to-skin contact for mothers and their healthy infants (Anderson, Moore, Hepworth, & Bergman, 2003). Article only consisted of one page and required advance knowledge of statistics in order to understand

11.  Gretchen A. Dabrowski RN, BSN

12.  Qualitative evidence-based discussion  Utilizes historical studies  The article’s findings provided evidence that “newborns placed skin-to-skin with mothers remained considerably warmer during the first three hours of life” (Dabrowski, p. 66)

13. Kangaroo Care at Birth for Full Term Infants: A Pilot Study Mary W. Walters, MS, RN. Kim M. Boggs, MSN, RN, BC. Susan Ludington-Hoe, PHD, CNM, FAAN. Kimberly M. Price, RN, IBBCLC. Barbara Morrison, PHD, FNP, CNM.

14.  Level I qualitative research study  Approval obtained from hospital review board  All of the researchers practiced in women's health  Clear purpose statement  Outlined clearly in a systematic process discussing the descriptive design

15.  Judith S. Mercer CNM, DNSc Debra A. Erickson-Owens CNM, Ms Barbara Graves CNM, MN, MPH Mary Muford Haley CNM, MS

16.  Article listed additional findings to benefit neonate.  Clear summarization of articles reviewed  Findings significant for the benefit of this intervention (p<or =0.02-0.03)  Large population used for study and randomized controlled trials  Benefits of KC care shown for long and short-term.  Article supports the benefit of maintaining and increasing temperature when infant placed skin- to-skin  Recommendation made of KC care

17.  Rintaro Mori, MD, PHD, MSc, FRCPCH Rajesh Khanna Debbie Pledge Takeo Nakayama

18.  Peer reviewed journal  Recent publication 2010  Significantly related to the research question  Directly evaluated physiological parameters affecting infants before-and-after the KC intervention to evaluate safety  Consisted of both systematic reviews and random-controlled trials  Methods categorized

19.  Meta-analysis included 23 studies, consisting of 13 before-after studies, five randomized control trials, a cross-over trial, and four cohort studies  Limitations of studies were acknowledged  Confounding variables were eliminated to increase validity  p value was < 0.05 making this study significant in findings  Findings of this article showed an increase in body temperature during skin-to skin contact

21. BarrierBridge  The desire by the mother to allow visitors to hold the baby was reported (Anderson et al, 2003)  Provide education and encouragement to mothers regarding what KC is and the benefits KC has been shown to provide

22. BarrierBridge  The attitude of health care providers is noted to be a barrier to KC. This may be due to a lack of knowledge regarding the benefits of KC or fear of a change in practice  The provision of adequate education to both healthcare providers and patients, including their families, is a potential way to solve these barriers (Dabrowski, p. 65)

23.  Patient preference is an important aspect of implementing any evidence-based nursing practice (Nieswiadomy, 2008, p. 8)  Nurses should provide education and support for kangaroo care, but allow patients to express their preference about the utilization of kangaroo care

24.  The evidence highly supports a change in practice, encouraging skin-to-skin contact at birth  The evidence correlates well with the expectations of evidenced-based medicine research  Each of the articles selected clearly defines the purpose of the study  All of the selected articles are rated as level I or Level II, with the exception of one article, according to hierarchy of evidence  The articles chosen contain recent findings, with the oldest article being from 2007

25. Skin-to-Skin Contact

26.  “Birthing units that separate mothers and babies with the intention of preventing cold stress unwittingly increase the risk of cold stress, and at the same time deprive the pair of intimacy and bonding while delaying breastfeeding initiation” (Mercer et al., 2007, p. 267)  “The evidence suggests that skin-to-skin contact should be the mainstay of newborn thermoregulation” (Mercer et al., 2007, p. 267)  The benefit of increasing fetal well-being is the primary focus in these studies

27.  Initiation of skin-to-skin contact immediately after birth is an evidence-based nursing practice  More effective than the use of radiant warmers  Has many other benefits  Cost effective and more natural extension of the birth process

29. Implement Kangaroo Care The search of the literature and evaluation of current research support the recommendation to change the hospital’s current practice

30.  Anderson, G., Shiu, S., Dombrowski, M., Swinth, J., Albert, J., & Wada, N. (2003). Mother- newborn contact in a randomized trial of kangaroo (skin-to-skin) care. JOGNN: Journal of Obstetric, Gynecologic & Neonatal Nursing, 32(5), 604-611. doi: 10.1177/0884217503256616  Anderson, G. C., Moore, E., Hepworth, J., and Bergman, N. (2003). Early skin-to-skin contact for mothers and their healthy newborn infants. Birth, 30(3), p. 206–207. doi: 10.1046/j.1523- 536X.2003.00247.x References

31.  Charpak, N., Gabriel Ruiz, J., Zupan, J., Cattaneo, A., Figueroa, Z., Tessier, R., Cristo, M., Anderson, G., Ludington, S., Mendoza, S., Mokhachane, M., and Worku, B. (2005), Kangaroo mother care: 25 years after. Acta Pædiatrica, 94(5), p. 514–522. doi: 10.1111/j.1651-2227.2005.tb01930.x  Dabrowski, G. (2007). Skin-to-skin contact: Giving birth back to mothers and babies. Nursing for Women's Health, 11(1), p. 64–71. doi: 10.1111/j.1751- 486X.2007.00119.x  Fardig, J. A. (1980). A comparison of skin-to-skin contact and radiant heaters in promoting neonatal thermoregulation, Journal of Nurse-Midwifery, 25(1), p. 19-28. doi: 10.1016/0091-218(80)90005-1

32.  Ferber, S. G., & Makhoul, I. R. (2004). The effect of skin-to- skin contact (kangaroo care) shortly after birth on the neurobehavioral responses of the term newborn: A randomized, controlled trial. Pediatrics, 113, 4. p.858(8). Retrieved from: http://www.pediatrics.org/cgi/content/full/113/4/858 ▶ Ford, L. C. (2010). Evidence based nursing practice project: NURS 350 Research in nursing. Retrieved from Ferris State University School of Nursing, Ferris Connect website: http://myfsu.ferris.edu/webct/urw/lc1399024356061.tp14 06116086031/displayContentPage.dowebct?pageID=14639 32005011&resetBreadcrumb=false&displayBCInsideFrame= true ▶ Fransson, A., Karlsson, H., Nilsson, K. (2005). Temperature variation in newborn babies: Importance of physical contact with the mother. Archives of Disease in Child: Fetal Neonatal Edition, 90(6), p. F500-504. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1721966/ doi:10.1136/adc.2004.066589

33.  Galligan, M. (2006). Proposed guidelines for skin-to- skin treatment of neonatal hypothermia. MCN: The American Journal of Maternal Child Nursing, 31(5), 298-306. Retrieved from: http://www.nursingcenter.com/_PDF_.aspx?an=0000 5721-200609000-00007.  Mance, M. (2008) Keeping infants warm: Challenges of hypothermia. Advances in Neonatal Care, 8(1), 6- 12. doi:10.1097/01.ANC.0000311011.33461.a5  Mercer, J. S., Erickson-Owens, D. A., Graves, B., Mumford Haley, M. (2007). Evidence based practices for the fetal to newborn transition. Journal of Midwifery & Women’s Health, 52(3), p.262-272. doi:10.1016/j.jmwh.2007.01.005

34.  Mori, R., Khanna, R., Pledge, D. and Nakayama, T. (2010). Meta-analysis of physiological effects of skin-to-skin contact for newborns and mothers. Pediatrics International, 52(2), p. 161–170. doi: 10.1111/j.1442-200X.2009.02909.x  Nieswiadomy, R. (2006). Foundations of nursing research. (5th ed.). Upper Saddle, New Jersey: Pearson Prentice Hall.  Walters, M. W., Boggs, K. M., Ludington-Hoe, S., Price, K. M., Morrison, B. (2007). Kangaroo care at birth for full term infants: A pilot study. The American Journal of Maternal/Child Nursing, 32(6), p. 375-381. doi:10.1097/01.NMC.0000298134.39785.6c