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14]

Original Article

A Randomized Controlled Trial of Kangaroo Mother

Care Versus Conventional Method on Vital Signs and
Arterial Oxygen Saturation Rate in Newborns Who were
Hospitalized in Neonatal Intensive Care Unit
Khadijeh Dehghani, Zahra Pour Movahed, Hamideh Dehghani, Khadijeh Nasiriani
Department of Nursing, Nursing and Midwifery School, Shaheed Sadoughi University of Medical Sciences and Health Services, Yazd, Iran

ABSTRACT
Background and Objectives: The Kangaroo mother care(KMC) method is the best care method that can provide the newborns skin normal
contact with the mothers skin for all newborns, especially the premature or underweight. However, this method has not still become common
in some countries and many hospitals in Iran. Thus, the present study aimed to determine the impact of KMC method on vital signs and arterial
oxygen saturation of newborns compared to the incubator care method in order to facilitate this method. Materials and Methods:This clinical
trial study was performed on 53 neonates who have been hospitalized in Neonatal Intensive Care Unit; they were randomly divided into two
case and control groups. The KMC was conducted on newborns in the study group for an hour each day for 3 consecutive days. The vital
signs including temperature, respiratory and heart rate per minute, and the arterial oxygen saturation rate were measured and recorded before,
during and after caring process in both groups and then were compared and analyzed. Results and Conclusion: The results showed that
the average temperature variations and the arterial oxygen saturation rate between the two groups had significant differences in 3 days of
examining(P<0/056, P=0/00), but there were no significant differences in the mean heart and respiration rate between the two groups(P=NS).
Thus, the Kangaroo care method is effective in the improvement and stabilizing of vital signs of newborns, and nurses can train this method to
mothers.

Key words:
Body temperature and oxygen level, Kangaroo mother care method, vital signs

BACKGROUND AND OBJECTIVES
The Kangaroo care method(Kangaroo mother care[KMC])
is skintoskin contact between mother and infant[1] and a
method of care for all newborns, especially the premature or
underweight, and creates better conditions for mother and
newborn compared to incubator caring method.[24] KMC
was first introduced in Bogot, Columbia by Dr.Edgar Rey
and Hector Martinez in 1978 as a way of compensation
for the overcrowding of incubators in hospitals caring
for preterm infants.[2] This method is based on three
basic principles, including skintoskin contact, exclusive
breastfeeding, and support to the motherinfant dyad. To
establish the skintoskin contact, the newborn is placed
in front of the mothers chest and is guided by a cloth bag,
wrapped around a newborn and the mother. This could be
done from the beginning of birth or anytime during the
night and day, but its short and intermittent periods are
also useful.[5] Many studies show that skintoskin contact
through KMC leads to breathing regulation and stabilizing,
her lactation enhances, and her conditions and discomforts
will relieve, and her postpartum hemorrhage will be
prevented.[9] Furthermore, the newborn feeding is performed
better in this method; the newborn grows faster.[10] Usually,
separating the newborn from the mother and incubator
care will cause the secretion of stress hormones, intense
crying and despair in newborn, which are harmful to the
newborns health and can decrease the body temperature
and irregularity in heartbeat and breathing.[11,12] The KMC
Address for correspondence:
Dr.Khadijeh Nasiriani,
Department of Nursing, Nursing and Midwifery School,
Shaheed Sadoughi University of Medical Sciences and Health
Services, Yazd, Iran.
Email:Nasiriani@gmail.com
Access this article online
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Website:
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improvement in respiratory distress, increased and/or

heart rate (HR) regulation, and increased arterial oxygen DOI:
saturation rate.[68] In addition, the mothers supportive and 10.4103/2249-4847.151163
caring behaviors become further during this procedure;

26 Journal of Clinical Neonatology | Vol. 4 | Issue 1 | January-March 2015

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Dehghani, etal.: Kangaroo mother care versus conventional method
can, therefore, be effective in supplying the newborns
needs and stabilizing the newborns physiological states
and survival of the preterm neonate.[4,1316] However, some
studies indicate no significant differences in physiological
measures of newborns under KMC.[17] This indicates
the need to further research in this area. What done
today in most of the newborn units in Iranian hospitals
is different from that must be done. Mothernewborn
separation due to hospitalization of newborn in the ward
and his/her incubator care may have adverse effects on
both mother and the newborn. Furthermore, no study has
been already conducted in this regard in the city of Yazd.
Thus, the researchers decided to conduct a study aimed at
determining the impact of KMC on vital signs and arterial
oxygen saturation rate in newborns hospitalized in Neonatal
Intensive Care Unit(NICU). It is hoped that the results can
enhance the improvement of newborns and facilitate the
implementation of this care method in our hospitals.
MATERIALS AND METHODS
This study is a randomized clinical trial study type. This study
is a doubleblind; Infants due to age and statistical analyst
were not informed from groups. That has been posed in the
Ethics Committee of the Shaheed Sadoughi University of
Yazd city and registered in IRCT138901223679N1. In this
study, to determine the sample size by considering test power
of 80% and significance level of 5% and(s=4, d=3) based on
previous studies, the sample size was calculated 50 neonate.
Initially, the eligible newborns hospitalized in the NICU,
who required incubatorcaring, after getting written consent
from their mothers and with physicians coordination were
divided into two groups of the case group (27 subjects) of
KMC and the control group (26 subjects) of conventional
incubator care using the random number table. The study
inclusion criteria included: Consent and mental and physical
ability of mothers for performing KMC, the physicians
allowance, weighing more than 1800 g for the newborn,
gestational age of 32weeks and above, no abnormalities and
problems of nervous, cardiovascular and respiratory systems
in newborns, no clinical instability and infections, no surgery
performed on them, exacerbated crying newborn, and not
being NPO. All newborns not meeting the above conditions
were excluded from the study. In order to gather information,
the registration forms, including two sections of demographic
data(age, sex, birth weight) and vital signs(HRs, respiratory
rate, and the auxiliary temperature) and the arterial oxygen
saturation rate on percentage scale were used. The vital
signs and arterial oxygen saturation rate of newborns in
both groups were recorded 5min before the start of the care
process. Mothers were instructed before the procedure.
Also during the mother and baby were supported by a
nurse and researcher. Mothers showed desire and good
Journal of Clinical Neonatology | Vol. 4 | Issue 1 | January-March 2015
cooperation during the procedure. Hence, the case
group mothers were trained properly, and the required
information and explanations along with displaying the
video description about the KMC method were provided
for them, and the KMC was applied to their newborns.
Thus, the naked newborn, only wearing diaper and
cap, was placed in a straight state between the mothers
breasts and was supported by a cloth bag. The caring was
performed for 3 consecutive days and each time for 1h.
The procedure was conducted for all samples by the head
nurse and with the researchers presence and monitoring
in the morning shift, and the mothers were supported and
encouraged during the caring process. The changes in pulse,
respiration, temperature, and arterial oxygen saturation rate
of the case group were controlled and recorded during the
care process, at 30min after starting the procedure and at
the end of caring process before returning the newborn
to the incubator. The mentioned items in the control
group (conventional incubator care) were also measured
and recorded simultaneously with the case group.
To measure the pulse and respiration, the 22,004 data scope
passport monitoring system was used. The pulse oximetry
in NICU was used to measure the arterial oxygen saturation
rate, and a mercury thermometer was used to measure
the temperature with an auxiliary approach for 3 min. To
maintain the reliability of the instrument during the research,
the same pulse oximetry device and monitoring system were
applied to newborns in the same situation. The pulse oximetry
probe was taped to the toe of the left foot of all newborns.
In addition, the calibration of the monitoring device was
performed routinely by the ward. The validity of the pulse
oximetry device and the monitor system was confirmed
and upheld by citing the manufacturer and the brand
standards. The simultaneous observation and recording
method by two researchers were used for the reliability of
temperature measurements (r = 0.087). During the care
process, no treatment measures and painful procedures were
performed in both groups, and the room temperature was
retained between 24C and 26C. The newborns could feed
during the care process as needed. After recording the vital
signs and the arterial oxygen saturation rate, the data were
encoded and analyzed using the SPSS version 15 software
(IBM corporation). The independent samples ttest was
used to compare the means of vital signs and arterial oxygen
saturation rates between the two groups. The repeated
measure test was used to test the means differences in
consecutive days due to repeating of variables review.
RESULTS
The results of the study showed that there were no significant
differences between the means of gestational age, birth weight,
and sex in two groups of newborns. The mean gestational
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Dehghani, etal.: Kangaroo mother care versus conventional method

age in the case group has been as 34.48 2/42 weeks

Table3: Determining and comparing arterial oxygen
and in the control group as 35.07 2.4 weeks. The mean
saturation rate between two case study groups in
chronological age in the case and control groups has been,
different days before, during and after the care
respectively, as 9.56.15 and 9.116.89days. The average
Time Group Independent Repeated
birth weight in the two groups has been, respectively, as t test measure test
Control(26) Case(27)
2268.84490.03 and 2192.22619.85 g. The period time
First day
of hospitalization in the case group and the control group
Before 92.303.01 91.3310.2 P=0.644 P=0.000
has been, respectively, as 12/76.42 and 11.077.86days.
Between 91.733.06 94.142.59 P=0.003
In the case group, 51.85% of the samples (14 cases) were After 91.303.06 95.742.8 P=0.000
female and 48.15%(n=13) were male; in the control group, Second day
50% were female and 50% were male[Table1]. Before 90.961.94 93.482.1 P=0.000
Between 90.421.81 93.882.24 P=0.000
The comparison of temperature means during the first After 90.341.78 95.512.19 P=0.000
to 3rd days between the two groups showed a statistically Third day
significant difference using the statistical repeated measure Before 90.881.77 92.401.27 P=0.001
test(P=0.000), so that the average temperature in the case Between 90.071.67 94.511.69 P=0.000
group has increased compared to the control group[Table2]. After 89.961.48 96.331.77 P=0.000
Comparing the average HRs and respiratory rate per minute
in the 1st to 3rd days, respectively, showed that there is no
significant difference between the two groups (P = 0.541, Table4: Determining and comparing number of heart
P=0.586)[Tables3 and 4]. However, comparing the means beats between two case study groups in different days
of arterial oxygen saturation rates in the 1st to 3rd days before, during and after the care
showed that there are statistically significant differences Time Group Independent Repeated
t test measure test
between the two groups(P=0.000)[Table5]. Control(26) Case(27)
First day
Before 130.5922.9 133.1023.76 P=0.698 P=0.541
Table1: Comparison of demographic characteristics Between 13326.8 136.0713.5 P=0.349
between the two groups After 134.1511.6 133.8112.4 P=0.949
Items Case group Control group Second day
Gestational age(weeks) 34.482.42 35.072.4 Before 133.5711.8 136.6214.5 P=0.408
Chronological age(days) 9.56.15 9.116.89 Between 133.739.96 136.6612.4 P=0.949
Birth weight(g) 2268.84490.03 2192.22619.85 After 132.5710.15 134.7711.49 P=0.349
Period time of hospitalization(days) 12.76.42 11.077.86 Third day
Sex(%) Before 131.619.1 134.4812.75 P=0.353
Female 51.85 50 Between 132.339.07 132.339.77 P=0.821
Male 48.15 50 After 133.159.19 132.6210.14 P=0.845

Table2: Determining and comparing temperature Table5: Determining and comparing number of
average between two case study groups in different respiratory between two case study groups in different
days before, during and after the care days before, during and after the care
Time Group Independent Repeated Time Group Independent Repeated
t test measure test t test measure test
Control(26) Case(27) Control(26) Case(27)
First day First day
Before 36.150.31 36.410.18 P=0.001 P=0.000 Before 45.5711.55 45.747.61 P=0.951 P=0.586
Between 36.060.36 36.530.14 P=0.001 Between 46.3411.36 45.447.02 P=0.729
After 35.980.34 36.570.22 P=0.001 After 46.1110.93 46.076.66 P=0.987
Second day Second day
Before 36.130.28 36.300.19 P=0.01 Before 45.0710.43 45.076.66 P=0.859
Between 36.050.22 36.500.16 P=0.000 Between 46.389.65 45.296.51 P=0.631
After 35.980.22 36.600.21 P=0.000 After 46.1510.30 44.815.5 P=0.579
Third day Third day
Before 36.090.33 36.280.23 P=0.018 Before 46.8010.03 44.257.15 P=0.291
Between 35.990.25 36.470.13 P=0.000 Between 47.469.78 44.706.82 P=0.238
After 35.910.30 36.600.18 P=0.000 After 4710.02 44.626.20 P=0.304

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Dehghani, etal.: Kangaroo mother care versus conventional method
DISCUSSION
The study results showed a significant increase in the average
temperature in the case group in the 1stto 3rddays after KMC;
the findings are consistent with the results of many studies in
this regard.[1825] Only a study, before and after, showed that
the newborns temperature reduced during KMC compared
to the incubator care, although the temperature rates were
in the normal range.[26] Sontheimer etal. showed that even
in newborns transferring with KMC compared to incubator
care, the HR, respiratory rate, arterial oxygen saturation
rate, and the temperature remain constant. Hence, we can
say that the KMC leads to the temperature stability or its
increase in the normal range. Indeed, putting the newborn
in skin contact with the mother will prevent the heat loss.[5]
Increasing temperatures, particularly for lowweight and
premature newborns with tendency to hypothermia is very
useful and improves the treatment outcomes, while the
metabolic rate and oxygen consumption increase with the
heat loss and lead to physiological and metabolic instability,
homeostatic problems, apnea intensifying, and impaired
weight gain.[12,23,27]
The research results showed a significant increase in arterial
oxygen saturation rate during the 1stto 3rddays after KMC
compared to the control group, which is consistent with
the results of many studies.[2833] Increase in arterial oxygen
saturation rate can be due to calm and comfortable contact
of the newborn with the mother and possibly the reduced
oxygen consumption.[12] In a number of clinical trial studies
on similar preterm subjects, no changes have been reported
in the rate of arterial oxygen saturation during KMC.[34,35]
Furthermore, in a study, no change was observed in the rate
of arterial oxygen saturation in preterm neonates on heel
prick and during puncturing the heel stick during the KMC
than to the incubator cure.[36,37] Some researchers state that
during neonatal transport to the KMC, the rate of arterial
oxygen saturation may decrease, statistically, but not
clinically, significant and it will become stable in 3min after
the beginning of the care process. However, controlling the
head and putting it at the sniff situation in the midline in
order to minimize the changes in arterial oxygen during the
KMC is important. Thus, based on Alevel evidence, oxygen
saturation changes during Kangaroo care(KC) are minimal
and remain predominantly within acceptable clinical
ranges. Controlling infant head in the slightly sniffing
position and neck in the midline position is mandatory to
minimize desaturations.[34]
This study showed no statistically significant differences
in the average number of HR per minute between the two
groups, which are consistent with the results of a number
of studies.[11,9,38] Nimbalkar and et al. showed the HR was
statistically significant and lower in KMC group.[36] Cong
Journal of Clinical Neonatology | Vol. 4 | Issue 1 | January-March 2015
etal. showed longer(30min), and shorter KC(15min) in
heel stick can stabilize HR response in preterm infants.[38]
The results of a metaanalysis on 23 studies showed that
there was no significant difference in HRs at the time of
kangaroo and incubator caring methods.[34] Some studies
showed that the KMC causes increased HR in preterm
newborns.[19,21] The Dodds study showed the increased HR
with no statistically significant difference.[27] This suggests
that the increase in HR may be initially due to placing the
newborn in an upright state, and then, reduction in theHR
will occur due to more relaxation and less stress of the
newborn. Some researchers in randomized clinical trials
and quasiexperimental pretesttestposttest studies state
that the newborns HR may increase more by 510 beats/min
during the 2ndh of KMC than the 1sth due to the newborns
warming and head tilting upward.[34] The increase in arterial
oxygen saturation rate can clarify the reason of this fact
that the HR number remains stable despite the increased
temperature, since the increase in temperature normally
leads to an increase in pulse rate and HR.[12] KC for infants
in our study has been carried out for an hour while other
studies differ together in terms of execution time care.
According to the results of this study, there was no significant
difference in the average respiratory rate per minute in the
KMC group than to the incubator care, which is consistent
with the results of some studies.[26,12] A metaanalysis
study showed that the rate of respiration during the KC
reduces compared to the incubator care method.[12,28,39]
Almeida etal. 2007 quotes Sontheimer etal., the heart and
breathing rates are uncertain data, because the mothers
respiratory and cardiac patterns may be superimposed on
the newborns.[12] Reduced breathing number and increased
arterial oxygen saturation rate after KMC can be due to the
upright situation of the newborn during the caring process;
therefore, this status improves the ventilation and perfusion
and thus the respiratory functioning.[39]
In short, the results of research suggesting that the cardiac
and respiratory status are clinically in a reasonable range
during the KMC and shows more stability compared to the
incubator care; in fact, most clinical trial studies show that
the KMC has been effective in cardiacrespiratory parametric
stability.[34] Schlez et al. showed infants physiological
responses like respiratory rate did not differ significantly.[40]
CONCLUSION
In general, the results of this study showed that the KMC
can contribute in increasing the temperature and arterial
oxygen saturation rate and the cardiovascular and respiratory
stability in newborns. It is suggested: Training of nursing and
midwifery team in regard to the technique will be developed
in hospitals and prenatal clinics, and the mothers knowledge
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Dehghani, etal.: Kangaroo mother care versus conventional method
in this area will be improved. Furthermore, particular
nurses in each ward would be dedicated to this method,
and its performance would be enhanced. It is recommended
to conduct further research on the longterm impact of
KMC on multiple variables, like weight gain, period time
of hospitalization, mothers breastfeeding rate, vital signs,
etc., Furthermore, the procedure could be performed for
the underweight newborns and lower gestational age under
certain circumstances. A limitation of this study was the
most crowded ward in the morning shift, so the study was
conducted in the evening shift and the quiet hours.
ACKNOWLEDGMENTS
Finally, we have to thank the nursing staff, particularly
Mrs.Sotodeh, the NICU head nurse, and Dr.Mohammad Golshan,
the neonatologist for their help in this research.
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How to cite this article: Dehghani K, Movahed ZP, Dehghani
H, Nasiriani K. A randomized controlled trial of kangaroo mother
care versus conventional method on vital signs and arterial oxygen
saturation rate in newborns who were hospitalized in neonatal
intensive care unit. J Clin Neonatol 2015;4:26-31.
Source of Support: Nil, Conflict of Interest: None declared.

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Journal of Clinical Neonatology | Vol. 4 | Issue 1 | January-March 2015 31