Bergman Nils J
Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
Front Psychol. 2024 Jul 9;15:1385320. doi: 10.3389/fpsyg.2024.1385320. eCollection 2024.
In 2023, the World Health Organization (WHO) published a Global Position Paper on Kangaroo Mother Care (KMC), which is applicable to all countries worldwide: from the moment of birth, every "small and sick" newborn should remain with mother in immediate and continuous skin-to-skin contact (SSC), receiving all required clinical care in that place. This was prompted by the startling results of a randomized controlled trial published in 2021: in which 1,609 infants receiving immediate SSC were compared with 1,602 controls that were separated from their mothers but otherwise received identical conventional state-of-the-art care. The intervention infants showed a 25% reduction in mortality after 28 days.
The new WHO guidelines are a significant change from earlier guidance and common clinical practice. The author presents that separating mothers and babies is assumed to be "normal" (a paradigm) but actually puts newborns at increased risk for morbidity and mortality. The author presents arguments and ethical perspectives for a new perspective on what is "normal," keeping newborns with their mothers is the infant's physiological expectation and critical requirement for healthy development. The author reviews the scientific rationale for changing the paradigm, based on synchronous interactions of oxytocin on both mother and infant. This follows a critique of the new policies that highlights the role of immediate SSC.
This critique strengthens the case for implementing the WHO guidelines on KMC for small and sick babies. System changes will be necessary in both obstetric and neonatal settings to ensure seamless perinatal care. Based on the role of oxytocin, the author identifies that many current routine care practices may actually contribute to stress and increased vulnerability to the newborn. WHO has actionable recommendations about family involvement and presence in newborn intensive care units.
The concepts of resilience and vulnerability have specific definitions well known in perinatal care: the key outcome of care should be resilience rather than merely the absence of vulnerability. Newborns in all settings and contexts need us to re-evaluate our paradigms and adopt and implement the new WHO guidelines on KMC in perinatal care.
2023年，世界卫生组织（WHO）发布了一份关于袋鼠式护理（KMC）的全球立场文件，该文件适用于世界各国：从出生那一刻起，每一个“体弱多病”的新生儿都应与母亲保持立即且持续的皮肤接触（SSC），并在该位置接受所有所需的临床护理。这是由2021年发表的一项随机对照试验的惊人结果所推动的：该试验将1609名接受立即皮肤接触护理的婴儿与1602名与母亲分离但接受相同常规先进护理的对照组婴儿进行了比较。干预组婴儿在28天后死亡率降低了25%。
世卫组织的新指南与早期指导意见和常见临床实践有重大变化。作者指出，将母婴分离被认为是“正常”的（一种范式），但实际上会使新生儿面临更高的发病和死亡风险。作者提出了关于“正常”的新观点的论据和伦理视角，让新生儿与母亲在一起是婴儿的生理期望和健康发育的关键要求。作者基于催产素对母婴双方的同步相互作用，回顾了改变这一范式的科学依据。这是在对强调立即皮肤接触护理作用的新政策进行批评之后。
这一批评强化了为体弱多病的婴儿实施世卫组织袋鼠式护理指南的理由。产科和新生儿科室都需要进行系统变革，以确保无缝的围产期护理。基于催产素的作用，作者指出，许多当前的常规护理做法实际上可能会给新生儿带来压力并增加其脆弱性。世卫组织对家庭参与新生儿重症监护病房并在其中陪伴有可行的建议。
复原力和脆弱性的概念在围产期护理中有特定的定义，广为人知：护理的关键结果应该是复原力，而不仅仅是没有脆弱性。所有环境和背景下的新生儿都需要我们重新评估我们的范式，并在围产期护理中采用和实施世卫组织关于袋鼠式护理的新指南。
