Tessier R, Cristo M, Velez S, Giron M, de Calume Z F, Ruiz-Palaez J G, Charpak Y, Charpak N
School of Psychology, Laval University, Quebec, Canada.
Pediatrics. 1998 Aug;102(2):e17. doi: 10.1542/peds.102.2.e17.
Based on the general bonding hypothesis, it is suggested that kangaroo mother care (KMC) creates a climate in the family whereby parents become prone to sensitive caregiving. The general hypothesis is that skin-to-skin contact in the KMC group will build up a positive perception in the mothers and a state of readiness to detect and respond to infant's cues.
The randomized controlled trial was conducted on a set of 488 infants weighing <2001 g, with 246 in the KMC group and 242 in the traditional care (TC) group. The design allows precise observation of the timing and duration of mother-infant contact, and takes into account the infant's health status at birth and the socioeconomic status of the parents. BONDING ASSESSMENT: Two series of outcomes are assessed as manifestations of a mother's attachment behavior. The first is the mother's feelings and perceptions of her premature birth experience, including her sense of competence, feelings of worry and stress, and perception of social support. The second outcome is derived from observations of the mother and child's responsivity to each other during breastfeeding at 41 weeks of gestational age.
KMC has three components. The first is the kangaroo position. Once the premature infant has adapted to extrauterine life and is able to breastfeed, he is positioned on the mother's chest, in a upright position, with direct skin-to-skin contact. The second component is kangaroo nutrition. Although breastfeeding is the prime source of nutrition, infants also may receive preterm formula whenever necessary and vitamin supplements. The third component is the clinical control; infants are monitored on a regular basis, daily until they are gaining at least 20 g per day. Afterward, weekly clinic visits are scheduled until term, which constitutes the ambulatory minimal neonatal care. In the TC group, infants are kept in incubators until they are able to self-regulate their temperature and are thriving (ie, have an appropriate weight gain). Infants are discharged according to current hospital practice, usually not before their weight is approximately 1700 g. Afterward, as with the KMC group, weekly clinic visits are scheduled until term.
We observed a change in the mothers' perception of her child, attributable to the skin-to-skin contact in the kangaroo-carrying position. This effect is related to a subjective "bonding effect" that may be understood readily by the empowering nature of the KMC intervention. Moreover, in stressful situations when the infant has to remain in the hospital longer, mothers practicing KMC feel more competent than do mothers in the TC group. This is what we call a resilience effect. In these stressful situations we also found a negative effect on the feelings of received support of mothers practicing KMC. We interpret this as an isolation effect. To thwart this deleterious effect, we would suggest adding social support as an integral component of KMC. The observations of the mothers' sensitive behavior did not show a definite bonding effect, but rather a resilience effect. This is attributable to the KMC intervention; mothers practicing KMC were more responsive to an at-risk infant whose development has been threatened by a longer hospital stay. Otherwise, we observed that the mothers (in both the KMC group and the TC group) had behavioral patterns that were adapted to the child's at-risk health status and to the precarious condition of some premature infants requiring intensive care. We conclude that the infant's health status may be a more prominent factor in explaining a mother's more sensitive behavior, which overshadows the kangaroo-carrying effect.
These results suggest that KMC should be promoted actively and that mothers should be encouraged to use it as soon as possible during the intensive care period up to the 40 weeks of gestational age. Thus, KMC should be viewed as a means of humanizing the process of g
基于一般的情感联结假说，有人提出袋鼠式护理（KMC）在家庭中营造了一种氛围，使父母易于提供敏感的照料。一般的假说是，KMC组中的皮肤接触会在母亲心中建立积极的认知，并使她们处于一种准备好察觉并回应婴儿暗示的状态。
对一组488名体重小于2001克的婴儿进行了随机对照试验，KMC组有246名婴儿，传统护理（TC）组有242名婴儿。该设计允许精确观察母婴接触的时间和时长，并考虑到婴儿出生时的健康状况以及父母的社会经济地位。情感联结评估：评估两组结果作为母亲依恋行为的表现。第一个是母亲对早产经历的感受和认知，包括她的能力感、担忧和压力感以及对社会支持的认知。第二个结果来自对胎龄41周时母乳喂养期间母婴相互反应的观察。
KMC有三个组成部分。第一个是袋鼠式体位。一旦早产儿适应宫外生活并能够进行母乳喂养，就将他以直立姿势放在母亲胸前，进行直接的皮肤接触。第二个组成部分是袋鼠式营养。虽然母乳喂养是主要的营养来源，但婴儿在必要时也可能会接受早产配方奶粉和维生素补充剂。第三个组成部分是临床监测；婴儿每天接受定期监测，直到他们每天体重增加至少20克。之后，安排每周门诊就诊直至足月，这构成了门诊最小化新生儿护理。在TC组中，婴儿被放在暖箱中，直到他们能够自我调节体温并茁壮成长（即体重有适当增加）。婴儿按照当前医院的做法出院，通常在体重约1700克之前不会出院。之后，与KMC组一样，安排每周门诊就诊直至足月。
我们观察到母亲对孩子的认知发生了变化，这归因于袋鼠式抱姿中的皮肤接触。这种效应与一种主观的“情感联结效应”有关，KMC干预的赋能性质可能很容易理解这种效应。此外，在婴儿必须在医院停留更长时间的压力情况下，实施KMC的母亲比TC组的母亲感觉更有能力。这就是我们所说的恢复力效应。在这些压力情况下，我们还发现实施KMC的母亲所感受到的支持对她们的情感有负面影响。我们将此解释为隔离效应。为了避免这种有害影响，我们建议将社会支持作为KMC的一个组成部分。对母亲敏感行为的观察并未显示出明确的情感联结效应，而是一种恢复力效应。这归因于KMC干预；实施KMC的母亲对发育因住院时间延长而受到威胁的高危婴儿反应更积极。否则，我们观察到母亲（KMC组和TC组的母亲）都有适应孩子高危健康状况以及一些需要重症护理的早产儿不稳定状况的行为模式。我们得出结论，婴儿的健康状况可能是解释母亲更敏感行为的一个更突出因素，这掩盖了袋鼠式抱姿的效果。
这些结果表明应积极推广KMC，并应鼓励母亲在孕40周的重症护理期间尽早使用。因此，KMC应被视为使护理过程人性化的一种手段。
