Keeping the LBW babies dry and warm (prevention of hypothermia)

see also Temperature control in NYI for risks of hypothermia.

The definition of Continuous Kangaroo Mother Care (KMC) is care of a preterm infant carried skin-to- skin with the mother. Its key features include early, continuous and prolonged skin-to-skin contact between the mother and the baby, and exclusive breastfeeding (ideally) or feeding with breast milk.
Mortality, hypothermia, rates of infection and readmission are lower in neonates nursed in continuous KMC when compared with conventional care. All newborns weighing 2000 g or less at birth should be provided as close to continuous Kangaroo mother care as possible (3).

Intermittent KMC is the practice of skin-to-skin care alternated with the use of a hot cot, a radiant warmer or an incubator care for the baby. Intermittent KMC is associated with reduced rates of hypothermia and infection compared to conventional care.

In Malawi there are three categories of KMC

  1. Facility KMC - recommended for all neonates with a birth weight of < 1500 grams
  2. Ambulatory KMC - 1500 - 1800 grams after discharge from a facility but continues to be followed up by that facility
  3. Community KMC - >1800 grams and clinically stable

If neither continuous nor intermittent KMC is possible then an overhead radiant warmer, incubator or a hot cot may be used to keep the baby warm. The room where a LBW baby is nursed should be kept warm (25C). The baby should wear a hat to cover the head. Wet clothing should be changed frequently to keep baby warm and dry. Regular monitoring of axillary temperature should be done.

Key facts for providers and mothers/guardians – Skin-to-skin contact (Kangaroo Mother Care)

If there are no signs of distress, a mother can provide a warm environment with “Kangaroo care” for the baby at home or hospital. Place the baby, with a nappy, socks and hat, upright inside mothers’ clothing against mother’s bare skin between her breasts, with the infant’s head turned to one side. Tie the infant to the mother with a cloth and cover the mother and infant with the mother’s clothes. Let baby suckle at the breast as often as s/he wants, but at least every 2 hours. Mother should sleep propped up so that the baby stays upright. If environmental temperature is low add a blanket to mother’s wrap. When mother wants to bathe or rest, ask the father or another family member to ‘Kangaroo’ the baby or wrap the infant in several layers of warm clothing, covered with blankets and keep in a warm place.