Neonatology

Skin-to-Skin Contact (Kangaroo Care) Guidelines

Skin-to-skin contact between an infant and his or her parents

Hospitalized newborns

Infants who are not medically stable or who have had an acute or sudden deterioration in condition within the past 24 hours
Infants with a chest tube and/or intracardiac line (RA or LA)

Maintain neurobehavioral organizational state and physiological stability including oxygenation, heart rate and thermoregulation during transfers and holding
Remain free from any adverse effects associated with transfer or holding of infant such as extubation and thermal instability (optimal)
Begin a bonding process (optimal)

Assess whether the infant is a candidate for skin-to-skin contact (kangaroo care) — the infant should be medically stable and not have a chest tube or intracardiac line (RA, LA). Also, the family should be willing to participate.
Assess parents' readiness to provide skin-to-skin care:
- Is the parent willing to spend the expected length of time (minimum of one hour) holding the infant skin-to-skin?
- Is there a verbalized understanding of teaching materials and viewed video?
- Is the parent dressed appropriately with a button down shirt?
If the infant is intubated, assess the type of transfer technique that should be performed — parent transfer or nurse transfer (read our intubated infant guidelines for more information). The type of transfer will depend on the parent's ability to get in and out of the chair by himself or herself.
Before transferring an intubated infant, assess vital signs, pain score, breath sounds and ventilator tubing for excess water.
If the infant is intubated, monitor vital signs including temperature and pain score at 15 minutes post transfer and then every hour while infant is being held skin-to-skin.

Discuss the infant's tolerance for skin-to-skin contact with primary medical team

Review information about skin-to-skin contact (kangaroo care) with parent(s) and show video
If the infant is intubated, teach parent(s) transfer techniques and demonstrate the technique using a doll
Tell parents that a change in vital signs during transfer and while holding infant indicates medical instability and may require ending the skin-to-skin session

Evaluate parent's return demonstration of transfer technique
Assess parent's comfort level during skin-to-skin contact and need for a positioning device to support the infant

Treatment interventions — plan for skin-to-skin contact (kangaroo care)
Flowsheet
- Duration of skin-to-skin contact
- Infant's tolerance of skin-to-skin care
- Vital signs and pain score for intubated infant
Progress note — problems encountered and action taken
Interdisciplinary Patient-Family Education Flowsheet — teaching completed

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