Improving Kangaroo Care
The Gosnell Family Neonatal Intensive Care Unit (NICU), home to GCH’s Division of Neonatology, is the only one of its kind in the region to provide highly specialized care for sick and premature newborns, including those requiring advanced treatment for respiratory failure, heart disease, and neurologic injury. For the past five years, the division has been nationally recognized by U.S. News & World Report among the “Best Children’s Hospitals” in neonatology.
"Our NICU has the latest design elements and the best innovative technology that is available to make it the safest, most advanced NICU for patient care,” said Dr. Carl D'Angio, Division of Neonatology Chief.
In 2022, the NICU joined the PAIRED Initiative, part of the Florida Perinatal Quality Collaborative, designed to help NICUs develop and implement unit-specific strategies to both improve family engagement with staff so that they can assist in the care of their infants and to facilitate the adoption or expansion of safe skin-to-skin care, in order to achieve better outcomes for infants and families.
Skin-to-skin care, also known as Kangaroo care, is one of the most important aspects of an infant’s care since it involves direct contact with a parent when the infant is placed skin-to-skin on their bare chest. During this time, a mom or dad is able to quietly bond with their infant while providing soothing and familiar sounds such as their heartbeat or voice. Studies have shown that skin-to-skin care improves outcomes for premature babies admitted to the NICU. Some of these benefits include improvements in temperature regulation, growth and neurodevelopment, sleep quality, and feeding in small babies, as well as decreases in infection rates, infant stress, mortality, and length of NICU stay. Skin-to-skin care also provides benefits to families including reduced pain and stress, better milk production, and improved bonding to name a few.
‘We know, based on evidence, that skin-to-skin care provides a large number of medical benefits both to families and to the infants in our unit, but skin-to- skin care has yet to be universally considered a medical intervention as it should in the field of neonatology,” said Colby Day Richardson, MD, neonatologist and Medical Director of the GCH NICU. “At the Golisano Children’s Hospital NICU, we are committed to promoting skin-to-skin care as part of our mission to provide optimal healthcare to our infants and their families.”
Over the past few years, there have been many quality improvement projects performed within the NICU. The addition of new chairs to support an increase in opportunities for comfortable and accessible Kangaroo Care has been just one aspect of that work. Changes in the way care is provided, such as the addition of small baby rounds, and new family support services have also been pivotal in advancing care for NICU families.
The new chairs, The Kangaroo Chair by IoA, are designed specifically to support Kangaroo Care in the NICU and feature a soft contoured back that embraces the caregiver and baby, allowing parents to rock their baby to sleep, and supports movement and adjustments as parents and baby turn from side to side. They also feature safety locking in all positions, including the reclined positions, to prevent sudden unwanted movement that could startle baby or cause potentially dangerous outcomes, and can be used as an additional comfortable sleep option for parents and family members once baby is returned to their incubator or crib, allowing a more restful sleep.
Families have been at the center of the work to provide new developments and upgrades in the NICU. “Each step of the way, we asked our families for input, and we listened to them,” said Dr. Day Richardson. “We trialed the chairs with multiple families and tracked skin-to-skin rates along the way.”
“The old chairs were not good for your back; some of them didn’t recline, and they didn’t have the piece that holds the tubes and the wires. I love the new chairs. I sleep in them most of the time because they are so comfortable and cozy… I can sit for hours in the new chairs and cuddle and hold my baby,” said Tiara Nesmith (Pictured).
Since focusing on skin-to-skin care in February 2022, the NICU has seen an increase in the percentage of infants and families who have utilized skin-to-skin care during their admissions from 57% to 70%, which equates to approximately 130 more infants experiencing skin-to-skin care in the unit per year. Additionally, families are also performing skin-to-skin care sooner after the birth of their infants. Most recently, families are, on average, holding their infants during the first five days of life—much sooner than they had been the year before, when most were not performing skin-to-skin care, on average, until after more than a week of life.
“The new chairs have truly given families a sense of normalcy,” said Karen Paul, RN, MSN, and nurse manager for the NICU. “Families are more comfortably holding their babies for longer periods of time. This has been a big factor in empowering families and strengthening bonds with their babies.”
The NICU’s care team—comprised of neonatologists, advanced practice providers, trainees, nurses, and a variety of specialized therapists—works to help babies meet their specific emotional, behavioral, and developmental needs in the most natural ways possible as their bodies continue the growth and development that occurs prior to birth. Their goals are to aide newborns in developing new abilities, maximize their comfort, and ensure bonding with parent caregivers. As the Regional Perinatal Center for the Finger Lakes Region, the division cares for the more than 1,000 newborns admitted to the hospital annually, with approximately 100 per year of those being small-baby admissions (infants born at fewer than 28 weeks’ gestational age or weighing fewer than 1000 grams), as well as an additional 250 newborns who are transferred from nearly seventeen referring hospitals to GCH by the Neonatal Transport Team.
Through the generous support of the community and past and present families, the NICU has been able to purchase 15 chairs to date and hopes to continue to raise funds to completely furnish all of its 68 rooms with a new Kangaroo Chair. Anyone who wishes to support this effort can visit givetokids.urmc.edu/kangaroocare.