Neonatal medicine takes a tender clue from kangaroos Health: Technology moves over as premature babies thrive when nestled naturally against their mothers' skin.


Jakhaila Miracle Braxton is resting her 3-pound-something body on a tiny piece of sheepskin in an incubator at Mercy Hospital. Meant to be born in 1997, she's spending her first Christmas in the neonatal intensive care unit with 16 other preemies. Lying in their transparent isolettes, these infants appear as fragile, precious and untouchable as museum exhibits.

Neptina Jones, 25, stares at Jakhaila longingly. Born seven weeks premature, Jakhaila is Jones's fourth child and first girl -- her miracle, she says.

The young mother, still a bit tender from her C-section, has come to take part in a new therapeutic program called kangaroo care. Cradling her tiny daughter between her breasts, skin to skin, Neptina sits in a glide-a-rocker and moves gently back and forth. Jakhaila is warmed by her mother's body. She hears the #F heartbeat that used to soothe her, feels the breathing that used to rock her. Her body resumes its fetal position and Jakhaila relaxes into sleep.

Tears of joy and relief run down Neptina's cheeks as she holds her baby. This separation has taken its toll on her as well. Her other births were full term; she brought three sons home with her from the hospital.

Now she arranges care for her children so that she can leave her West Baltimore home to hold her little girl for an hour each day.

"It's a lot of stress," Jones says. "Knowing I can't be here, I'm always worrying about if she's up here crying. When she was first born, she was cranky a lot, but when they let me hold her she went right to sleep. She was calm when I touched her."

This low-tech, skin-to-skin technique for preemies helps infants gain weight quicker and leave the hospital sooner than those who are isolated from touch in the incubators. Named after the pouch nursing used by kangaroos for their babies, kangaroo care was created in Colombia and introduced to the United States eight years ago by nurse-midwife Susan Ludington and nurse Gene Anderson.

Ludington, who was recently hired at the University of Maryland School of Nursing, has researched the technique's effectiveness for the National Institutes of Health. The World Health Organization has requested she develop an educational and training center for kangaroo care, which she plans to start at the nursing school. The technique is now used in 200 of the roughly 500 American neonatal intensive care units, she says.

Typically, babies who are born prematurely -- at 37 weeks or younger -- are placed in incubators that control their temperature. They are protected from too much human contact because of studies showing that touching increased their levels of stress.

Ludington's studies, however, show that kangaroo care allows preemies to relax and fall into the deep sleep they need to be able to breathe easier, gain weight and go home sooner.

"The babies in the incubator are much more active and agitated than those in kangaroo care," she says. "In the incubator, they only fall into deep sleep for 5 to 20 seconds at a time. In kangaroo care, they get up to 2 1/2 times as much deep sleep and up to 26 minutes at a time of quiet regular sleep." In quiet sleep, Ludington says. babies are less active and conserve their energy better, which helps them gain weight.

The World Health Organization recommends that medically stable babies aged 28 weeks who have completed a week of hospitalization be offered kangaroo care.

Ludington learned about the technique when she went to Colombia to lecture about the infant development program she had originated at the University of California Los Angeles. In return, the physicians in Bogota showed her the therapy they had devised for pre-term babies because they lacked incubators.

"Kangaroo care was not being used in the United States because it's unconventional and anti-technology," Ludington says. "We have relied upon technology for the survival of these babies. My charge was to test the natural approach to see if it was safe and has a benefit. And we have documented both."

The NICU at Mercy Medical Center has been using kangaroo care for several years. Neonatologist Susan Dulkerian says the technique makes the babies calmer and appear more satisfied.

Ludington plans to introduce the therapy into the transitional care unit that caters to preemies at the University of Maryland Medical Center. She also hopes to establish a unit offering kangaroo care to mothers and relatively stable preemies immediately following birth.

She recommends mothers and fathers use the therapy for at least an hour at a time so that their babies can get a good stretch of sleep.

"Actually, we recommend spending as much time as possible," she says. "After about an hour and a half, though, we've found the daddies start getting fanny fatigue. Women seem to be able to stay a little bit longer."

Ludington says skin-to-skin therapy regulates a baby's temperature better than an incubator.

"In the first 10 minutes, the mother's breast temperature increases dramatically to make sure the baby stays warm," she says. "The father's chest temperature doesn't make as rapid a rise, but as long as the baby is on his chest, it keeps warming up."

Conversely, if the baby's temperature reaches 99 degrees, the mother's breast temperature drops to make sure her baby's temperature doesn't rise to a level that affects breathing.

This temperature-adjusting phenomenon, known as "maternal neonatal thermal synchrony," also works by power of suggestion, says Ludington. Studies show that merely mentioning the baby may be too hot or too cold will cause a change in the caregiver's chest temperature.

"The mother's breast temperature makes four times as many adjustments to the baby's temperature than the incubator will," Ludington says. "I think it's time we stop this relentless separation of mother and infant because they really have a symbiotic relationship and need to be together."

The benefits to new mothers are easy to document, she says.

"It clearly reduces their stress. You can see the mom smile and the baby smile and best of all, they both go to sleep. When you have a mommy fall asleep with her baby, you've achieved a great level of comfort because you can only fall asleep when you feel safe."

Jakhaila Miracle Braxton was born seven weeks early because her mother had developed dangerously high blood pressure. Like many mothers of preemies, Neptina Jones has struggled with guilt about her baby's untimely birth as well as panic at being away from her.

Kangaroo care helps with both.

"I just feel a whole lot better when I hold her," Neptina says, gazing down at Jakhaila's peaceful, sleeping face. "And she looks a whole lot happier."

Pub Date: 12/31/96

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