Saturday, February 8, 2014

I Think We'll Leave Kangaroo Care to the Kangaroos

Dear Ellie,

Today, the nurses did your weekly bed change.  The nurse in charge insisted that we do what is called "Kangaroo Care."  That's when the mother tucks her preemie close to her chest for a short period of time.  It's supposed to help enhance milk production (since, presumably, it gets those hormones pumping) and a lot of people claim that it's good for the baby...  but this was the moment we were fearing!  At such a young age while STILL on a respirator, we had our apprehensions.  On the way to the hospital, your mother and I both were coming up with excuses on how to avoid it, but when we both stoutly declined, the nurse got a little pushy about it.  In a moment of wussiness, we gave in.

I think we both regretted not growing a backbone, because moving the tangled mass of wires off of the incubator and onto your mother's collar bone made for a pretty big mess, not the least of which was stress for you.  There was a lot of tugging and twisting, with the endotracheal tube in your throat getting jostled around.  Each time, your mouth opened with in pain and your eyes clenched.  Your blood oxygen levels wobbled all over the place and aside from that, I was afraid that the line might damage your trachea.  I'm guessing the experience was supposed to be one filled with coos and smiles and fuzzy warm feelings.  It wasn't.  All three of us squirmed and grimaced uncomfortably.  Fortunately, you are now safely back in your new incubator, and the three of us are a lot calmer.

Anyway, out of about 20 pictures of the ordeal, we got one that made the experience appear carefree and blissful, so we have the nurse to thank for that!  I think we'll enjoy being physically close to you when you are just a TAD bit bigger!


  1. Kangaroo Care really is good for them... there has been research done.
    Babies can sense how you are feeling, try to be calm and relax! It's not all cooing and smiles. Everything your wife touches helps to make antibodies in the breastmilk so touching all the wires and stuff around and connected to Ellie is a good thing. I'm happy to see she was able to do this! My husband was terrified the first time.

  2. Yep, this post ruffled some feathers, understandably (I got some critical text messages!) You are definitely right, Little Hassels. Kangaroo Care does some outstanding things when it comes to improving a baby's sleep patterns, improving milk, improving cognitive development, etc. However, all of the contemporary literature pertains to non-micro preterm newborns (between 23-28 weeks), and the positive effects demonstrated by the data disintegrates once you look at micro-preemies as a separate statistical grouping. For instance, the study with the best methodology that I noticed (Skin-to-skin contact [Kangaroo Care] accelerates autonomic and neurobehavioural maturation in preterm infants) had participants that were a median gestational age of about 31 weeks with a standard deviation of 2.65. This study had the youngest participant I could find of any other study (25.5 weeks) which wasn't even Ellie's age when Ellie tried it. It makes sense that research would focus on newborns over 28 weeks gestational age because, well, that's where your most data points come from. The afore mentioned study even made some allusions in the discussion to the fact that Kangaroo Care for micro-preemies could be counter productive.

    So I guess what I'm getting at is that all pre-termers aren't created equally. Most are going to benefit, since most are going to be older than 28 weeks, but those that are younger than 28 weeks... well, that there is a black box that has not been studied (perhaps, because a lot of doctors are concerned about subjecting such frail babies to these kinds of natural experiments). If basically no research has been done on Kangaroo Care for micro-preemies, but NICU care for micro-preemies and non-micro preemies is considerably different with far greater risks faced by the former, then I think its probably better to play it safe. Also, considering that Ellie's response to the episode caused severe weesing and a swift desaturation of her oxygen levels, I'm a little more than nervous about trying it again until she's an age that has been studied.

    So I guess you could say that that was the underlying source of my nail biting. I promise though, there is pleeeenty of Kangaroo Care in the future. I'll even WEAR a Kangaroo Pouch and Kangaroo Ears when my turn comes. I'll even take a picture and post it for little Ellie (and everyone else!) to see!

  3. Thanks for the clarifying response! In searching for an article I did come across something that indicated it may not be helpful for early term micro preemies so soon but I didn't want you to be completely discouraged!

    One of our earlier Kangaroo Care experiences I left so concerned about my son because he seemed more distressed and breathing poorly and thought I had heard him make some noise (and they shouldn't be able to make noise when intubated). The NICU called later to tell us he had extubated himself. We were fortunate that he was able to tolerate Hi-Flow at that point and did not need to be re-intubated. So I can relate about it being a stressful experience and worry about damaging their tiny frail body. It was much easier once he was on a nasal cannula.

    I have gathered that you are a statistical guy (I am intrigued by your point of view in this NICU journey) but I'm more emotional and just want to share another story And let me know if my comments get annoying.

  4. Ha, Hassels, of course you aren't being annoying. I like people who are critical. Better to have someone contest me on something than to run the risk of continuing to believe that something is correct when it is actually wrong. I can't be offended either, so just fire away. The company is great, so all of your comments are welcome!

    But yes, going through the NICU journey with some experience in biology and statistics makes things a lot easier in a lot of ways, and a little bit MORE frustrating in others. Rani and I have grown to understand most of the conditions, bells and whistles, etc. but on the other hand, the doctors can be very patronizing, which drives us barmy. You ask them a question and they tell you "there's no way of knowing!" when, in fact, the answer isn't a secret at all.

    For instance, we asked the doctors what the probability of a micro-preemie's ductus artereosis reopening. The doctors replied, "It can happen, but there's no way of knowing how likely!" Poppycock! As it turns out the subject has been studied and is pretty well understood. After 15 minutes of browsing the medical literature, Rani found the odds were around 15 percent for Ellie's statistical grouping. GRRRR.

    I don't know if doctors are just trying to protect themselves from lawsuits or what, but their answers always come down to: "Your baby has somewhere between a 1 to 99 percent chance of getting any particular condition." REALLY? GRRRR, again.

    To be fair, in their defense, there isn't much we're going to do with that information other than, you know, adjust our expectations anyway... but we would appreciate more honesty when it comes to this kind of stuff.

  5. Hi Dana! I know this is an old post and you may not get this request but I thought I'd try anyways. I work at an NICU and we are putting together a parent resource binder and I was looking for a picture of KC with an intubated baby. I came across your picture of Rani and Ellie and was wondering if we could use it.

    On another note, I'm so sorry your experience with KC was one of anxiety and will be remembered as a negative one for you and your little family. The transfer out of the isolette to KC with an intubated baby is always stressful, but the cuddle itself is usually worth it. Unfortunately, like you say, not all babies are created the same. I hope you had lots of stress-free cuddles after this one!

    1. Certainly KaiserJen!

      I sent you an e-mail so hopefully you got it.