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Effects for kangaroo care: systematic review & meta analysis

캥거루 케어가 미숙아와 어머니에게 미치는 효과 : 체계적 문헌고찰 및 메타분석

  • 임정희 (계명대학교 일반대학원 간호학과) ;
  • 김가은 (계명대학교 간호대학 간호학과) ;
  • 신영희 (계명대학교 간호대학 간호학과)
  • Received : 2016.01.04
  • Accepted : 2016.03.03
  • Published : 2016.03.31

Abstract

This paper reports the results of a systematic review (SR) and meta-analysis research to compare the effect of Kangaroo care, targeting mothers and premature infants. A randomized clinical trial study was performed until February 2015. The domestic literature contained the non-randomized clinical trial research without restriction according to the level of the study design. A search of the Ovid-Medline, CINAHL, PubMed and KoreaMed, the National Library of KOREA, the National Assembly Library, NDSL, KISS and RISS. Through the KMbase we searched and combined the main term ((kangaroo OR KC OR skin-to-skin) AND (care OR contact)) AND (infant OR preterm OR Low Birth Weight OR LBW), ((kangaroo OR kangaroo OR kangaroo) AND (care OR nursing care OR management OR skin contact)) was made; these were all combined with a keywords search through the selection process. They were excluded in the final 25 studies (n=3051). A methodology checklist for randomized controlled trials (RCTs) designed by SIGN (Scottish Intercollegiate Guidelines Network) was utilized to assess the risk of bias. The overall risk of bias was regarded as low. In 16 studies that were evaluated as a grade of "++", 9 studies were evaluated as a grade of "+". As a result of meta-analysis, kangaroo care regarding the effects of premature mortality, severe infection/sepsis had an insignificant effect. Hyperthermia incidence, growth and development (height and weight), mother-infant attachment, hypothermia incidence, length of hospital days, breast feeding rate, sleeping, anxiety, confidence, and gratification of mothering role were considered significant. In satisfaction of the role performance, depression and stress presented contradictory research results for individual studies showing overall significant difference. This study has some limitations due to the few RCTs comparing kangaroo care in the country. Therefore, further RCTs comparing kangaroo care should be conducted.

본 연구는 미숙아와 어머니를 대상으로 캥거루 케어 효과를 비교하기 위해 수행된 체계적 문헌고찰 및 메타분석 연구이다. 2015년 2월까지 출간된 무작위 임상실험연구를 검토하였으며, 국내문헌은 연구설계수준에 따른 제한 없이 비무작위 임상실험연구를 포함하였다. 문헌은 Ovid-Medline, CINAHL, PubMed와 국내 DB인 KoreaMed, 국립중앙도서관, 국회도서관, 국가과학기술전자도서관, KISS, RISS, 한국의학논문을 통해 ((kangaroo OR KC OR skin-to-skin) AND (care OR contact)) AND (infant OR preterm OR Low Birth Weight OR LBW), ((캥거루 OR 캉가루 OR 캉가루식) AND (케어 OR 간호 OR 관리 OR 돌보기 OR 피부접촉)) 등을 주요어로 조합하여 검색하였으며, 선택배제과정을 거쳐 최종 25편(n=3051)의 문헌이 분석에 포함되었다. 문헌에 대한 질평가는 SIGN에서 제시한 평가도구를 사용하였으며, 질평가 결과는 16편에서 ++, 9편에서 +로 평가되어 전반적으로 비뚤림 위험은 없는 것으로 판단하였다. 미숙아를 대상으로 한 캥거루 케어의 효과에 대한 메타분석 결과, 미숙아 사망률, 중증 감염/패혈증 발생률, 저체온 발생률, 병원입원기간, 모유수유율, 수면상태, 어머니의 불안, 어머니 역할수행 자신감, 어머니 역할수행 만족도에서 통계적으로 유의한 효과가 있었으며, 고체온 발생률, 미숙아의 성장발달(신장, 체중), 모아애착, 우울, 스트레스는 유의미한 차이가 없었다. 국내에서 캥거루 케어에 대한 무작위 임상실험연구 수가 적어 효과크기에 대한 확증적 결과를 얻는 데에는 다소 제한이 있었으므로 향후 이와 관련된 무작위 임상실험연구의 효과검증에 대한 노력이 지속적으로 이루어져야 할 것으로 사료된다.

Keywords

Acknowledgement

Supported by : 계명대학교

References

  1. Korea National Statistics Office, Birth certificate data 2011, Retrieved January 10, 2013, http://kostat.go.kr/portal/korea/kor_nw/2/2/3/index.board?bmode=read&aSeq=259 511, 2012.
  2. Hahn WH, Chang JY, Bae CW. Birth Statistics and Mortality Rates for Neonatal Intensive Care Units in Korean during, 2007: Collective Results from 57 Hospitals, J Korean Soc Neonatal, 16, 1, 36-47, 2009.
  3. Conde-Agudelo, A., Belizan, J. M., & Diaz-Rosello, J., Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Database of Systematic Reviews, 16, 4, CD002771, 2014.
  4. Lee, S. B., Shin, H. S., Effect of Kangaroo Care on Anxiety, Maternal Role Confidence, and Maternal Infant Attachment of Mothers who Delivered Preterm Infants, Journal of Korean Academy of Nursing, 37, 6, 949-956, 2007. https://doi.org/10.4040/jkan.2007.37.6.949
  5. Jang, M. Y., Effect of Kangaroo Care on Growth in Premature Infants and on Maternal Attachment, Journal Korean Academy Child Health Nursing, 15, 4, 335-342, 2009. DOI: http://dx.doi.org/10.4094/jkachn.2009.15.4.335
  6. Engler AJ, Ludington-Hoe SM, Cusson RM, Adams R, Bahnsen M, Brumbaugh F, et al., Kangaroo care: National survey of practice, knowledge, barriers, and perceptions, Maternal Child Nursing, 27, 3, 146-153, 2002. DOI: http://dx.doi.org/10.1097/00005721-200205000-00004
  7. Moon, Y. I., Koo, H. Y., The Effects of Kangaroo Care on Anxiety and Confidence and Gratification of Mothering Role in Mothers of Low Birth Weight Infants, Child Health Nursing Research, 6, 3, 281-290, 2000.d
  8. Lee, J. H., Bang, K. S., The Effects of Kangaroo Care on Maternal Self-esteem and Premature Infants' Physiological Stability, Korean Journal Women Health Nursing, 17, 5, 454-462, 2011. DOI: http://dx.doi.org/10.4069/kjwhn.2011.17.5.454
  9. Ali SM, Sharma J, Sharma R, Alam S., Kangaroo mother careas compared to conventional care for low birth weight babies, Dicle Medical Journal, 36, 3, 155-160, 2009.
  10. Blaymore Bier JA, Ferguson AE, Morales Y, Liebling JA, Archer D, Oh W, Vohr BR., Comparison of skin-to-skin contact with standard contact in low-birth-weight infants who are breast-fed, Archives of Pediatrics & Adolescent Medicine, 150, 12, 1265-1269, 1996. DOI: http://dx.doi.org/10.1001/archpedi.1996.02170370043006
  11. Boo NY, Jamli FM., Short duration of skin-to-skin contact: effects on growth and breastfeeding, Journal of Paediatrics and Child Health, 43, 12, 831-836, 2007. DOI: http://dx.doi.org/10.1111/j.1440-1754.2007.01198.x
  12. Cattaneo A, Davanzo R,Worku B, Surjono A, Echeverria M, Bedri A, Haksari E, Osorno L, Gudetta B, Setyowireni D, Quintero S, Tamburlini G., Kangaroo mother care for low birthweight infants: a randomized controlled trial in ifferent settings, Acta Paediatrica, 87, 9, 976-985, 1998. DOI: http://dx.doi.org/10.1111/j.1651-2227.1998.tb01769.x
  13. Charpak N,Ruiz-Pelaez JG, Figueroade C.Z, Charpak Y., Kangaroo mother versus traditional care for newborn infants 2000 grams: a randomized, controlled trial, pediatrics, 100, 4, 682-688, 1997. https://doi.org/10.1542/peds.100.4.682
  14. Eka Pratiwi IGAP, Soetjiningsih, Made KardaneI., Effect of kangaroo method on the risk of hypothermia andduration of birth weight regain in low birth weight infants: a randomized controlled trial, Paediatrica Indonesiana, 49, 5, 253-258, 2009. https://doi.org/10.14238/pi49.5.2009.253-8
  15. Gathwala G, Singh B, Balhara B., KMC facilitates mother baby attachmentin low birth weight infant, Indian Journal of Pediatrics, 75, 1, 43-47, 2008. DOI: http://dx.doi.org/10.1007/s12098-008-0005-x
  16. Ghavane S, Murki S, Subramanian S, Gaddam P, Kandraju H, Thumalla S., Kangaroo Mother Care in Kangaroo ward for improving the growth and breastfeeding outcomes when reaching term gestational ageinvery low birth weight infants, Acta Paediatrica, 101, 12, 545-549, 2012. DOI: http://dx.doi.org/10.1111/apa.12023
  17. Kadam S, Binoy S, Kanbur W, Mondkar JA, Fernandez A., Feasibility of kangaroo mother care in Mumbai, Indian Journal of Pediatrics, 72, 1, 35-38, 2005. DOI: http://dx.doi.org/10.1007/BF02760578
  18. Ramanathan K, Paul VK, Deorari AK, Taneja U, George G., Kangaroo Mother Care in very low birth weight infants, Indian Journal of Pediatrics, 68, 11, 1019-1023, 2001. DOI: http://dx.doi.org/10.1007/BF02722345
  19. Roberts KL, Paynter C, McEwan B., A comparison of kangaroo mother care and conventional cuddling care, Neonatal Network, 19, 4, 31-35, 2000. DOI: http://dx.doi.org/10.1891/0730-0832.19.4.31
  20. Rojas MA, Kaplan M, Quevedo M, Sherwonit E, Foster LB, Ehrenkranz RA, Mayes L., Somatic growth of preterm infants during skin-to-skin care versus traditional holding: a randomized, controlled trial, Journal of Developmental and Behavioral Pediatrics, 24, 3, 163-168, 2003. DOI: http://dx.doi.org/10.1097/00004703-200306000-00006
  21. Sloan NL, Camacho LW, Rojas EP, Stern C., Kangaroo mother method: randomised controlled trial of an alternative method of care for stabilised low-birthweight infants, Lancet, 344, 8925, 782-785, 1994. DOI: http://dx.doi.org/10.1016/S0140-6736(94)92341-8
  22. Suman RP, Udani R, Nanavati R., Kangaroo mother care for low birth weight infants: a randomized controlled trial, Indian Pediatrics, 45, 1, 17-23, 2008.
  23. Whitelaw A, Heisterkamp G, Sleath K, Acolet D, Richards M., Skin to skin contact for very low birth weight infants and their mothers, Archives of Disease in Childhood, 63, 11, 1377-1381, 1988. DOI: http://dx.doi.org/10.1136/adc.63.11.1377
  24. Worku B, Kassie A., Kangaroo mother care: a randomized controlled trial on effectiveness of early kangaroo mother care for the low birthweight infants in Addis Ababa, Ethiopia, Journal of Tropical Pediatrics, 51, 2, 93-97, 2005. DOI: http://dx.doi.org/10.1093/tropej/fmh085
  25. Evalotte Morelius, Annika Ortenstrand, Elvar Theodorsson, Anneli Frostell., A randomised trial of continuous skin-to-skin contact after preterm birth and the effects on salivary cortisol, parental stress, depression, and breastfeeding, Early Human Development, 91, 2015, 63-70, 2014.
  26. SM Nimbalkar, VK Patel, DV Patel, AS Nimbalkar, A Sethi and A Phatak., Effect of early skin-to-skin contact following normal delivery on incidence of hypothermia in neonates more than 1800g: randomized control trial, Journal of Perinatology, 2014, 34, 364-368, 2014. DOI: http://dx.doi.org/10.1038/jp.2014.15
  27. Koo, H. Y., The Effects of Kangaroo Care on Body Weight, Physiologic Responses and Behavioral States in Premature Infants, Journal of Korean Academy of Nursing, 30, 1, 171-182, 2000. https://doi.org/10.4040/jkan.2000.30.1.171
  28. Shin, H. J., Park, I. S., Effect of Kangaroo Care on Mental and Motor Development in Premature Infant and Maternal Role Confidence, Journal Korean Society Matern Child Health, 17, 2, 215-226, 2013. https://doi.org/10.21896/jksmch.2013.17.2.215
  29. Jang, M. Y., The Effect of Kangaroo Care on Weight and Stress Hormone(Cortisol) in Premature Infants, Journal Korean Academy Child Health Nursing, 14, 2, 138-145, 2008.