By Diane Schultz
“Safety should be a birthright” Clementine Wamariya
Before continuing with the posts I thought I should address a very important issue when it comes to KC
As I have said before I believe fully in the benefits of KC for any infant (premature or full term). To enable that infant and family to benefit from KC, safety must always be part of the equation.
A risk factor for Apparent Life threatening Events (ALTE) is KC that is unsupervised and without an attentive observer. Despite this risk, when comparisons are made between ALTEs with KC and ALTEs without; ALTEs without KC were higher. Another term that has been talked about since KC has been increasing in NICUs and Maternal Child areas is Sudden Unexpected Postnatal Collapse (SUPC), a rare event but can have catastrophic consequences.
Risk factors for SUPC include:
First breastfeeding attempt
Mother in episiotomy position
A primiparous mother
Parents left alone with baby during the first hours after birth
Implementations to Reduce SUPC:
A continual secure surveillance of the newborn in the first hours and days of life
Safe early skin to skin care (SSC) in the delivery room
Safe breastfeeding establishment in the first days of life
Secure positioning of the infant during sleep
SUPC of Newborn infants: A review of cases, definitions, risks and preventative measures. Herlenius E., and Kuhn P. (2013)
Our Maternal/Child department is incredibly busy as are most centres these days. Every effort must always be made to fully educate staff and the families about safety for our newborns.
Safety Education should include:
Anytime KC is happening there should be attentive and continuous observation
To facilitate respiratory expansion, infant should be elevated off of horizontal (Bohnhourst, 2010; Heinman et al, 2010)
There should be no obstruction of the infant’s nose and the head needs to be turned to one side
Neck should not be flexed or extended but in a slight “sniffing” position
Infant’s body should be positioned to maintain ventral surface to ventral surface contact
Infant should be secured with blankets, wraps and/or parent’s hands to prevent sliding (I prefer using the parent’s hands to contain the infant and then cover them both with blankets. I feel the parent has better awareness of babe’s position that way)
Our unit is made up of pods with curtains that can divide each bedside. When our parents are holding KC those curtains are to be left open so the nurse can observe. We prop our parent’s arms so they don’t get tired and tuck both in with blankets. We have also created a standard work procedure for our intubated and fragile infants so staff transfer and secure the infant the same way each time.
We also attend all high-risk deliveries. When I leave babies in kangaroo position after a delivery, I always make sure the baby’s face is turned toward the L&D nurse, not away so she can easily observe the infant even if she is tending to mom.
Everything we do in life has risks; swimming, driving a vehicle, voting, etc. To do these things there are safety measures put in place. You wouldn’t avoid driving a car because it has safety risks. You take driving lessons, pass a test, follow the rules of the road, and that way you get to enjoy the benefits of driving. I feel it is the same with KC, education and safety measures should always be in place so that infant and family can enjoy the benefits.