WIP 4 - Improving Rates of Kangaroo Care Equitably in a Level IV Neonatal Intensive Care Unit

Poster Number: WIP 4
Publication Number: WIP 4.2626

Background: Kangaroo mother care (KMC) is associated with improved outcomes for preterm and low birth weight infants in the neonatal intensive care unit (NICU). KMC reduces overall risk of death, sepsis and hypothermia and improves rates of exclusive breastfeeding at hospital discharge and infant growth. Despite clear evidence supporting the benefits of this low-cost, high-yield intervention, there remain multiple barriers to achieving consistent KMC in the NICU that have been widened by disparities. Our center, a level IV NICU, had low baseline rates of KMC, with 43% of eligible infants being held within the first 24 hours of life and 25% of infants never having a documented instance of KMC during their admission.

Objective: The primary SMARTIE aim of this project is to increase the number of eligible infants receiving KMC at the University of Washington NICU within the first 24 hours of life by 25% over a 6-month period and increase any documentation of KMC during their stay to 75% irrespective of parental language of care, race or ethnicity.

Design/Methods: IRB approval has been obtained and baseline data collected from May 2022 to April 2023. Potential barriers and interventions to improve rates of KMC were identified and a key driver diagram was developed. The primary outcomes of this project will be time to first hold and total number of holds per admission. Secondary outcomes will include cumulative duration of KMC, total holds per admission for each caregiver, families preferred language and self-identified race/ethnicity. Balancing measures will include unplanned extubation, line removal and severe apnea, bradycardia or desaturation events.
Our first PDSA (Plan-Do-Study-Act) cycle will be the development of an updated standardized clinical guideline of who and when kangaroo holding should occur based on clinical factors such as gestational age. Second and third PDSA cycles respectively will include optimization of the electronic medical record for easy documentation of KMC and provider, nursing, and family focused education on the importance of KMC.