Kangaroo Care for Premature Babies in the NICU

Innovative i-Rainbow guide helps parents and caregivers know when the time is right for vital skin-to-skin care

An adult hand holding a newborn's hand

Kangaroo Care Awareness Day is May 15, so it’s a great time to celebrate the positive health benefits that kangaroo care has for newborns. Several studies show that kangaroo care—skin-to-skin time between a baby and a parent—lowers the risk of newborn health problems, promotes breastfeeding, and helps establish a bond between parents and babies.

That’s all great news, but when you have a premature baby who is staying in the Neonatal Intensive Care Unit (NICU), it can be hard to know when and how to provide kangaroo care. Your child may be hooked up to machines for feeding and oxygen and seem very small and fragile. As a new parent, you can find it intimidating to hold and nurture your child.

We encourage you to find a way to interact with your premature baby and work up to kangaroo care, because your loving touch and support is an extremely important aspect of your baby’s neurodevelopment.

“Certainly, you want to provide kangaroo care as early and as often as possible as soon as your baby is ready, but if your baby is very immature or ill, it can be hard to know when it’s the right time,” says Melissa Scala, MD, neonatal-perinatal medicine specialist at Stanford Medicine Children’s Health.

A Rainbow of options for preemie interaction

To encourage parents to get involved in their premature baby’s care in the NICU, Dr. Scala and colleagues Eilish Byrne, PT, DSC, and Allison Freccero, OTD, OTR/L, developed the i-Rainbow, a novel evidence-based clinical guide that helps doctors and nurses determine the type of interaction that a critically ill premature baby is ready for, including kangaroo care. The i-Rainbow is based on a six-level color-coded acuity scale, like a rainbow. Each stage has detailed, clear medical criteria on what type of interaction a baby can receive. At each stage, a menu of activities is provided for parents to choose from. 

“In stage one, parents use the gentlest way to interact: sharing the maternal scent. Next, they put still hands on their baby to mimic the boundaries of the uterus. Stage three can be talking or singing to your baby,” Dr. Scala says. “The early stages prepare babies for kangaroo care, which includes all of these interactions at once.”

Babies can move up and down the rainbow, depending on their current health. Some stay in one stage for weeks, while others move in a single day. The i-Rainbow is a one-of-a-kind protocol allowing real-time flexibility and meeting a baby where she or he is. Unlike other protocols in the nation, it enables the care team to practice precision medicine and develop a customized care plan specific to a baby’s condition and current state.

Empowering parents to provide kangaroo care

Having a baby in the NICU is overwhelming. Parents can feel a loss of control and constant worry for their premature baby.

“Their dreams of what it would be like to be a new parent are shattered. Parents can feel adrift and unsure how to be a parent, or unsure of what their role is to help their baby grow and develop,” Dr. Scala says. “I-Rainbow helps them replace the activities they thought they would be doing with new ones.”

When a baby tolerates scent, gentle touching, and talking and singing, they graduate to stage four, and it’s skin-to-skin time with baby lying on a parent’s bare chest. Kangaroo care is linked to lower rates of depression and anxiety in parents, measured by a drop in cortisol levels.

“Being involved in their premature baby’s care reduces parental stress and improves their sense of self-efficacy. Parents are super-important in their baby’s neurodevelopmental growth,” Dr. Scala says.

Not many places offer the i-Rainbow, but that’s changing, since Dr. Scala and her Stanford Children’s colleagues have made it freely available for other hospitals to adopt. It’s now in use at more than 20 hospitals across the country. Having set criteria also evens the playing field, helping to remove disparities and biases in care.

Ask to be involved in your baby’s care

If you, a friend, or a family member have a baby in the NICU, remember to be proactive.

“The number one thing I wish parents of premature babies would do is ask their hospital team, ‘How can I be involved in my baby’s care, today?’ This reminds the NICU team to communicate the important ways parents can contribute to helping their babies grow and develop,” Dr. Scala says. “They will find a way for you to interact.”

Learn more about kangaroo care >


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