| dc.description.sponsorship | The literature review outlines the origin and development of KMC. Relevant biological and anthropological articles are summarised to provide a full background, as well as the recent history of modern neonatal care. Epidemiological and public health aspects relating to skin-to-skin contact, breastfeeding generally, breastfeeding of prematures, and feeding methods are reviewed. Research on KMC and the current status of KMC is described. Finally proposed rationales and hypotheses for KMC are summarised. The systematic review analyses 29 trials incorporating any control group, of these 14 articles were randomised controlled trials, the remainder being interrupted time series or historical controls. Only 6 trials were appraised as unlikely to be biased. All trials on birth KMC were done on fullterm infants. No trials on fullterm or premature infants showed any adverse effects of KMC. Comparisons of articles was difficult due to the variety of contexts and parameters described. A framework of the essential context and management parameters which are required to properly interpret controlled trials and management programmes for KMC is presented. A single study with an historical control suggests perinatal mortality can be improved with KMC practised continuously from birth. A formal randomised controlled trial is required before policy recommendations on this can be made. A fully prepared protocol with this objective concludes this thesis. Its primary hypothesis is that skin-to-skin contact from birth is superior to current conventional methods of care. It would in fact suffice to show that KMC is safe, and as good as the incubator for caring for the newborn. The study will require four nurse researchers to conduct continuous monitoring of cardiorespiratory functions for 6 hours post-birth on 100 mother-infant dyads, randomly assigned to KMC or conventional method of care. A detailed study design with data collection forms is provided, at a stage just prior to submission for ethics committee approval and funding application. | en_US |
