Standardizing a Method to Safely Perform Kangaroo Care for Neonates While on High-Frequency Jet Ventilation

Abstract

Background:

Kangaroo care (KC) is the valuable practice of holding a naked diaper-clad infant on the bare chest of a parent. High frequency jet ventilation (HFJV) is lung protective ventilation that is designed to minimize volume-induced injury to immature surfactant deficient alveoli. This type of ventilation requires one ventilator to deliver the Jet breaths and another ventilator to deliver the PEEP. Therefore, there are 2 circuits that are tethered to the already small endotracheal tube (usually 2.5 mm – 3.0 mm). This type of ventilation complicates the KC process because of the risk of an unplanned extubation (UE). Therefore, NICU’s Tiny Baby Workgroup composed of Physicians, Respiratory Therapists, Nurses and APP’s carefully developed a standardized method to provide KC to this population to reduce the risk of UEs.

Methods:

This is a Quality Improvement Observational Cohort Study, Retrospective Chart Review in which all premature infants (born 23.0-29.6 weeks gestation admitted to UK-KCH NICU who received HFJV from October 2017 to February 2019 were included. Comparison of neonates who received KC while on HFJV (Jet/KC) to those who did not receive KC while on HFJV (Jet/Non-KC). UE rates during KC on Jet-KC neonates was compared to UE due to other causes (poor ETT securement, repositioning, nursing care, emesis, agitation/spontaneous movement) in Jet/non-KC group. Chi-squared or Fisher’s exact tests were used to compare categorical variables.

Results:

Data was collected for a total of 34 extremely premature infants placed on HFJV between October 2017 and February 2019. Three neonates were excluded due to insufficient clinical information. Out of 61 neonates on HFJV, 20 neonates received KC (Jet/KC group), of which 4 had UEs during KC. There were 41 neonates in the Jet/non-KC group, of which 14 had UE due to other causes as mentioned in the Methods Section. There was no significant difference in the incidence of UE between the 2 groups (P = .56) using Chi Square analysis as a measure of association. Gestational age in weeks (24.9 ± 1.46 vs 25.7 ± 1.52, Mean ± SD, P = .06) and birth weight in grams (742.8 ± 225.14 vs 812.9 ± 234.27 Mean ± SD, P = .27) were comparable in Jet/KC and Jet/Non-KC groups respectively.

Conclusions:

This observational cohort study demonstrates that KC can be safely used with HFJV without significant risk of UE. KC while on HFJV did not result in an increase in UE in extreme prematurity compared to other causes.