Providing more effective kangaroo care during the COVID-19 pandemic: A quality improvement project in a Lebanese neonatal intensive care unit

Abstract Background Kangaroo care has become the standard in caring for preterm infants; however, its application still faces many barriers due to insufficient staff or parental education or participation and most recently visitation restrictions after the COVID-19 pandemic. Methods This quality improvement project (QIP) took place in a tertiary center’s neonatal intensive care unit in Lebanon from September 2018 to March 2021. It aimed to increase kangaroo care practice and maternal milk use among admitted infants. Nurses and parents received education and hands-on training about kangaroo care and skin-to-skin contact. Nurses’ and parents’ knowledge, attitude, and behavior toward kangaroo care were evaluated pre- and post-intervention. Balancing measures included hypothermia, central line infection, catheter dislodgement, and babies being dropped. COVID-19 visitation restrictions during QIP cycles were documented. Results A total of 143 infants received kangaroo care during the project period and 105 (73%) were ≤34 weeks of gestation. By the end of the QIP, kangaroo care practice increased from 2.5 to 7 h per infant stay (from a median of 45 min per session to 60 min per session). Infants receiving more than five kangaroo care sessions had higher maternal milk use (71.3% vs. 52.8%; P = 0.002) and growth velocity (12.1 vs. 2.0 g/kg/day; P < 0.001). Parents’ perceived behavior and frequency of performing kangaroo care–related tasks improved significantly (P < 0.005) compared to before QIP. Thirty-seven of 44 participating nurses reported more perceived behavior transferring ventilated babies (P = 0.049). Conclusion This QIP successfully increased kangaroo care practice and maternal milk use in a resource-limited environment, despite COVID-19 restrictions. More work is needed to ensure sustainability and replicability.