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Kangaroo Care, Preterm infants, Nursing practice, Skin-to-skin contact



  1. Engler, Arthur J. DNSc, RNC, APRN
  2. Ludington-Hoe, Susan M. PhD, CNM, FAAN
  3. Cusson, Regina M. PhD, RNC, APRN
  4. Adams, Rene MS, RNC
  5. Bahnsen, Millie MS, RNC, CRNP
  6. Brumbaugh, Eileen MS, RNC, NNP
  7. Coates, Patricia MS, RNC, CRNP
  8. Grieb, Jane MS, RNC, NNP
  9. McHargue, Lisa MS, RNC, CRNP
  10. Ryan, Deborah L. MS, RNC, NNP
  11. Settle, Mary MS, RNC, NNP
  12. Williams, Denise MS, RNC, CRNP


Purpose: A national survey was conducted to assess practice, knowledge, barriers, and perceptions regarding Kangaroo Care (KC)-the holding of diaper-clad preterm infants skin-to-skin, chest-to-chest by parents.


Design: A descriptive survey was conducted.


Methods: Kangaroo Care Questionnaires (KCQs), developed for the study, were sent to nurse managers in all hospitals in the United States that were identified as providing neonatal intensive care services (N = 1,133), and were to be completed by the nurse most familiar with the practice of KC in that unit. A second KCQ was sent to nonrespondents. Descriptive statistics were used to summarize the data.


Results: A response rate of 59% (N = 537) was achieved. Over 82% of the respondents reported practicing KC in their neonatal intensive care units (NICUs). Nurses were knowledgeable about KC. Major barriers to practicing KC for certain types of infants were infant safety concerns, as well as reluctance by nurses, physicians, and families to initiate or participate in KC. Many NICUs do not permit KC for certain types of infants (e.g., those on vasopressors or high-frequency ventilation). Over 60% of respondents agreed that low gestational age or weight were not contraindications. Respondents from NICUs in which KC is practiced were more positive in their perceptions than respondents from NICUs that do not practice KC.


Clinical Implications: The findings suggest that in order to overcome barriers to the practice of KC, nurses need educational offerings highlighting the knowledge and skills needed to provide KC safely and effectively. These educational offerings should also emphasize the value of KC to infants and parents. In addition, knowledgeable practitioners need to develop evidence-based policies and procedures that will lead to successful KC.