# embeddings_queue

created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 0f32fef4-690f-44ea-9165-61e88211ef8f
encoding: FLOAT32
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{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 32, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 584, "chroma:document": "\uf8ff if apnoeic spells become more frequent, examine the baby: this may be an early sign\nof infection. Treat according to the institutional protocol.\nOnce the baby has recovered from the initial complications due to preterm birth, is stable\nand is receiving KMC, the risk of serious illness is small but significant. The onset of a serious\nillness in small babies is usually subtle and is overlooked until the disease is advanced and\ndifficult to treat. Therefore it is important to recognize those subtle signs and give prompt\ntreatment. Teach the mother to recognize danger signs and ask her to seek care when\nconcerned. Treat the condition according to the institutional guidelines.\nDanger signs\n\u00b5 Difficulty breathing, chest in-drawing, grunting\n\u00b5 Breathing very fast or very slowly\n\u00b5 Frequent and long spells of apnoea\n\u00b5 The baby feels cold: body temperature is below normal despite rewarming\n\u00b5 Difficulty feeding: the baby does not wake up for feeds anymore, stops feeding or\nvomits\n\u00b5 Convulsions"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 72ffbff3-5e48-4f04-9620-77d91529cf12
encoding: FLOAT32
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{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 32, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 585, "chroma:document": "vomits\n\u00b5 Convulsions\n\u00b5 Diarrhoea\n\u00b5 Yellow skin\n27"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 17e7f758-a38e-4100-9f65-57be94c25c1a
encoding: FLOAT32
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{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 33, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 586, "chroma:document": "KANGAROO MOTHER CARE\nReassure the mother that there is no danger if the baby:\n(cid:1) sneezes or has hiccups;\n(cid:1) passes soft stools after each feed;\n(cid:1) does not pass stools for 2-3 days.\n4.7 Feeding\nBreastfeeding preterm babies is a special challenge.\nFor the first few days a small baby may not be able to take any oral feeds and may need to be\nfed intravenously. During this period the baby receives conventional care.\nOral feeds should begin as soon as baby\u2019s condition permits and the baby tolerates them.\nThis is usually around the time when baby can be placed in kangaroo position. This helps the\nmother to produce breast milk, so it increases breastfeeding.\nBabies who are less than 30 to 32 weeks gestational age usually need to be fed through a\nnaso-gastric tube, which can be used to give expressed breast milk. The mother can let her baby\nsuck her finger while he is having tube feeds. Tube-feeding can be done when the baby is in\nkangaroo position."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: a7d5d5b0-bffe-4c30-a6b7-cee0c4dfea47
encoding: FLOAT32
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{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 33, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 587, "chroma:document": "kangaroo position.\nBabies between 30 and 32 weeks gestational age can take feeds from a small cup. Cup feeds\ncan be given once or twice daily while a baby is still fed mostly through a naso-gastric tube. If\nhe takes cup feeds well, tube-feeding can be reduced. For cup-feeding the baby is taken out of\nthe kangaroo position, wrapped in a warm blanket and returned to the kangaroo position after\nthe feed. Another way to feed a baby at this stage is by expressing milk directly into the baby\u2019s\nmouth. This way the baby does not need to be taken out from the kangaroo position.\nBabies of about 32 weeks gestational age or more are able to start suckling on the breast.\nBaby may only root for the nipple and lick it at first, or he may suckle a little. Continue giving\nexpressed breast milk by cup or tube, to make sure that the baby gets all that he needs.\nWhen a small baby starts to suckle effectively, he may pause during feeds quite often and"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: fd3879d0-9e36-4022-ae81-b350d39adec7
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 33, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 588, "chroma:document": "When a small baby starts to suckle effectively, he may pause during feeds quite often and\nfor quite long periods. It is important not to take him off the breast too quickly. Leave him on\nthe breast so that he can suckle again when he is ready. He can continue for up to an hour if\nnecessary. Offer a cup feed after the breastfeed, or alternate breast and cup feeds.\nMake sure that the baby suckles in a good position. Good attachment may make effective\nsuckling possible at an earlier stage.\nBabies from about 34 to 36 weeks gestational age or more can often take all that they need\ndirectly from the breast. However, supplements from a cup continue to be necessary\noccasionally.\nDuring this initial period the mother needs a lot of support and encouragement to establish\nand maintain lactation until the baby is ready to breastfeed. Primiparae, adolescent mothers,\nand mothers of very small infants may need even more encouragement, help and support\nduring the institutional stay and later at home."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 52fa3722-7aeb-4286-a893-fdd1e931fc33
encoding: FLOAT32
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{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 33, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 589, "chroma:document": "during the institutional stay and later at home.\n28"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 6938a8a0-5d6e-4ec5-93b8-e49dbbd01208
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 34, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 590, "chroma:document": "Discuss breastfeeding with the mother\n\uf8ff Reassure her that she can breastfeed her small baby and she has enough milk;\n\uf8ff explain that her milk is the best food for such a small baby. Feeding for him is even\nmore important than for a big baby;\n\uf8ff at the beginning a small baby does not feed as well as a big baby; he may\n\u2013tire easily and suck weakly at first\n\u2013suckle for shorter periods before resting\n\u2013fall asleep during feeding\n\u2013have long pauses after suckling, and feed longer\n\u2013not always wake up for feeds;\n\uf8ff explain that breastfeeding will become easier as baby becomes older and bigger;\n\uf8ff help her place and attach the baby in the kangaroo position.\nBreastfeeding\nThe kangaroo position is ideal for breastfeeding. As soon as the baby shows signs of readiness\nfor breastfeeding, by moving tongue and mouth, and interest in sucking (e.g. fingers or\nmother\u2019s skin), help the mother to get into a breastfeeding position that ensures good\nattachment."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 9048fb92-d793-4490-86f5-fd58bbef99c0
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 34, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 591, "chroma:document": "mother\u2019s skin), help the mother to get into a breastfeeding position that ensures good\nattachment.\nTo start breastfeeding choose appropriate time - when the baby is waking from a sleep,\nor is alert and awake. Help the mother to sit comfortably in an armless chair with the baby in\nskin-to-skin position. For the first breastfeeds take the baby out of the pouch and wrap or dress\nhim to better demonstrate the technique. Then put the baby into the kangaroo position and ask\nthe mother to ensure good position and attachment.19\nHelp the mother to position her baby\n\uf8ff Show the mother the correct position and attachment for breastfeeding;\n\uf8ff show the mother how to hold her baby:\n\u2013 hold the baby\u2019s head and body straight;\n\u2013 make the baby face her breast, the baby\u2019s nose opposite her nipple;\n\u2013hold the baby\u2019s body close to her body;\n\u2013support the baby\u2019s whole body, not just the neck and shoulders;\n\uf8ff show the mother how to help her baby to attach:\n\u2013 touch her baby\u2019s lips with her nipple;"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: c560f0a6-fefc-4d60-8968-20413f87d9d3
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 34, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 592, "chroma:document": "\uf8ff show the mother how to help her baby to attach:\n\u2013 touch her baby\u2019s lips with her nipple;\n\u2013 wait until her baby\u2019s mouth is wide open;\n\u2013 move her baby quickly onto her breast, aiming the infant\u2019s lower lip well below\nthe nipple;\n\uf8ff show the mother signs of good attachment:\n\u2013 baby\u2019s chin is touching her breast;\n\u2013 his mouth is wide open;\n\u2013 his lower lip is turned out;\n\u2013 a larger area of the areola is visible above rather than below the baby\u2019s mouth;\n\u2013 sucks are slow and deep, sometimes pausing.\n29"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 1f4d1a24-e864-43ed-a965-27c0ba770a5d
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 35, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 593, "chroma:document": "KANGAROO MOTHER CARE\nLet the baby suckle on the breast as long as he wants. The baby may feed with long pauses\nbetween sucks. Do not interrupt the baby if he is still trying.\nSmall babies need breastfeeding frequently, every 2-3 hours. Initially they may not wake up\nfor feeds and must be wakened. Changing the baby before the feed may make him more alert.\nSometimes it helps to express a little milk with each suck. If the breast is engorged, encourage\nthe mother to express a small amount of breast milk before starting breastfeeding; this will\nsoften the nipple area and it will be easier for the baby to attach.\nEven if the baby is not yet suckling well and long enough (very preterm), offer the breast\nfirst, and then use an appropriate alternative feeding method. Do whatever works best in your\nsetting: let the mother express breast milk into baby\u2019s mouth or let her express breast milk and\nfeed it to the baby by cup or tube.\nFig.7 Breastfeeding in KMC"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 5cc5af2b-6a8f-4e9e-9279-4e217b243c3e
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{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 35, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 594, "chroma:document": "feed it to the baby by cup or tube.\nFig.7 Breastfeeding in KMC\nGive special support to mothers who breastfeed twins\n\uf8ff Reassure the mother that she has enough breast milk for two babies;\n\uf8ff explain to her that twins may take longer to establish breastfeeding since they are\nfrequently born preterm and with low birth weight.\n30"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: a645f426-2643-4c66-8c37-d193d2dcb153
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 36, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 595, "chroma:document": "Help the mother feed her twins\n\uf8ff Feeding one baby at a time until breastfeeding is well established;\n\uf8ff finding the best method for her twins: if one is weaker, encourage her to make sure\nthat the weaker twin gets enough milk. If necessary, she can express milk for him\nand feed him by cup after initial breastfeeding;\n\uf8ff alternating the side each baby is offered daily.\nAlternative feeding methods\nThe baby can be fed by expressing breast milk directly into his mouth or giving expressed\nmother\u2019s breast milk or appropriate formula by cup or tube.\nExpressing breast milk\nHand expression is the best way to express breast milk. It is less likely to carry infection than\na pump, and can be used by every woman at any time. A technique to express milk effectively\nis described in the WHO breastfeeding counselling course.19\nShow the mother how to express breast milk and let her do it. Do not express her milk for"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 86374b12-4a56-47a9-a0f8-9e1f84f50829
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 36, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 596, "chroma:document": "Show the mother how to express breast milk and let her do it. Do not express her milk for\nher. To establish lactation and feed a small baby she should start expressing milk on the first\nday, within six hours of delivery, if possible. She should express as much as she can and as often\nas the baby would breastfeed. This means at least every 3 hours, including during the night. To\nbuild up her milk supply, if it seems to be decreasing after a few weeks, she should express her\nmilk very often for a few days (every hour) and at least every 3 hours during the night.\nMothers often develop their own style of hand expression once they have learned the basic\nprinciples. Some will express both breasts at the same time, leaning forward with a container\nbetween their knees and pausing every few minutes to let the sinuses refill with breast milk.\nEvery mother will find her own rhythm, which is usually slow and regular. Encourage mothers"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 8445dfba-8dbc-4b44-a6cb-47556a8341a3
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 36, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 597, "chroma:document": "Every mother will find her own rhythm, which is usually slow and regular. Encourage mothers\nto express breast milk their own way, providing it works for them.\nIf a mother is expressing more milk than her small baby needs, let her express the second\nhalf of the milk from each breast into a different container. Let her offer the second half of\nthe expressed breast milk first. This way the baby gets more hind milk, which gives him the\nextra energy he needs and helps him grow better. If the mother can only express very small\nvolumes at first, give whatever she can produce to her baby and supplement with formula\nmilk if necessary.\nExpressing breast milk takes time, patience and forward planning. Ask the mother to start\nat least half an hour before the baby\u2019s feed, irrespective of the method used. If possible, use\nfreshly expressed breast milk for the next feed. If there is more milk than the baby needs, it\ncan be stored in a refrigerator for up to 48 hours at 4\u00b0C.\n31"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: e16baa2a-10e2-4349-a7e8-32c2f936bc15
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 37, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 598, "chroma:document": "KANGAROO MOTHER CARE\nExpressing breast milk directly into baby\u2019s mouth\nBreast milk can be expressed directly into the baby\u2019s mouth, but the mother should first\nbecome familiar with expressing breast milk by hand.\nThe baby can be fed while in kangaroo position\n\uf8ff Hold the baby in skin-to-skin contact, the mouth close to the nipple;\n\uf8ff wait until the baby is alert and opens mouth and eyes (very small babies may need\nlight stimulation to be kept awake and alert);\n\uf8ff express a few drops of breast milk;\n\uf8ff let the baby smell and lick the nipple, and open the mouth;\n\uf8ff express breast milk into the baby\u2019s open mouth;\n\uf8ff wait until baby swallows the milk;\n\uf8ff repeat the procedure until the baby closes his mouth and will take no more breast milk\neven after stimulation;\n\uf8ff ask the mother to repeat this operation every hour if the baby weighs less than 1200g\nand every two hours if the baby weighs more than 1200g;\n\uf8ff be flexible at each feed, but check that the intake is adequate by measuring the daily"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: ae0d321c-10c2-47da-a972-fdd09fad8fca
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 37, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 599, "chroma:document": "\uf8ff be flexible at each feed, but check that the intake is adequate by measuring the daily\nweight gain.\nExperience shows that mothers learn this method quickly. Moreover, it has an advantage over\nother methods since no utensils are required, thus ensuring good hygiene. It is not possible,\nhowever, to assess the amount of milk given, especially at the beginning, when it could be too\nsmall for the baby\u2019s needs. Later, it can be assumed to be adequate as long as the baby is\ngaining weight (see below). The method has, however, not been assessed systematically and\ncompared to other methods.\nCup-feeding\nCups and other traditional utensils such as the \u201cpaladai\u201d in India53 can be used to feed even\nvery small babies, as long as they swallow the milk.59,60 For details of cup-feeding techniques, see\nthe WHO breastfeeding counselling course (pp. 340-344).19\nMothers can easily learn this technique and feed their babies with adequate amounts of milk."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: b15833c6-5065-4abf-b0f8-61ec0d3c76de
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 37, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 600, "chroma:document": "Mothers can easily learn this technique and feed their babies with adequate amounts of milk.\nCup-feeding presents a few advantages over bottle-feeding since it does not interfere with\nsuckling at the breast; a cup is easily cleaned with soap and water, if boiling is not possible, and\nenables the baby to control his own intake. At first, the mother may prefer to take the baby out\nof the kangaroo position.\nSyringe or dropper-feeding\nThe technique is similar to that for expressing breast milk in baby\u2019s mouth: measure the\nrequired amount of breast milk in a cup and pour it directly into the baby\u2019s mouth with a\nregular or special spoon, syringe or dropper. Some more milk is given once the baby has\nswallowed the given amount. Spoon-feeding takes longer than cup-feeding and spillage can\nbe substantial. Feeding with syringes and droppers is not faster than cup-feeding. Moreover,\nsyringes and droppers are more difficult to clean and more expensive.\n32"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 9faf9c2f-7726-40f6-9209-9ace285b5b06
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 38, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 601, "chroma:document": "Bottle-feeding\nThis is the least preferred feeding method and is not recommended. It may hinder breathing\nand oxygenation61, 62 and it interferes with suckling. Bottles and teats must be sterilized in\ninstitutions, and boiled at home.\nTube-feeding\nTube-feeding is used when the baby cannot yet swallow, or coordinate swallowing and\nbreathing, or tires too easily and does not get enough milk. While the health worker inserts\nthe tube and prepares the syringe or dropper, mother can let the baby suck her breast.\nThe baby can be tube-fed in the kangaroo position.\nHow to insert a tube\n\uf8ff Take the baby out of the kangaroo position, wrap her in a warm cloth and place her on\na warm surface;\n\uf8ff insert the tube through the baby\u2019s mouth rather than the nose: small babies breathe\nthrough the nose and the tube placed in the nostrils may obstruct breathing;\n\uf8ff use No. 5 to No. 8 French gauge short feeding tubes, depending on the size of the\ninfant;"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 30c08b24-cd2e-4aee-874f-64b8b3dbbbce
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 38, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 602, "chroma:document": "\uf8ff use No. 5 to No. 8 French gauge short feeding tubes, depending on the size of the\ninfant;\n\uf8ff measure and mark the distance from the mouth to the ear and to the lower tip of the\nsternum on the tube with a felt pen;\n\uf8ff pass the tube through the mouth into the stomach until the felt pen mark reaches the\nlips; baby\u2019s breathing should be normal with the tube in place;\n\uf8ff secure the tube to the infant\u2019s face with a tape;\n\uf8ff replace the tube every 24-72 hours. Keep it closed or pinched while removing it to\navoid dripping fluid into the baby\u2019s throat.\nHow to prepare and use the syringe\n\uf8ff Determine the amount of milk for the feed (Table 3);\n\uf8ff choose the corresponding size syringe;\n\uf8ff remove the piston from the syringe and discard it;\n\uf8ff attach the syringe to the tube;\n\uf8ff pour the required amount of breast milk into the syringe;\n\uf8ff hold the syringe barrel above baby\u2019s stomach and let the milk flow by gravity;\ndo not inject the milk;"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: fd466b9e-bd53-4f5a-b69e-32c558363fe1
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 38, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 603, "chroma:document": "do not inject the milk;\n\uf8ff observe the baby during feeding for any change in breathing and spilling;\n\uf8ff when feeding is completed close off the tube with a spigot;\n\uf8ff during tube-feeding baby can suck the breast or the mother\u2019s finger (Fig.8).\n33"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 0492f3e7-8700-461e-a955-af4e40e1020b
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 39, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 604, "chroma:document": "KANGAROO MOTHER CARE\nAs soon as the baby shows signs of readiness for oral feeding (breastfeeding or cup, spoon,\nsyringe, or dropper-feeding), feed at first once or twice a day, while the baby is still mostly fed\nthrough a tube. Gradually reduce tube feeds and remove the tube when the baby takes at least\nthree consecutive feeds of breast milk by cup.\nQuantity and frequency\nFrequency of feeding will depend on the quantity of milk the baby tolerates per feed and the\nrequired daily amount. As a guide, the amount per feed for small newborn preterm babies\nshould be steadily increased as follows:\n(cid:1) up to day 5 slowly increase the total amount and the amount per feed, to help the\nnewborn infant get used to enteral feeding;\n(cid:1) after day 5 steadily increase the quantity to achieve the amount required for the baby\u2019s age as\nindicated in Tables 2 and 3;\n(cid:1) by day 14 the baby should take 200ml/kg/day, which is the amount required for steady growth."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 4dccca63-7d8d-4d1c-94bb-8826bb6547ee
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 39, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 605, "chroma:document": "Table 3 shows the approximate amount and number of feeds required as the baby grows\nolder. Avoid overfeeding or feeding too rapidly to lessen the risk of milk aspiration or\nabdominal distension.\nVery small babies should be fed every two hours, larger babies every three hours. If necessary,\nwake mother and baby during the day and night to ensure regular feeding.\nTable 2. Amount of milk (or fluid) needed per day by birth weight and age\nBirth weight Feed every Day 1 Day 2 Day 3 Day 4 Day 5 Days 6-13 Day 14\n1000-1499g 2 hours 60 ml/kg 80 ml/kg 90 ml/kg 100 ml/kg 110 ml/kg 120-180 180-200\n\u22651500 g 3 hours ml/kg ml/kg\nTable 3. Approximate amount of breast milk needed per feed by birth weight and age\nBirth weight Number Day 1 Day 2 Day 3 Day 4 Day 5 Days 6-13 Day 14\nof feeds\n1000g 12 5 ml/kg 7 ml/kg 8 ml/kg 9 ml/kg 10 ml/kg 11-16 ml/kg 17 ml/kg\n1250g 12 6 ml/kg 8 ml/kg 9 ml/kg 11 ml/kg 12 ml/kg 14-19 ml/kg 21 ml/kg\n1500g 8 12 ml/kg 15 ml/kg 17 ml/kg 19 ml/kg 21 ml/kg 23-33 ml/kg 35 ml/kg"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: adeb8634-ec10-48bb-8706-cc7821c26f91
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 39, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 606, "chroma:document": "1500g 8 12 ml/kg 15 ml/kg 17 ml/kg 19 ml/kg 21 ml/kg 23-33 ml/kg 35 ml/kg\n1750g 8 14 ml/kg 18 ml/kg 20 ml/kg 22 ml/kg 24 ml/kg 26-42 ml/kg 45 ml/kg\n2000g 8 15 ml/kg 20 ml/kg 23 ml/kg 25 ml/kg 28 ml/kg 30-45 ml/kg 50 ml/kg\nTransition from an alternative feeding method to exclusive breastfeeding may occur earlier\nin larger babies and much later in very small babies and may take a week. Encourage mother\nto start breastfeeding as soon as the baby shows signs of readiness. At the beginning the baby\nmay not suckle long enough but even short sucking stimulates milk production and helps the\nbaby to \u201cpractice\u201d. Keep reassuring the mother and helping her with breastfeeding the baby.\nAs the baby grows, gradually replace scheduled feeding with feeding on demand.\n34"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 611c04f7-5296-493e-ad67-1d22a921c89e
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 40, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 607, "chroma:document": "When the baby moves on to exclusive breastfeeding and measuring the amount of milk intake\nis not possible, weight gain remains the only way to assess whether feeding is adequate.\nFig.8 Tube-feeding in KMC\nIf the mother is HIV-positive and chooses replacement feeding, suggest using cup-feeding.\nFor further information on this issue, please refer to HIV and infant feeding counselling\ncourse.20\n4.8 Monitoring growth\nWeight\nWeigh small babies daily and check weight gain to assess first the adequacy of fluid intake\nand then growth. Small babies lose weight at first, immediately after birth: weight loss of up to\n10% in the first few days of life has been considered acceptable. After the initial weight loss,\nnewborn babies will slowly regain birth weight, usually between 7 and 14 days after birth. After\nthat babies should be gaining weight, a little at the beginning, more later on. No weight loss is"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 4b0bae46-b894-41c9-8c2f-79a7bad79845
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 40, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 608, "chroma:document": "that babies should be gaining weight, a little at the beginning, more later on. No weight loss is\nacceptable though after this initial period. Good weight gain is considered a sign of good health,\npoor weight gain is a serious concern. There is no upper limit for weight gain for breastfed\ninfants, but the lower limit should be no less than 15g/kg/day.\nAdequate daily weight gain from the second week of life is15g/kg/day.\nApproximate weight gains for different post-menstrual ages are given\nbelow:\n(cid:1) 20g/day up to 32 weeks of post-menstrual age, corresponding approximately\nto 150-200g/week;\n(cid:1) 25g/day from 33 to 36 weeks of post-menstrual age, corresponding approximately\nto 200-250g/week;\n(cid:1) 30g/day from 37 to 40 weeks of post-menstrual age, corresponding approximately\nto 250-300g/week.\n35"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: a62c6f55-1f50-48d4-96a2-d277bf3b03b8
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 41, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 609, "chroma:document": "KANGAROO MOTHER CARE\nThere are no universally accepted recommendations regarding frequency of growth\nmonitoring for LBW and preterm infants. There is no universal reference chart for plotting the\npostnatal weight gain of those babies but intrauterine growth charts by week of gestation, with\npercentiles or standard deviations, are used instead.\nIt is not known whether an extrauterine growth similar to the one the preterm infant would\nhave had in utero is an appropriate criterion for monitoring postnatal weight gain. It seems\nreasonable, however, to aim for a weight of at least 2500g or more by the 40th week of\npost-menstrual age.\nThe following recommendations are based on experience\n\uf8ff Weigh babies once a day; more frequent weighing might upset the baby and be a\ncause of anxiety and concern for the mother. Once the baby has started gaining\nweight, weigh every second day for a week and then once weekly until the baby has\nreached full term (40 weeks or 2500g);"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 42c24837-e7ed-4369-8d3a-049290aa39d3
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 41, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 610, "chroma:document": "reached full term (40 weeks or 2500g);\n\uf8ff weigh the baby in the same way every time, i.e. naked, with the same calibrated scales\n(with 10g intervals if possible), placing a clean warm towel on the scales to avoid\ncooling the infant;\n\uf8ff weigh the baby in a warm environment;\n\uf8ff if you have a local weight chart showing the expected intrauterine growth, plot the\nweight on the graph to monitor growth.\nGrowth monitoring, especially for daily weight gain, requires accurate and precise scales\nand a standardized weighing technique. Spring scales are not precise enough for frequent\nmonitoring of weight gain when weight is low, and may lead to wrong decisions. Analogue\nmaternity hospital scales (with 10g intervals) are the best alternative. If such accurate and\nprecise scales are not available, do not weigh KMC infants daily but rely on weekly weighing\nfor growth monitoring. Weight is recorded on a weight chart and weight gain is assessed daily\nor weekly.\nHead circumference"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 2d62b237-de95-400e-9f75-b2b40b4f4104
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 41, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 611, "chroma:document": "or weekly.\nHead circumference\nMeasure head circumference weekly. Once baby is gaining weight, head circumference will\nincrease by between 0.5 and 1cm per week. For adequacy of head growth refer to national\nanthropometric standards.\nAlternative methods for monitoring growth\nAlternative methods, such as measuring baby\u2019s length, and chest and arm circumference, are\nless useful for growth monitoring and are not recommended for the following reasons:\n\u2013 length is less reliable than weight. It increases more slowly and does not help to make\ndecisions about feeding or illness;\n\u2013 surrogates, such as chest and arm circumference, have been proposed to assess size\nat birth and as a tool to evaluate the need for special care.63, 64 Their effectiveness for\ngrowth monitoring in LBW and preterm infants has not yet been assessed.\n36"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: b4894e6d-f518-44b7-bf50-d137e24b73fd
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 42, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 612, "chroma:document": "4.9 Inadequate weight gain\nIf weight gain is inadequate for several days, first assess the feeding technique, frequency,\nduration and schedule, and check that night feeds are given. Advise the mother to increase\nthe frequency of feeds or to feed on demand. Encourage her to drink fluids when thirsty.\nThen look for other conditions as possible reasons for poor weight gain:\n(cid:1) oral thrush (white patches in the mouth) can interfere with feeding. Treat the baby by giving her\nan oral suspension of nystatin (100,000 IU/ml); use a dropper to apply 1ml in the oral mucosa\nand paint the mother\u2019s nipples after each feed until the lesions heal. Treat for 7 days;\n(cid:1) rhinitis is quite disturbing for the baby because it interferes with feeding. Nasal drops of normal\nsaline solution in each nostril before each feed may help to relieve nasal obstruction;\n(cid:1) urinary tract infection is a possible insidious cause. Investigate if the baby fails to grow without"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 7dfe083b-5efb-4ab9-9644-0609a2c39d6a
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 42, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 613, "chroma:document": "obvious reasons. Treat according to national/local treatment guidelines;\n(cid:1) severe bacterial infection can initially manifest itself with poor weight gain and poor feeding.\nIf a previously healthy baby becomes unwell and stops feeding, consider this as a serious danger\nsign. Investigate for infection and treat according to national/local treatment\nguidelines.\nOther causes of failure to gain weight include patent ductus arteriosus and other diseases\nthat may be difficult to diagnose in settings with scarce resources. Refer the baby who fails to\ngain weight after the exclusion or treatment of the above common causes to a higher level of\ncare, for further investigation and treatment.\nIf a mother\u2019s breast milk supply is reduced and does not satisfy baby\u2019s needs, she must in-\ncrease it. This often happens where there is a breastfeeding difficulty: baby is not suckling well,\nthe mother has been away or sick and stopped feeding her baby (on increasing breast milk and"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 2d80af03-7444-40b9-9151-45a75f8e1770
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 42, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 614, "chroma:document": "the mother has been away or sick and stopped feeding her baby (on increasing breast milk and\nrelactation see the WHO breastfeeding counselling course, pp 348-358,19 and the WHO\ndocument Relactation: A review of experience and recommendations for practice 65 ). This should be\nthe first step before turning to other methods.\nLactogogues\nHerbal teas obtained from sesame, fenugreek, fennel, cumin, basil and aniseed have not been\nproven effective in increasing breast milk production. Beer and other alcoholic drinks used\nin some cultures to increase lactation should be discouraged since alcohol in breast milk is\ndangerous for babies.66, 67 Domperidone can help increase milk supply. It could be used as a\nsupportive procedure and only after all other effective methods for improving milk production\nhave been tried out. Always follow national guidelines.\nIf despite all these efforts the baby is not gaining weight, consider supplementing"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 51b36eb4-0ec3-4bc4-bc56-d97af14efcc4
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 42, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 615, "chroma:document": "If despite all these efforts the baby is not gaining weight, consider supplementing\nbreastfeeding with preterm formula, given by cup after each feed. To prepare formula milk\nfollow the instructions on the box.\nDo not make important decisions about formula supplementation on the basis of daily\nweight, since this is subject to large variations. Only weight change over a few days, or weekly\nweight gain, is a good basis for such decisions.\n37"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: e13ca923-9a34-404d-ba3a-62b43b4d90a4
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 43, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 616, "chroma:document": "KANGAROO MOTHER CARE\nDiscuss with the mother whether this is a feasible, affordable and safe option that will\nbe available for several months. Show her how to prepare it and give it safely. Follow the\ninstructions on the package. Return to exclusive breastfeeding as soon as possible after the\ninfant has gained weight for some time. Monitor more closely the health and growth of small\ninfants fed or supplemented with formula since they are more exposed than breastfed babies to\ninfection and malnutrition. Try, if at all possible, not to discharge a small baby with formula\nsupplements.\nEnsure that the facility follows the rules prescribed by the International Code of Marketing of\nBreast-milk Substitutes, issued by WHO.68\n4.10 Preventive treatment\nSmall babies are born without sufficient stores of micronutrients. Preterm babies, irrespective\nof weight, should receive iron and folic acid supplementation from the second month of life"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 1ebea6c4-228a-4f73-bf86-e15659103f70
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 43, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 617, "chroma:document": "of weight, should receive iron and folic acid supplementation from the second month of life\nuntil one year of chronological age. The recommended daily dose of iron is 2mg/kg body\nweight/day.\n\uf8ff Explain to the mother that:\n\u2013 iron is essential for baby\u2019s health and growth;\n\u2013 the baby needs to take iron regularly: at the same time every day, after breastfeeding;\n\u2013 baby\u2019s stools may become darker, which is normal.\n\uf8ffExplore her concerns.\n4.11 Stimulation\nAll infants need love and care to flourish, but very preterm babies need even more attention\nto be able to develop normally since they have been deprived of an ideal intrauterine environment\nfor weeks or even months. They are instead exposed to too much light, noise and painful stimuli\nduring their initial care. KMC is an ideal method since the baby is rocked and cuddled, and\nlistens to the mother\u2019s voice while she goes about her everyday activities. Fathers too can"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 43e166c3-52cb-4182-9736-e8d32fc56855
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 43, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 618, "chroma:document": "listens to the mother\u2019s voice while she goes about her everyday activities. Fathers too can\nprovide such an environment. Health workers have an important role to play in encouraging\nmothers and fathers to express their emotions and love to their babies.\nHowever, if the baby has other problems due to preterm birth or its complications, additional\ntreatment may be necessary. Guidance on such treatment can be found in standard textbooks or\nin the WHO manual Managing newborn problems. A guide for doctors, nurses and midwives.56\n4.12 Discharge\nDischarge means letting the mother and baby go home. Their own environment, however,\ncould be very different from the KMC unit at the facility, where they were surrounded by\nsupportive staff. They will continue to need support even though this will not have to be as\nintensive and frequent. The time of discharge may therefore vary depending on the size of the\nbaby, bed availability, home conditions and accessibility of follow-up care. Usually, a KMC"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: a64f78a5-4398-4bab-b40b-a843dc41a866
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 43, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 619, "chroma:document": "baby, bed availability, home conditions and accessibility of follow-up care. Usually, a KMC\nbaby can be discharged from the hospital when the following criteria are met:\n(cid:1) the baby\u2019s general health is good and there is no concurrent disease such as apnoea or infection;\n(cid:1) he is feeding well, and is exclusively or predominantly breastfed;\n(cid:1) he is gaining weight (at least 15g/kg/day for at least three consecutive days);\n38"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 7487c047-fdb4-4d86-8492-9b9778a9f508
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 44, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 620, "chroma:document": "(cid:1) his temperature is stable in the KMC position (within the normal range for at least three\nconsecutive days);\n(cid:1) the mother is confident in caring for the baby and is able to come regularly for follow-up visits.\nThese criteria are usually met by the time the baby weighs more than 1500g.\nThe home environment is also very important for the successful outcome of KMC. The mother\nshould go back to a warm, smoke-free home and should have support for everyday household tasks.\nWhere there are no follow-up services and the hospital is far away, mother and baby should\nbe discharged later.\nImmunize the baby according to national policy and give enough iron/folate tablets to last\nuntil the follow-up visit. Fill in the home-based baby\u2019s record. Ensure that the mother knows:\n(cid:1) how to apply skin-to-skin contact until baby shows signs of discomfort;\n(cid:1) how to dress the baby, when he is not in kangaroo position, to keep him warm at home;"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: d5095627-3602-44dd-8dca-0e8ffca9f706
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 44, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 621, "chroma:document": "(cid:1) how to dress the baby, when he is not in kangaroo position, to keep him warm at home;\n(cid:1) how to bath the baby and keep him warm after the bath;\n(cid:1) how to respond to baby\u2019s needs such as increasing the duration of skin-to-skin contact if he has\ncold hands and feet or low temperature at night;\n(cid:1) how to breastfeed the baby during the day and night according to instructions;\n(cid:1) when and where to return for follow-up visits (schedule the first visit and give the mother\nwritten/pictorial instructions for the above issues);\n(cid:1) how to recognize danger signs;\n(cid:1) where to seek care urgently if danger signs appear;\n(cid:1) when to wean the baby from KMC.\nShe should return immediately to hospital, or go to another appropriate\nprovider, if the baby:\n(cid:1) stops feeding, is not feeding well, or vomits;\n(cid:1) becomes restless and irritable, lethargic or unconscious;\n(cid:1) has fever (body temperature above 37.5\u00b0C);"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 59f7b6d1-ac28-4759-9d49-f0cf774f8eb3
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 44, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 622, "chroma:document": "(cid:1) has fever (body temperature above 37.5\u00b0C);\n(cid:1) is cold (hypothermia - body temperature below 36.5\u00b0C) despite rewarming;\n(cid:1) has convulsions;\n(cid:1) has difficulty breathing;\n(cid:1) has diarrhoea;\n(cid:1) shows any other worrying sign.\nTell the mother that it is always better to seek help, if in doubt: when caring for small\ninfants it is better to seek care too often than to disregard important symptoms.\nEarly discharge becomes a goal for the mother as she gains confidence in her ability to care\nfor her baby. A baby can be discharged earlier if the following criteria are met:\n(cid:1) adequate information on home care is given at discharge to mothers and their families, preferably\nas written and pictorial instructions;\n(cid:1) mothers have received instructions on danger signs, and know when and where to seek care.\n39"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 2de5527b-c03d-4497-bf92-ef3fca0ad729
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 45, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 623, "chroma:document": "KANGAROO MOTHER CARE\n4.13 KMC at home and routine follow-up\nEnsure follow-up for the mother and the baby, either at your facility or with a skilled provider\nnear the baby\u2019s home. The smaller the baby is at discharge, the earlier and more frequent\nfollow-up visits he will need. If the baby is discharged in accordance with the above criteria,\nthe following suggestions will be valid in most circumstances:\n\u2013 two follow-up visits per week until 37 weeks of post-menstrual age;\n\u2013 one follow-up visit per week after 37 weeks.\nThe content of the visit may vary according to mother\u2019s and baby\u2019s needs; check the follow-\ning, however, at each follow-up visit:\nKMC\nDuration of skin-to-skin contact, position, clothing, body temperature, support for the\nmother and the baby. Is the baby showing signs of intolerance? Is it time to wean the baby\nfrom KMC (usually at around 40 weeks of post-menstrual age, or just before)? If not,\nencourage the mother and family to continue KMC as much as possible."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 204364b7-9074-4244-ad0e-362d23f234fc
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 45, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 624, "chroma:document": "encourage the mother and family to continue KMC as much as possible.\nBreastfeeding\nIs it exclusive? If yes, praise the mother and encourage her to continue. If not, advise her on\nhow to increase breastfeeding and decrease supplements or other fluids. Ask and look for any\nproblem and provide support. If the baby is taking formula supplements or other foods,\ncheck their safety and adequacy; make sure that the family has the necessary supply.\nGrowth\nWeigh the baby and check weight gain in the last period. If weight gain is adequate, i.e. at\nleast 15g/kg/day on average, praise the mother. If it is inadequate, ask and look for possible\nproblems, causes and solutions; these are generally related to feeding or illness. To check\nadequate daily weight gain please refer to box on page 37.\nIllness\nAsk and look for any signs of illness, reported by the mother or not. Manage any illness\naccording to your local protocols and guidelines. In case of non-exclusive breastfeeding, ask"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 3f09632c-7c62-4f5c-8637-1ed6193c20f3
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 45, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 625, "chroma:document": "according to your local protocols and guidelines. In case of non-exclusive breastfeeding, ask\nand look particularly for signs of nutritional or digestive problems.\nDrugs\nGive a sufficient supply of drugs, if needed, to last until the next follow-up visit.\nImmunization\nCheck that the local immunization schedule is being followed.\nMother\u2019s concerns\nAsk the mother about any other problem, including personal, household, and social\nproblems. Try to help her find the best solution for all of them.\nNext follow-up visit\nAlways schedule or confirm the next visit. Do not miss the opportunity, if time allows, to\ncheck and advise on hygiene, and to reinforce the mother\u2019s awareness of danger signs that\nneed prompt care.\nSpecial follow-up visits\nIf these are required for other medical or somatic problems, encourage the mother to attend\nthem and help her if needed.\nRoutine child care\nEncourage the mother to attend routine child care once the baby reaches 2500g or 40 weeks\nof post-menstrual age.\n40"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 476ac2e9-37f8-4495-9f01-fafd6c897cae
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 46, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 626, "chroma:document": "References\n1 Low birth weight. A tabulation of available information. Geneva, World Health Organization, 1992 (WHO/\nMCH/92.2).\n2 de Onis M, Blossner M, Villar J. Levels and patterns of intrauterine growth retardation in developing\ncountries. European Journal of Clinical Nutrition, 1998, 52(Suppl.1):S5-S15.\n3 Essential newborn care. Report of a Technical Working Group (Trieste 25-29 April 1994). Geneva, World\nHealth Organization, 1996 (WHO/FRH/MSM/96.13).\n4 Ashworth A. Effects of intrauterine growth retardation on mortality and morbidity in infants and\nyoung children. European Journal of Clinical Nutrition, 1998, 52(Suppl.1):S34-S41; discussion:\nS41-42.\n5 Murray CJL, Lopez AD, eds. Global burden of disease: a comprehensive assessment of mortality and\ndisability from diseases, injuries and risk factors in 1990 and projected to 2020. Boston, Harvard School\nof Public Health, 1996 (Global burden of disease and injuries series, vol. 1)."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: c8e4d4e3-6b56-4a4b-9b77-5c600a0b6743
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 46, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 627, "chroma:document": "of Public Health, 1996 (Global burden of disease and injuries series, vol. 1).\n6 Gulmezoglu M, de Onis M, Villar J. Effectiveness of interventions to prevent or treat impaired fetal\ngrowth. Obstetrical & Gynecological Survey, 1997, 52:139-149.\n7 Kramer MS. Socioeconomic determinants of intrauterine growth retardation. European Journal of\nClinical Nutrition, 1998, 52(Suppl.1):S29-S32; discussion: S32-33.\n8 McCormick MC. The contribution of low birth weight to infant mortality and childhood morbidity.\nThe New England Journal of Medicine, 1985, 312:82-90.\n9 Rey ES, Martinez HG. Manejo racional del ni\u00f1o prematuro. In: Universidad Nacional, Curso de\nMedicina Fetal, Bogot\u00e1, Universidad Nacional, 1983.\n10 Thermal control of the newborn: A practical guide. Maternal Health and Safe Motherhood Programme.\nGeneva, World Health Organization, 1993 (WHO/FHE/MSM/93.2).\n11 Shiau SH, Anderson GC. Randomized controlled trial of kangaroo care with fullterm infants: effects"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 7669a555-8ebb-414f-a60a-cfe13879f62b
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 46, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 628, "chroma:document": "on maternal anxiety, breastmilk maturation, breast engorgement, and breast-feeding status. Paper\npresented at the International Breastfeeding Conference, Australia\u2019s Breastfeeding Association,\nSydney, October 23-25, 1997.\n12 Cattaneo A, et al. Recommendations for the implementation of kangaroo mother care for low birthweight\ninfants. Acta Paediatrica, 1998, 87:440-445.\n13 Cattaneo A, et al. Kangaroo mother care in low-income countries. Journal of Tropical Pediatrics, 1998,\n44:279-282.\n14 Bergman NJ, J\u00fcrisoo LA. The \u201ckangaroo-method\u201d for treating low birth weight babies in a developing\ncountry. Tropical Doctor, 1994, 24:57-60.\n15 Lincetto O, Nazir AI, Cattaneo A. Kangaroo Mother Care with limited resources. Journal of Tropical\nPediatrics, 2000, 46:293-295.\n16 Anderson GC. Current knowledge about skin-to-skin (kangaroo) care for preterm infants. Journal of\nPerinatology, 1991, 11:216-226."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: aab9136f-d8bc-46ce-909f-1b7b7277dde3
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 46, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 629, "chroma:document": "Perinatology, 1991, 11:216-226.\n17 Christensson K, et al. Randomised study of skin-to-skin versus incubator care for rewarming low-risk\nhypothermic neonates. The Lancet, 1998, 352:1115.\n18 Shekelle PG. Clinical guidelines: Developing guidelines. British Medical Journal, 1999,\n318:593-596.\n19 Breastfeeding counselling: A training course - Trainer\u2019s guide. Geneva, World Health Organization,\n1993 (WHO/CDR/93.4). Also available from UNICEF (UNICEF/NUT/93.2).\n20 HIV and infant feeding counselling: A training course - Trainer\u2019s guide. Geneva, World Health\nOrganization, 2000 (WHO/FCH/CAH/00.3). Also available from UNICEF (UNICEF/PD/NUT/\n00-4) or UNAIDS (UNAIDS/99.58).\n41"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 87854cc9-6542-4d1f-a617-eb5325b27923
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 47, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 630, "chroma:document": "KANGAROO MOTHER CARE\n21 Charpak N, Ruiz-Pelaez JG, Figueroa de Calume Z. Current knowledge of kangaroo mother\nintervention. Current Opinion in Pediatrics, 1996, 8:108-112.\n22 Ludington-Hoe SM, Swinth JY. Developmental aspects of kangaroo care. Journal of Obstetric, Gynecologic,\nand Neonatal Nursing, 1996, 25:691-703.\n23 Conde-Agudelo A, Diaz-Rosello JL, Belizan JM. Kangaroo mother care to reduce morbidity and\nmortality in low birth weight infants. Cochrane Library, Issue 2, 2002.\n24 Sloan NL, et al. Kangaroo mother method: randomised controlled trial of an alternative method of\ncare for stabilised low-birthweight infants. The Lancet, 1994, 344:782-785.\n25 Charpak N, et al. Kangaroo mother versus traditional care for newborn infants \u2264 2000 grams:\na randomized controlled trial. Pediatrics, 1997, 100:682-688.\n26 Cattaneo A, et al. Kangaroo mother care for low birthweight infants: a randomised controlled trial in\ndifferent settings. Acta Paediatrica, 1998, 87:976-985."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 9af794b6-fa5e-4537-9d84-efcfec5b7354
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 47, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 631, "chroma:document": "different settings. Acta Paediatrica, 1998, 87:976-985.\n27 Kambarami RA, Chidede O, Kowo DT. Kangaroo care versus incubator care in the management of\nwell preterm infants: a pilot study. Annals of Tropical Paediatrics, 1998, 18:81-86.\n28 Whitelaw A, Sleath K. Myth of marsupial mother: home care of very low birth weight infants in Bogot\u00e1,\nColombia. The Lancet, 1985, 1:1206-1208.\n29 Charpak N, et al. Kangaroo-mother programme: an alternative way of caring for low birth weight\ninfants? One year mortality in a two-cohort study. Pediatrics, 1994, 94:804-810.\n30 Anderson GC, et al. Birth-associated fatigue in 34-36 week premature infants: rapid recovery with\nvery early skin-to-skin (kangaroo) care. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 1999,\n28:94-103.\n31 Lincetto O, et al. Impact of season and discharge weight on complications and growth of kangaroo\nmother care treated low birthweight infants in Mozambique. Acta Paediatrica, 1998, 87:433-439."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: a4b555f0-b241-4ded-80e3-f1ecebd5208e
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 47, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 632, "chroma:document": "mother care treated low birthweight infants in Mozambique. Acta Paediatrica, 1998, 87:433-439.\n32 Schmidt E, Wittreich G. Care of the abnormal newborn: a random controlled trial study of the \u201ckangaroo\nmethod\u201d of care of low birth weight newborns. In: Consensus Conference on Appropriate\nTechnology Following Birth, Trieste, 7-11 October 1986. WHO Regional Office for Europe.\n33 Whitelaw A, et al. Skin-to-skin contact for very low birth weight infants and their mothers. Archives of\nDisease in Childhood, 1988, 63:1377-1381.\n34 Wahlberg V, Affonso D, Persson B. A retrospective, comparative study using the kangaroo method as\na complement to the standard incubator care. European Journal of Public Health, 1992, 2:34-37.\n35 Syfrett EB, et al. Early and virtually continuous kangaroo care for lower-risk preterm infants: effect on\ntemperature, breast-feeding, supplementation and weight. In: Proceedings of the Biennial Conference"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: ed71c74d-bd86-4bfa-867b-2e6ac6f5000b
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 47, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 633, "chroma:document": "temperature, breast-feeding, supplementation and weight. In: Proceedings of the Biennial Conference\nof the Council of Nurse Researchers. Washington, DC, American Nurses Association, 1993.\n36 Blaymore-Bier JA, et al. Comparison of skin-to-skin contact with standard contact in low birth weight\ninfants who are breastfed. Archives of Pediatrics & Adolescent Medicine, 1996, 150:1265-1269.\n37 Hurst NM, et al. Skin-to-skin holding in the neonatal intensive care unit influences maternal milk\nvolume. Journal of Perinatology, 1997, 17:213-217.\n38 Christensson K. Fathers can effectively achieve heat conservation in healthy newborn infants. Acta\nPaediatrica,1996, 85:1354-1360.\n39 Ludington-Hoe SM, et al. Selected physiologic measures and behavior during paternal skin contact\nwith Colombian preterm infants. Journal of Developmental Physiology, 1992, 18:223-232.\n40 Acolet D, Sleath K, Whitelaw A. Oxygenation, heart rate and temperature in very low birth weight"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 4f748d85-6139-483b-bb9d-ebc63ebcfb21
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{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 47, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 634, "chroma:document": "40 Acolet D, Sleath K, Whitelaw A. Oxygenation, heart rate and temperature in very low birth weight\ninfants during skin-to-skin contact with their mothers. Acta Paediatrica Scandinavica, 1989, 78:\n189-193.\n41 de Leeuw R, et al. Physiologic effects of kangaroo care in very small preterm infants. Biology of the\nNeonate, 1991, 59:149-155.\n42 Fischer C, et al. Cardiorespiratory stability of premature boys and girls during kangaroo care. Early\nHuman Development, 1998, 52:145-153.\n43 Anderson GC, Wood CE, Chang HP. Self-regulatory mothering vs. nursery routine care postbirth:\neffect on salivary cortisol and interactions with gender, feeding, and smoking. Infant Behavior and\nDevelopment, 1998, 21:264.\n44 Christensson K, et al. Temperature, metabolic adaptation and crying in healthy full-term newborns\ncared for skin-to-skin or in a cot. Acta Paediatrica, 1992, 81:488-493.\n45 Christensson K, et al. Separation distress call in the human infant in the absence of maternal body"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 279a141b-1a4e-4b5c-a0d5-7a1b322c668c
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{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 47, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 635, "chroma:document": "contact. Acta Paediatrica, 1995, 84:468-473.\n46 Affonso D, Wahlberg V, Persson B. Exploration of mother\u2019s reactions to the kangaroo method of pre-\nmaturity care. Neonatal Network, 1989, 7:43-51.\n42"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: c8cdc55c-ea91-4bac-b4b4-a46fc37f79a7
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{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 48, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 636, "chroma:document": "47 Affonso D, et al. Reconciliation and healing for mothers through skin-to-skin contact provided in an\nAmerican tertiary level intensive care nursery. Neonatal Network, 1993,12:25-32.\n48 Legault M, Goulet C. Comparison of kangaroo and traditional methods of removing preterm infants\nfrom incubators. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 1995, 24:501-506.\n49 Bell EH, Geyer J, Jones L. A structured intervention improves breast-feeding success for ill or preterm\ninfants. American Journal of Maternal and Child Nursing, 1995, 20:309-314.\n50 Tessier R, et al. Kangaroo mother care and the bonding hypothesis. Pediatrics, 1998, 102:390-391.\n51 Hylander MA, Strobino DM, Dhanireddy R. Human milk feedings and infection among very low\nbirth weight infants. Pediatrics, 1998, 102:E38.\n52 Schanler RJ, Shulman RJ, Lau C. Feeding strategies for premature infants: beneficial outcomes of\nfeeding fortified human milk versus preterm formula. Pediatrics, 1999, 103:1150-1157."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 77e9a7f4-1b64-4a42-b2a1-dd3583bc4c20
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{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 48, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 637, "chroma:document": "feeding fortified human milk versus preterm formula. Pediatrics, 1999, 103:1150-1157.\n53 Malhotra N, et al. A controlled trial of alternative methods of oral feeding in neonates. Early Human\nDevelopment, 1999, 54:29-38.\n54 Sontheimer D, et al. Pitfalls in respiratory monitoring of premature infants during kangaroo care.\nArchives of Disease in Childhood, 1995, 72:F115-117.\n55 Lubchenco LO, et al. Intrauterine growth as estimated from live born birth weight data at 24 to 42\nweeks of gestation. Pediatrics, 1963, 32:793-800.\n56 Managing newborn problems. A guide for doctors, nurses and midwives. Geneva, World Health\nOrganization (in press).\n57 Jenni OG, et al. Effect of nursing in the head elevated tilt position (15 degrees) on the incidence of\nbradycardic and hypoxemic episodes in preterm infants. Pediatrics, 1997, 100:622-625.\n58 Ludington-Hoe SM, Hadeed AJ, Anderson GC. Physiologic responses to skin-to-skin contact in"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 8410d906-89b3-4282-9d72-fd870b2920e2
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{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 48, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 638, "chroma:document": "58 Ludington-Hoe SM, Hadeed AJ, Anderson GC. Physiologic responses to skin-to-skin contact in\nhospitalized premature infants. Journal of Perinatology, 1991, 11:19-24.\n59 Gupta A, Khanna K, Chattree S. Cup feeding: an alternative to bottle feeding in a neonatal intensive\ncare unit. Journal of Tropical Pediatrics, 1999, 45:108-110.\n60 Lang S, Lawrence CJ, Orme RL. Cup feeding: an alternative method of infant feeding. Archives of\nDisease in Childhood, 1994, 71:365-369.\n61 Bier JB, et al. Breast-feeding of very low birth weight infants. Journal of Pediatrics, 1993, 123:\n773-778.\n62 Poets CF, Langner MU, Bohnhorst B. Effects of bottle feeding and two different methods of gavage\nfeeding on oxygenation and breathing patterns in preterm infants. Acta Paediatrica, 1997, 86:\n419-423.\n63 Birth weight surrogates: The relationship between birth weight, arm and chest circumference. Geneva, World\nHealth Organization, 1987."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 93fb7b20-cac8-4988-bb78-a55927e3e92e
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{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 48, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 639, "chroma:document": "Health Organization, 1987.\n64 Diamond JD, et al. The relationship between birth weight and arm and chest circumference in Egypt.\nJournal of Tropical Pediatrics, 1991, 37:323-6.\n65 Relactation: A review of experience and recommendations for practice. Geneva, World Health Organization,\n1998 (WHO/CHS/CAH/98.14).\n66 Mennella JA, Gerrish CJ. Effects of exposure to alcohol in mother\u2019s milk on infant sleep. Pediatrics,\n1998, 101:E2.\n67 Rosti L, et al. Toxic effects of a herbal tea mixture in two newborns. Acta Paediatrica, 1994, 83:683.\n68 International code of marketing of breast-milk substitutes. Geneva, World Health Organization, 1981\n(HA34/1981/REC/1, Annex 3).\n43"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: be7f59c2-9bc9-43f5-93b7-bab298fa9206
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{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 49, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 640, "chroma:document": "KANGAROO MOTHER CARE\n44"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: d39bcc0d-e019-491a-94f4-9457ef231218
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 50, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 641, "chroma:document": "Annexes\nI Records and indicators\nClinical records for hospital and follow-up care of small babies vary from place to place and\naccording to the level of care offered to LBW and preterm infants. Essential information on\nKMC, when this is part of the care programme, must also be recorded. The following additional\ninformation should be recorded daily:\n(cid:1) For the baby hospital record:\n\u2013 when KMC began (date, weight and age);\n\u2013 condition of the baby;\n\u2013 details on duration and frequency of skin-to-skin contact;\n\u2013 whether the mother is hospitalized or is coming from home;\n\u2013 predominant feeding method;\n\u2013 observations about lactation and feeding;\n\u2013 daily weight gain;\n\u2013 episodes of illness, other conditions or complications;\n\u2013 the drugs baby is receiving;\n\u2013 details on discharge: condition of the baby, maternal readiness, conditions at home that\nmake discharge possible; date, age, weight and post-menstrual age at discharge; feeding"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 0fae9f08-8553-4b04-a8d1-d2909a247074
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 50, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 642, "chroma:document": "make discharge possible; date, age, weight and post-menstrual age at discharge; feeding\nmethod and instructions for follow-up (where, when and how frequently).\nMother should be given a discharge letter summarizing the course of hospitalization and\ninstructions for home care, medication and follow-up. It is also necessary to record whether the\nbaby was transferred to another institution or died.\n(cid:1) The follow-up record should contain, besides the usual data on the baby, the following\ninformation:\n\u2013 when the baby was first seen (date, age, weight and post-menstrual age);\n\u2013 feeding method;\n\u2013 daily duration of skin-to-skin contact;\n\u2013 any concerns mother may have;\n\u2013 whether baby has to be or has been readmitted to hospital;\n\u2013 when mother stopped skin-to-skin contact (date, age of the baby, weight, post-menstrual\nage, reasons for stopping and feeding method at weaning);\n\u2013 other important remarks."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 6a65f658-d2e2-4a0c-a515-fee0628d1950
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 50, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 643, "chroma:document": "age, reasons for stopping and feeding method at weaning);\n\u2013 other important remarks.\nIf the follow-up care is provided at the facility where the baby was hospitalized, the hospital\nrecord and the follow-up record should be a single document. If this cannot be done, the two\nrecords must be linked by an identification number. The records can obviously be used to\ndevelop an electronic database. The follow-up record presented in this annex is derived from\nthose used by KMC programmes in some countries.\n45"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: d5fa99d9-2a20-4344-b74b-a0fb3afd6e98
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 51, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 644, "chroma:document": "KANGAROO MOTHER CARE\nAn example of how information on KMC can be added to the follow-up record:\nDate of visit .. /.. /.... .. /.. /.... .. /.. /.... .. /.. /.... .. /.. /.... .. /.. /.... .. /.. /.... .. /.. /....\nAge\nWeight\nweight gain\nFeeding\nmethod\nAverage daily\nduration of\nskin-to-skin\ncontact\nComplaints\nReadmission\nto hospital\nWeaned Reasons for weaning and other comments\nDate\nAge (in days)\nPost-menstrual age\nWeight\nThese data will provide basic information for daily baby care and process and outcome\nindicators for programme monitoring.\n(cid:1) When KMC forms part of a care programme for small babies it is important to know the\nfollowing:\n\u2013 the number of small babies (<2000g and/or <34 weeks) treated and the proportion\nreceiving KMC;\n\u2013 mean age at start of KMC (stratified by weight and gestational age at birth, and weight\nand post-menstrual age when starting);\n\u2013 type of KMC (predominant or partial);\n\u2013 mean duration of KMC (in days);"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: a1f643a7-7028-4374-872c-325f55dbac8a
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 51, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 645, "chroma:document": "\u2013 type of KMC (predominant or partial);\n\u2013 mean duration of KMC (in days);\n\u2013 mean weight gain during KMC in institution and at home;\n\u2013 mean age of weaning from KMC (stratified by weight and gestational age at birth, and weight\nand post-menstrual age when starting);\n\u2013 feeding method for babies at weaning from KMC (exclusively/partly breastfed, or not\nbreastfed);\n\u2013 proportion of babies needing hospitalization during home KMC;\n\u2013 death rate during KMC, at institution and at home.\n46"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: d2e58d57-47c4-4dee-9ca3-8e62ae8910b0
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 52, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 646, "chroma:document": "II Birth weight and gestational age\nAt different gestational ages birth weight can vary by about one kilogram; at a given weight\nbabies can be of different gestational ages.\nTable 4. Mean birth weights (g) with 10th and 90th percentiles by gestational age\nGestational age Mean birth weight 10th percentile 90th percentile\n28 1200 900 1500\n29 1350 1000 1650\n30 1500 1100 1750\n31 1650 1200 2000\n32 1800 1300 2350\n33 2000 1500 2500\n34 2250 1750 2750\n35 2500 2000 3000\n36 2750 2250 3250\n37 3000 2450 3500\n38 3200 2650 3700\n39 3350 2800 3900\n40 3500 3000 4100\n47"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 12aa171d-229f-41a5-97d2-055dbb16b5a4
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 53, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 647, "chroma:document": "KANGAROO MOTHER CARE\nIII Constraints\nKMC has been included in national guidelines for the care of LBW and preterm infants,\nand successfully implemented in many countries. Experience shows that the main problems,\nobstacles and constraints fall under four categories: policy, implementation, communication and\nfeeding. Some possible solutions are suggested in Table 5.\nTable 5. Implementing KMC\nProblems, obstacles and constraints Possible solutions\nPolicy\n(cid:2)Lack of plans, policies, guidelines, protocols, manuals (cid:2)Development of plans, policies, guidelines, protocols, manuals\n(cid:2)Lack of institutional, academic and professional support (cid:2)Establishing links with ministries, medical schools, agencies and\norganizations; advocacy work\n(cid:2)Lack of adequate training and continuous education (cid:2)Establishing basic, post-graduate and in-service courses\n(cid:2)Risk of an isolated and vertical programme (cid:2)Integration with existing programmes"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 3a347523-c3bc-4b48-b636-5400514c1c07
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 53, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 648, "chroma:document": "(cid:2)Risk of an isolated and vertical programme (cid:2)Integration with existing programmes\n(cid:2)Poor access to evidence, literature and documentation (cid:2)Creation of local and regional libraries; links with\nmain documentation centres\n(cid:2)Legal problems (e.g. KMC not included in the interventions (cid:2)Proposing changes to existing laws, rules and regulations;\nfinanced by the health care system) involving mothers and families\nImplementation\n(cid:2)Resistance of managers, administrators and health workers (cid:2)Adequate information on effectiveness, safety, feasibility and cost\n(cid:2)Poor facilities, equipment, supplies, organization, (cid:2)Improving structure and organization, procurement of\nlack of time basic equipment; ensuring supplies\n(cid:2)Cultural problems: misguided beliefs, attitudes, practices (cid:2)Appropriate training and information strategies, community\nparticipation\n(cid:2)Apparent initial increase of workload (cid:2)Introducing changes step-by-step"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 610438b8-b428-4a3a-95de-395c6939d4af
encoding: FLOAT32
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{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 53, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 649, "chroma:document": "participation\n(cid:2)Apparent initial increase of workload (cid:2)Introducing changes step-by-step\n(cid:2)Redistribution of tasks, multidisciplinary approach (cid:2)Writing new job descriptions, encouraging team work and\nfrequent joint review of problems\n(cid:2)Resistance of mothers and families (cid:2)Hospital and community support groups\n(cid:2)Lack of monitoring and evaluation (cid:2)Gathering, analysing and discussing standard data\nCommunication\n(cid:2)Mothers and families unaware of KMC (cid:2)Adequate information in the antenatal period and at the referral\nfacility\n(cid:2)Poor communication and support in hospital and during (cid:2)Improving communication and support skills of health workers\nfollow-up\n(cid:2)Inadequate community and family support (cid:2)Community meetings, mass media, hot lines\n(cid:2)Hostility of politicians and other health professionals (cid:2)Articles, newsletters, interest groups, testimonies\nFeeding"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 4a62cf3c-ee35-483a-8400-ff88ec6525b6
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 53, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 650, "chroma:document": "Feeding\n(cid:2)Low rate of exclusive breastfeeding after long separation (cid:2)Reducing separation as much as possible; implementation\nof infants from mothers of feeding guidelines\n(cid:2)Difficult growth monitoring, lack of adequate standards (cid:2)Accurate scales, appropriate growth charts, clear instructions\n(cid:2)Inadequate growth despite good implementation (cid:2)Good skills for assessing breastfeeding and alternative\nof breastfeeding guidelines feeding methods\n(cid:2)High prevalence of HIV-positive mothers (cid:2)Voluntary counselling and testing of parents; infant feeding\ncounselling, appropriate replacement feeding for preterm infants;\nsafe alternatives to breast milk; pasteurisers\n48"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\kmc_file.pdf", "file_path": "pdfs\\kmc_file.pdf", "page": 0, "total_pages": 25, "Author": "client1", "CreationDate": "D:20140626153516+05'30'", "Creator": "PScript5.dll Version 5.2.2", "Keywords": "kmc", "ModDate": "D:20200402215911+05'30'", "Producer": "Adobe Acrobat Pro DC 20 Paper Capture Plug-in; modified using iText\u00ae 7.1.7 \u00a92000-2019 iText Group NV (AGPL-version)", "Title": "kmc", "chunk_index": 651, "chroma:document": "Kangaroo\nMother\nCare\nTeaching Aids: NNF KMC-1"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: f288569c-c825-4384-8e6d-a9e42312805a
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_file.pdf", "file_path": "pdfs\\kmc_file.pdf", "page": 1, "total_pages": 25, "Author": "client1", "CreationDate": "D:20140626153516+05'30'", "Creator": "PScript5.dll Version 5.2.2", "Keywords": "kmc", "ModDate": "D:20200402215911+05'30'", "Producer": "Adobe Acrobat Pro DC 20 Paper Capture Plug-in; modified using iText\u00ae 7.1.7 \u00a92000-2019 iText Group NV (AGPL-version)", "Title": "kmc", "chunk_index": 652, "chroma:document": "What is KMC\nA special way of caring for Low birth\n\uf06e\nweight (LBW) babies\nIt promotes\n\uf06e\nEffective thermal control\n\uf0a7\nBreast feeding\n\uf0a7\nPrevention of infection\n\uf0a7\nParental bonding\n\uf0a7\nTeaching Aids: NNF KMC-2"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 9fc6fd42-af3e-41ec-aa5b-9e075c47ae0d
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_file.pdf", "file_path": "pdfs\\kmc_file.pdf", "page": 2, "total_pages": 25, "Author": "client1", "CreationDate": "D:20140626153516+05'30'", "Creator": "PScript5.dll Version 5.2.2", "Keywords": "kmc", "ModDate": "D:20200402215911+05'30'", "Producer": "Adobe Acrobat Pro DC 20 Paper Capture Plug-in; modified using iText\u00ae 7.1.7 \u00a92000-2019 iText Group NV (AGPL-version)", "Title": "kmc", "chunk_index": 653, "chroma:document": "Components of KMC\nSkin-to-skin contact\n\uf06e\nEarly, continuous and\nprolonged skin-to-\nskin contact\nExclusive breast\n\uf06e\nfeeding\nPromotes lactation\nand facilitates\nfeeding\nTeaching Aids: NNF KMC-3"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: cea5f3f8-60e9-42b1-8bcd-6cf6062990d1
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_file.pdf", "file_path": "pdfs\\kmc_file.pdf", "page": 3, "total_pages": 25, "Author": "client1", "CreationDate": "D:20140626153516+05'30'", "Creator": "PScript5.dll Version 5.2.2", "Keywords": "kmc", "ModDate": "D:20200402215911+05'30'", "Producer": "Adobe Acrobat Pro DC 20 Paper Capture Plug-in; modified using iText\u00ae 7.1.7 \u00a92000-2019 iText Group NV (AGPL-version)", "Title": "kmc", "chunk_index": 654, "chroma:document": "Pre-requisites of KMC\nSupport to the mother\n\uf06e\nIn hospital &\n\uf0a7\nAt home\n\uf0a7\nPost-discharge follow up\n\uf06e\nTeaching Aids: NNF KMC-4"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 6568bc90-454a-4abe-8bff-cb4f32a5a4d0
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_file.pdf", "file_path": "pdfs\\kmc_file.pdf", "page": 4, "total_pages": 25, "Author": "client1", "CreationDate": "D:20140626153516+05'30'", "Creator": "PScript5.dll Version 5.2.2", "Keywords": "kmc", "ModDate": "D:20200402215911+05'30'", "Producer": "Adobe Acrobat Pro DC 20 Paper Capture Plug-in; modified using iText\u00ae 7.1.7 \u00a92000-2019 iText Group NV (AGPL-version)", "Title": "kmc", "chunk_index": 655, "chroma:document": "Benefits of KMC\nBreast feeding\n\uf06e\nIncreased breast feeding rates\n\uf0a7\nIncreased duration of breast feeding\n\uf0a7\nThermal control\n\uf06e\nEffective thermal control\n\uf0a7\nEquivalent to conventional incubator\n\uf0a7\ncare\nTeaching Aids: NNF KMC-5"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 2ed3a730-69f7-4887-8d90-a7cd5738c2f6
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_file.pdf", "file_path": "pdfs\\kmc_file.pdf", "page": 5, "total_pages": 25, "Author": "client1", "CreationDate": "D:20140626153516+05'30'", "Creator": "PScript5.dll Version 5.2.2", "Keywords": "kmc", "ModDate": "D:20200402215911+05'30'", "Producer": "Adobe Acrobat Pro DC 20 Paper Capture Plug-in; modified using iText\u00ae 7.1.7 \u00a92000-2019 iText Group NV (AGPL-version)", "Title": "kmc", "chunk_index": 656, "chroma:document": "Benefits of KMC (cont..)\nEarly discharge\n\uf06e\nBetter weight gain ______.\n\uf06e\nEarly discharge\nLesser morbidity\n\uf06e\nRegular breathing\n\uf06e\nDecreased episodes of apnea\n\uf06e\nProtection from nosocomial infections\n\uf06e\nTeaching Aids: NNF KMC-6"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: a6d73ccb-7651-4e0d-a2f4-18f716f670ea
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_file.pdf", "file_path": "pdfs\\kmc_file.pdf", "page": 6, "total_pages": 25, "Author": "client1", "CreationDate": "D:20140626153516+05'30'", "Creator": "PScript5.dll Version 5.2.2", "Keywords": "kmc", "ModDate": "D:20200402215911+05'30'", "Producer": "Adobe Acrobat Pro DC 20 Paper Capture Plug-in; modified using iText\u00ae 7.1.7 \u00a92000-2019 iText Group NV (AGPL-version)", "Title": "kmc", "chunk_index": 657, "chroma:document": "Benefits of KMC (cont..)\nOther benefits\n\uf06e\nLess stress to the infant\n\uf0a7\nStronger bonding\n\uf0a7\nDeep satisfaction for mother\n\uf0a7\nMore confident parents\n\uf0a7\nTeaching Aids: NNF KMC-7"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: c68db60a-eb0d-4292-99bd-7271f05bbb6d
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_file.pdf", "file_path": "pdfs\\kmc_file.pdf", "page": 7, "total_pages": 25, "Author": "client1", "CreationDate": "D:20140626153516+05'30'", "Creator": "PScript5.dll Version 5.2.2", "Keywords": "kmc", "ModDate": "D:20200402215911+05'30'", "Producer": "Adobe Acrobat Pro DC 20 Paper Capture Plug-in; modified using iText\u00ae 7.1.7 \u00a92000-2019 iText Group NV (AGPL-version)", "Title": "kmc", "chunk_index": 658, "chroma:document": "Requirements for KMC\nimplementation\nTraining\n\uf06e\nNurses, physicians and other staff\nEducational material\n\uf06e\nInformation sheets, posters and video films on KMC\nFurniture\n\uf06e\nSemi-reclining easy chairs\nBeds with adjustable back rest\nTeaching Aids: NNF KMC-8"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: a031caf6-2477-4652-9728-94e9ef6e1717
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_file.pdf", "file_path": "pdfs\\kmc_file.pdf", "page": 8, "total_pages": 25, "Author": "client1", "CreationDate": "D:20140626153516+05'30'", "Creator": "PScript5.dll Version 5.2.2", "Keywords": "kmc", "ModDate": "D:20200402215911+05'30'", "Producer": "Adobe Acrobat Pro DC 20 Paper Capture Plug-in; modified using iText\u00ae 7.1.7 \u00a92000-2019 iText Group NV (AGPL-version)", "Title": "kmc", "chunk_index": 659, "chroma:document": "Eligibility criteria: Baby\nBirth weight >1800 gm:\n\uf06e\nStart at birth\nBirth weight 1200-1799 gm:\n\uf06e\nHemodynamically stable\nBirth weight <1200 gm:\n\uf06e\nHemodynamically stable\nHemodynamic stability is a MUST\nTeaching Aids: NNF KMC-9"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 5b8b5a02-3713-43f5-a023-7e2f55d8a533
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_file.pdf", "file_path": "pdfs\\kmc_file.pdf", "page": 9, "total_pages": 25, "Author": "client1", "CreationDate": "D:20140626153516+05'30'", "Creator": "PScript5.dll Version 5.2.2", "Keywords": "kmc", "ModDate": "D:20200402215911+05'30'", "Producer": "Adobe Acrobat Pro DC 20 Paper Capture Plug-in; modified using iText\u00ae 7.1.7 \u00a92000-2019 iText Group NV (AGPL-version)", "Title": "kmc", "chunk_index": 660, "chroma:document": "Eligibility criteria: Mother\nWillingness\n\uf06e\nGeneral health & nutrition\n\uf06e\nHygiene\n\uf06e\nSupportive family\n\uf06e\nSupportive community\n\uf06e\nTeaching Aids: NNF KMC-10"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 7d2ba18e-bf31-463c-a1b8-1612e81d1f05
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_file.pdf", "file_path": "pdfs\\kmc_file.pdf", "page": 10, "total_pages": 25, "Author": "client1", "CreationDate": "D:20140626153516+05'30'", "Creator": "PScript5.dll Version 5.2.2", "Keywords": "kmc", "ModDate": "D:20200402215911+05'30'", "Producer": "Adobe Acrobat Pro DC 20 Paper Capture Plug-in; modified using iText\u00ae 7.1.7 \u00a92000-2019 iText Group NV (AGPL-version)", "Title": "kmc", "chunk_index": 661, "chroma:document": "Preparing for KMC\nCounseling\n\uf06e\nDemonstrate procedure\n\uf0a7\nEnsure family support\n\uf0a7\nKMC support group\n\uf0a7\nMother\u2019s clothing\n\uf06e\nFront-open, light dress as per the local culture\n\uf0a7\nBaby\u2019s clothing\n\uf06e\nCap, socks, nappy and front-open sleeveless shirt\n\uf0a7\nor \u2018jhabala\u2019\nTeaching Aids: NNF KMC-11"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 9c273f2d-6fb3-4803-8b3f-876eaca21136
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_file.pdf", "file_path": "pdfs\\kmc_file.pdf", "page": 11, "total_pages": 25, "Author": "client1", "CreationDate": "D:20140626153516+05'30'", "Creator": "PScript5.dll Version 5.2.2", "Keywords": "kmc", "ModDate": "D:20200402215911+05'30'", "Producer": "Adobe Acrobat Pro DC 20 Paper Capture Plug-in; modified using iText\u00ae 7.1.7 \u00a92000-2019 iText Group NV (AGPL-version)", "Title": "kmc", "chunk_index": 662, "chroma:document": "KMC procedure:\nKangaroo positioning\nPlace baby between the mother\u2019s breasts in\n\uf06e\nan upright position\nHead turned to one side and slightly\n\uf06e\nextended\nHips flexed and abducted in a \u201cfrog\u201d position;\n\uf06e\narms flexed\nBaby\u2019s abdomen at mother\u2019s epigastrium\n\uf06e\nSupport baby\u2019s bottom\n\uf06e\nTeaching Aids: NNF KMC-12"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: dc46ddc6-146e-4da6-a40f-906a41f3f209
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_file.pdf", "file_path": "pdfs\\kmc_file.pdf", "page": 12, "total_pages": 25, "Author": "client1", "CreationDate": "D:20140626153516+05'30'", "Creator": "PScript5.dll Version 5.2.2", "Keywords": "kmc", "ModDate": "D:20200402215911+05'30'", "Producer": "Adobe Acrobat Pro DC 20 Paper Capture Plug-in; modified using iText\u00ae 7.1.7 \u00a92000-2019 iText Group NV (AGPL-version)", "Title": "kmc", "chunk_index": 663, "chroma:document": "KMC procedure:\nKangaroo positioning (cont..)\nHead turned\nto one side\nBaby between\nmother\u2019s breasts\nFrog-leg\nSupport baby\u2019s\nposition\nbottom\nTeaching Aids: NNF KMC-13"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 0b74c827-c211-4381-bac5-c5590f18ce54
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_file.pdf", "file_path": "pdfs\\kmc_file.pdf", "page": 13, "total_pages": 25, "Author": "client1", "CreationDate": "D:20140626153516+05'30'", "Creator": "PScript5.dll Version 5.2.2", "Keywords": "kmc", "ModDate": "D:20200402215911+05'30'", "Producer": "Adobe Acrobat Pro DC 20 Paper Capture Plug-in; modified using iText\u00ae 7.1.7 \u00a92000-2019 iText Group NV (AGPL-version)", "Title": "kmc", "chunk_index": 664, "chroma:document": "KMC procedure:\nKangaroo positioning (cont..)\nTeaching Aids: NNF KMC-14"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 72da629d-4034-44f9-8f77-f9a377d225ba
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_file.pdf", "file_path": "pdfs\\kmc_file.pdf", "page": 14, "total_pages": 25, "Author": "client1", "CreationDate": "D:20140626153516+05'30'", "Creator": "PScript5.dll Version 5.2.2", "Keywords": "kmc", "ModDate": "D:20200402215911+05'30'", "Producer": "Adobe Acrobat Pro DC 20 Paper Capture Plug-in; modified using iText\u00ae 7.1.7 \u00a92000-2019 iText Group NV (AGPL-version)", "Title": "kmc", "chunk_index": 665, "chroma:document": "Monitoring during KMC\nCheck if\nNeck position is neutral\n\uf06e\nAirway is clear\n\uf06e\nBreathing is regular\n\uf06e\nColor is pink\n\uf06e\nTemperature is being maintained\n\uf06e\nTeaching Aids: NNF KMC-15"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 2f341a81-bfc0-4f47-aa67-7b635834fa8c
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_file.pdf", "file_path": "pdfs\\kmc_file.pdf", "page": 15, "total_pages": 25, "Author": "client1", "CreationDate": "D:20140626153516+05'30'", "Creator": "PScript5.dll Version 5.2.2", "Keywords": "kmc", "ModDate": "D:20200402215911+05'30'", "Producer": "Adobe Acrobat Pro DC 20 Paper Capture Plug-in; modified using iText\u00ae 7.1.7 \u00a92000-2019 iText Group NV (AGPL-version)", "Title": "kmc", "chunk_index": 666, "chroma:document": "Initiation of KMC\nBaby should be stable\n\uf06e\nShort KMC sessions can be initiated even if\n\uf06e\nthe baby is receiving\nIV fluids\n\uf0a7\nOxygen therapy\n\uf0a7\nOrogastric tube feeding\n\uf0a7\nTeaching Aids: NNF KMC-16"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 87d43672-4552-4009-8fad-e931ff4b28fb
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_file.pdf", "file_path": "pdfs\\kmc_file.pdf", "page": 16, "total_pages": 25, "Author": "client1", "CreationDate": "D:20140626153516+05'30'", "Creator": "PScript5.dll Version 5.2.2", "Keywords": "kmc", "ModDate": "D:20200402215911+05'30'", "Producer": "Adobe Acrobat Pro DC 20 Paper Capture Plug-in; modified using iText\u00ae 7.1.7 \u00a92000-2019 iText Group NV (AGPL-version)", "Title": "kmc", "chunk_index": 667, "chroma:document": "Duration of Kangaroo Mother Care\nStart KMC sessions in the nursery\n\uf06e\nPractice one hour sessions initially\n\uf06e\nTransit from conventional care to longer KMC\n\uf06e\nTransfer baby to post-natal ward and\n\uf06e\ncontinue KMC\nIncrease duration up to 24 hours a day\n\uf06e\nTeaching Aids: NNF KMC-17"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: dabcfc00-61b7-4db3-8ef1-b721021ea6d5
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_file.pdf", "file_path": "pdfs\\kmc_file.pdf", "page": 17, "total_pages": 25, "Author": "client1", "CreationDate": "D:20140626153516+05'30'", "Creator": "PScript5.dll Version 5.2.2", "Keywords": "kmc", "ModDate": "D:20200402215911+05'30'", "Producer": "Adobe Acrobat Pro DC 20 Paper Capture Plug-in; modified using iText\u00ae 7.1.7 \u00a92000-2019 iText Group NV (AGPL-version)", "Title": "kmc", "chunk_index": 668, "chroma:document": "KMC during sleep and resting\nResting\nReclining or semi-recumbent position\n\uf06e\nAdjustable bed\n\uf06e\nSeveral pillows on an ordinary bed\n\uf06e\nEasy reclining chair\n\uf06e\nSleep\nSupporting garment restraint for baby\n\uf06e\nTeaching Aids: NNF KMC-18"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 7afeb475-21c5-4bd4-a49b-e4a5f577ff36
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_file.pdf", "file_path": "pdfs\\kmc_file.pdf", "page": 18, "total_pages": 25, "Author": "client1", "CreationDate": "D:20140626153516+05'30'", "Creator": "PScript5.dll Version 5.2.2", "Keywords": "kmc", "ModDate": "D:20200402215911+05'30'", "Producer": "Adobe Acrobat Pro DC 20 Paper Capture Plug-in; modified using iText\u00ae 7.1.7 \u00a92000-2019 iText Group NV (AGPL-version)", "Title": "kmc", "chunk_index": 669, "chroma:document": "KMC during sleep\nTeaching Aids: NNF KMC-19"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 783f509b-37e6-4f6b-9e4c-ecb6a4319985
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_file.pdf", "file_path": "pdfs\\kmc_file.pdf", "page": 19, "total_pages": 25, "Author": "client1", "CreationDate": "D:20140626153516+05'30'", "Creator": "PScript5.dll Version 5.2.2", "Keywords": "kmc", "ModDate": "D:20200402215911+05'30'", "Producer": "Adobe Acrobat Pro DC 20 Paper Capture Plug-in; modified using iText\u00ae 7.1.7 \u00a92000-2019 iText Group NV (AGPL-version)", "Title": "kmc", "chunk_index": 670, "chroma:document": "KMC during resting\nTeaching Aids: NNF KMC-20"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 33b03d6d-2c7d-4135-a01c-265ebf7b3aaa
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_file.pdf", "file_path": "pdfs\\kmc_file.pdf", "page": 20, "total_pages": 25, "Author": "client1", "CreationDate": "D:20140626153516+05'30'", "Creator": "PScript5.dll Version 5.2.2", "Keywords": "kmc", "ModDate": "D:20200402215911+05'30'", "Producer": "Adobe Acrobat Pro DC 20 Paper Capture Plug-in; modified using iText\u00ae 7.1.7 \u00a92000-2019 iText Group NV (AGPL-version)", "Title": "kmc", "chunk_index": 671, "chroma:document": "Any family member can do it !\nGrandmother\nFather\nFather & other family members can\nalso provide skin-to-skin care\nTeaching Aids: NNF KMC-21"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 120f41ff-b1e2-4798-abaf-c7e473ed464c
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_file.pdf", "file_path": "pdfs\\kmc_file.pdf", "page": 21, "total_pages": 25, "Author": "client1", "CreationDate": "D:20140626153516+05'30'", "Creator": "PScript5.dll Version 5.2.2", "Keywords": "kmc", "ModDate": "D:20200402215911+05'30'", "Producer": "Adobe Acrobat Pro DC 20 Paper Capture Plug-in; modified using iText\u00ae 7.1.7 \u00a92000-2019 iText Group NV (AGPL-version)", "Title": "kmc", "chunk_index": 672, "chroma:document": "Criteria for transfer\nFrom nursery to ward\nStable baby\n\uf06e\nGaining weight\n\uf06e\nMother confident of looking after the\n\uf06e\nbaby\nTeaching Aids: NNF KMC-22"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: c63dda03-8b98-4af6-a8b5-7ac85691d2cd
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{"source": "pdfs\\kmc_file.pdf", "file_path": "pdfs\\kmc_file.pdf", "page": 22, "total_pages": 25, "Author": "client1", "CreationDate": "D:20140626153516+05'30'", "Creator": "PScript5.dll Version 5.2.2", "Keywords": "kmc", "ModDate": "D:20200402215911+05'30'", "Producer": "Adobe Acrobat Pro DC 20 Paper Capture Plug-in; modified using iText\u00ae 7.1.7 \u00a92000-2019 iText Group NV (AGPL-version)", "Title": "kmc", "chunk_index": 673, "chroma:document": "Discharge criteria\nBaby is well with no evidence of infection\n\uf06e\nFeeding well (predominant breast milk)\n\uf06e\nGaining weight (15-20 gm/kg/day)\n\uf06e\nMaintaining body temperature (in room\n\uf06e\ntemperature)\nMother confident of taking care of the baby\n\uf06e\nFollow-up visits ensured\n\uf06e\nTeaching Aids: NNF KMC-23"}


created_at: 2025-05-02 10:00:24
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{"source": "pdfs\\kmc_file.pdf", "file_path": "pdfs\\kmc_file.pdf", "page": 23, "total_pages": 25, "Author": "client1", "CreationDate": "D:20140626153516+05'30'", "Creator": "PScript5.dll Version 5.2.2", "Keywords": "kmc", "ModDate": "D:20200402215911+05'30'", "Producer": "Adobe Acrobat Pro DC 20 Paper Capture Plug-in; modified using iText\u00ae 7.1.7 \u00a92000-2019 iText Group NV (AGPL-version)", "Title": "kmc", "chunk_index": 674, "chroma:document": "Discontinuation of KMC\nTerm gestation\n\uf06e\nWeight ~ 2500 gm\n\uf06e\nBaby uncomfortable\n\uf06e\nWriggling out\n\uf0a7\nPulls limbs out\n\uf0a7\nCries and fusses\n\uf0a7\nMother can continue KMC after giving the baby\na bath and during cold nights\nTeaching Aids: NNF KMC-24"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\kmc_file.pdf", "file_path": "pdfs\\kmc_file.pdf", "page": 24, "total_pages": 25, "Author": "client1", "CreationDate": "D:20140626153516+05'30'", "Creator": "PScript5.dll Version 5.2.2", "Keywords": "kmc", "ModDate": "D:20200402215911+05'30'", "Producer": "Adobe Acrobat Pro DC 20 Paper Capture Plug-in; modified using iText\u00ae 7.1.7 \u00a92000-2019 iText Group NV (AGPL-version)", "Title": "kmc", "chunk_index": 675, "chroma:document": "Post-discharge f ollow up\nOnce or twice a week till 37-40 wks / 2.5-3 kg\n\uf06e\nThereafter, once in 2-4 wks till 3 months PCA\n\uf06e\nSubsequently, every 1-2 months during first\n\uf06e\nyear\nMore frequent visits if baby is not growing\n\uf06e\nwell (< 15-20 gm/kg/day up to 40 weeks PCA\nand then < 10 gm/kg/day)\nTeaching Aids: NNF KMC-25"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 2, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 676, "chroma:document": "Kangaroo Mother Care\n&\noptiMal feeding of low birth weight infants\nOperational Guidelines | September 2014\nFor Programme Managers & Service Provider\nChild Health Division\nMinistry of Health and Family Welfare\nGovernment of India"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: e366f845-509d-45a1-917a-044baf830d1e
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 4, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 677, "chroma:document": "FOrewOrD\nBirth Weight is a reliable and sensitive indicator for predicting the immediate and long term\noutcome of a newborn. Low Birth Weight (LBW) is a challenging multifaceted public health\nproblem because it is associated with increased risk of morbidity and mortality in infants.\nLow Birth Weight newborns are four times more likely to die from common childhood\ndiseases in the first year of life, than their normal counterpart. The public health significance\nof Low Birth Weight is accentuated by its association with mental retardation, specialized\ninstitutional care and intensive care units. There is also emerging evidence that Low Birth\nWeight neonates are more prone to Non-Communicable Diseases (NCDs) like Diabetes\nMellitus, Hypertension and Coronary Artery Disease in later life.\nKangaroo Mother Care(KMC) and optimal feeding in Low Birth Weight infants are evidence\nbased cost-effective interventions which, when upscaled and implemented across all facilities"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 80dfca9d-5b22-4c94-be80-202e1a8b991b
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 4, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 678, "chroma:document": "based cost-effective interventions which, when upscaled and implemented across all facilities\ncan save up to half a million newborns. Despite the KMC network having been established in\nIndia in 1990s, this simple technique is still not being practiced universally across the country.\n\u201cKangaroo Mother Care and Optimal Feeding of Low Birth Weight Infants\u201d guidelines have\nbeen designed to emphasize the implementation of KMC in SNCUs and Medical Colleges on\npriority.\nThis guideline I am sure will help the service providers and programme managers alike to\nimplement KMC and optimal feeding and will go a long way in improving the survival and\ndevelopment of low birth infants.\nC.K. Mishra"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: ea7178d6-d396-419d-8069-88069466f20b
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 6, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 679, "chroma:document": "PreFaCe\nPreterm births and intra-uterine growth retardation lead to low birth weight (LBW),\nwhich is an important indirect cause of neonatal deaths. The global prevalence of\nLBW is 15.5% and in India, 27% of all live births are LBW.\nKangaroo Mother Care (KMC) is a simple, cost-effective way of caring for low birth\nweight infants and has been included in many guidelines and training modules\nreleased by Government of India. It has been observed that despite undergoing\ntraining, service providers are not adept at providing Kangaroo Mother Care for\nLBW newborns. It was therefore the need of the hour to have an implementation\nguideline for rolling out KMC at the facility level.\nThese guidelines will give a clear idea to service providers on what exactly KMC is\nand how KMC techniques can be implemented when caring for low birth weight\ninfants. I am confident that the guidelines will also be used by programme managers"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 46361f65-26dd-4746-b33d-4e1556a50ae5
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 6, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 680, "chroma:document": "infants. I am confident that the guidelines will also be used by programme managers\nand health facility managers to establish KMC units across the country and help in\nreducing neonatal mortality.\n(Dr. rakesh Kumar)"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: c25f7047-1df5-48fc-88eb-1ae1722c2379
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 8, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 681, "chroma:document": "aCKnOwleDGeMent\nIn India, Low Birth Weight (LBW) is an important underlying cause of neonatal\nmortality. Experience from world over shows that appropriate care of LBW infants,\nwhich encompasses feeding, temperature maintenance, hygienic care, early\ndetection of infections and treatment of complications can substantially reduce\nmortality rates.\n\u201cKangaroo mother care\u201d-a simple and cost effective technique was introduced\nin India in 1994 and KMC Network of India was also established. Though this\nintervention finds a place in various training modules it is not being implemented\nacross the facilities in the country.\nChild Health Division, Ministry of Health & Family Welfare (MOHFW), Govt. of India\nhas taken a decision to implement Kangaroo Mother Care at facility level. Operational\nGuidelines for \u201cKangaroo Mother Care and Optimal Feeding of Low birth Weight\ninfants\u201d is a step towards this direction.\nDr. P.K. Prabhakar, Deputy Commissioner, MOHFW coordinated the development of"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 285a1f35-e92b-4399-bbf0-8fd30acdd29b
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 8, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 682, "chroma:document": "Dr. P.K. Prabhakar, Deputy Commissioner, MOHFW coordinated the development of\nthese guidelines and led the team of Child Health Division and experts from various\ninstitutions and development partners. Contribution of all experts is gratefully\nacknowledged. Special thanks are due to Dr. Vinod K. Paul, Dr. A. Deorari, Dr. Rekha\nUdani, Dr. Sushma Nangia and Dr. Sadhana Mehta for reviewing the draft and\nhelping in finalizing the guidelines. Contribution of USAID-MCHIP in coordinating\nthe development and printing of this guideline is also acknowledged.\n(Dr. ajay Khera)"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: ed44fd79-d1b9-4ee0-9f5b-207fd0796641
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 10, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 683, "chroma:document": "list of ContribUtors\nMINISTRY OF HEALTH AND FAMILY WELFARE\nDr. Ajay Khera\nDr. P.K. Prabhakar\nDr. Renu Srivastava\nDr. Nimisha Goel\nMr. Sharad Singh\nEXPERTS\nDr. Vinod K. Paul Dr. Arun Kumar Singh Dr. Reeta Raisaily\nDr. Shashi Vani Dr. Harish Chellani Dr. R. Srinivasan\nDr. Siddharth Ram Ji Dr. Harish Kumar Prof. A.T. Arasar Seeralar\nDr. Rekha H. Udani Dr. Sachin Gupta Dr. Anju Puri\nDr. Ashok Deorari Dr. Gagan Gupta Dr. Pawan Pathak\nDr. Sushma Nangia Dr. Kanya Mukhopadhyay Dr. Rajesh Khanna\nDr. Sadhana Mehta Dr. Suman Rao Dr. Javvad Suri\nDr. J. Kumutha Dr. Rita Bora Dr. Sebanti Ghosh\nDr. Ruchi Nanavati Dr. Ramesh Agarwal Dr. Lata Bhat\nLIST OF CONTRIBUTORS ix"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 6f18b689-8f51-4f67-9e4f-a9c12f18877d
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 12, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 684, "chroma:document": "table of Contents\nAcronyms .........................................................................................................................................................................................xiii\nIntroduction .......................................................................................................................................................................................1\nKangaroo Mother Care Implementation .................................................................................................................................7\nOptimal Feeding of Low Birth Weight Infants .....................................................................................................................17\nAction Plan for Implementation and Scale-up ...................................................................................................................27"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 12, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 685, "chroma:document": "Annexure ..........................................................................................................................................................................................35\nAnnexure I: Manual Expression of Breast milk and Storage thereof ...........................................................................37\nAnnexure II: Alternative Feeding Methods (Cup/Spoon/Paladai Feeding) ..............................................................39\nAnnexure III: Follow-up Protocol after Discharge of a High-risk infant......................................................................43\nAnnexure IV: Infant Milk Substitutes Act ..............................................................................................................................46\nAnnexure V: Orientation on Kangaroo Mother Care ........................................................................................................48"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 12, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 686, "chroma:document": "References ........................................................................................................................................................................................49\nLISTTA OBFL EC OONF TCROIBNUTTEONRTSS xi"}


created_at: 2025-05-02 10:00:24
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 14, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 687, "chroma:document": "aCronYMs\nAIIMS All India Institute of Medical Sciences KMC Kangaroo Mother Care\nANM Auxiliary Nurse & Midwife KMCU Kangaroo Mother Care Unit\nASHA Accredited Social Health Activist KSCH Kalawati Saran Children\u2019s hospital\nAV aids Audio Visual aids LBW Low Birth weight\nBERA Brainstem evoked response LHMC Lady Hardinge Medical College\naudiometry MCH Maternal and Child Health\nCC Chest Circumference MCHIP Maternal and Child Health\nDEIC District Early Intervention Centre Integrated Program\nFBNC Facility Based Newborn Care MEN Minimal Enteral Nutrition\nF-IMNCI Facility based Integrated NHM National Health Mission\nManagement of Neonatal and NICU Newborn Intensive Care Unit\nChildhood Illnesses\nNNF National Neonatology Forum\nFOGSI Federation of Obstetric and\nOAE Otoacoustic Emissions\nGynaecological Societies of India\nPMA Post Menstrual Age\nGNM General Nursing and Midwifery\nPVL Periventricular leukomalacia\nHBNC Home Based Newborn Care\nRBSK Rashtriya Bal Swasthya Karyakram\nHC Head Circumference"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 14, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 688, "chroma:document": "HBNC Home Based Newborn Care\nRBSK Rashtriya Bal Swasthya Karyakram\nHC Head Circumference\nRCC Regional Collaborative Centre\nHib Haemophilus influenzae type B\nRMNCH+A Reproductive, Maternal, Newborn,\nIANN Indian Association of Neonatal\nChild and Adolescent Health\nNurses\nSGA Small for Gestational Age\nIAP Indian Academy of Paediatrics\nSNCU Sick Newborn Care Unit\nIM Intramuscular\nSTS Skin-to-Skin\nIMS Act Infant Milk Substitutes Act\nUSAID United States Agency for\nIQ Intelligence Quotient\nInternation Development\nJSSK Janani Shishu Suraksha Karyakram\nWHO-CC World Health Organization\nKEM King Edward Medical College Collaborative Centre\nACRONYMS xiii"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 16, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 689, "chroma:document": "introdUCtion\nl KANGAROO MOTHER CARE (KMC)\nl DEFINITIONS\nl EVIDENCE FOR KMC\nl PURPOSE OF THE GUIDELINES"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 18, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 690, "chroma:document": "iinnttrrooddUUCCttiioonn\nIntroduction\nOf the 20 million low birth weight infants born globally stabilizes body temperature, promotes breast feeding,\nevery year, about 8 million are in India. Over 80% of prevents infection and other morbidities. This also\nneonatal deaths occur among small infants - 65% leads to early discharge, better neurodevelopment\nare attributable to preterm infants and 19% to term- and encourages bonding between mother and\nsmall for gestational age, (SGA) (Lawn Every Newborn infant. KMC is initiated in the hospital and continued\nLancet Series 2014). India has the highest number at home until the infant needs it and for optimum\nof preterm births and also accounts for maximum care a regular follow-up must be ensured.\nnumber of neonatal deaths due to prematurity.\nKangaroo mother care has following components:\nIncidence of LBW in India is about 27% of total live\nbirths. 1. Skin-to-skin contact\n2. Exclusive breast feeding\nKangaroo Mother Care (KMC)"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 18, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 691, "chroma:document": "births. 1. Skin-to-skin contact\n2. Exclusive breast feeding\nKangaroo Mother Care (KMC)\nHowever, KMC should not be confused with routine\nskin-to-skin care at birth. World Health Organization\nKangaroo Mother Care is a low resource, evidence\n(WHO) recommends skin-to-skin care immediately\nbased, high impact intervention and standardised\nafter delivery for every newborn, irrespective of the\ncare for low birth weight infants which, like\nbirth weight to ensure warmth and early initiation of\nbreastfeeding, should be part of routine care. It can\nbreast feeding in the delivery room KMC is meant for\nprevent up to half of all deaths in infants weighing\nstable LBW infants and denotes a sustained, long-\n<2000g (Lawn et al, 2010).\nduration skin-to-skin contact.\nDEFINITIONS\nKangaroo is an animal found in Australia. She\nKangaroo Mother Care (KMC) is a simple method of\ninvariably delivers a premature baby. The premature,\ncare for low birth weight infants that includes early"}


created_at: 2025-05-02 10:00:24
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 18, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 692, "chroma:document": "care for low birth weight infants that includes early\nbaby kangaroo stays in the pouch of her mother,\nand prolonged skin-to-skin contact with the mother\nwhere it gets warmth and exclusive breast feeding\n(or a substitute caregiver) and exclusive and frequent\ntill it is mature enough to survive outside.\nbreastfeeding. This natural form of human care\nIntroduction 3"}


created_at: 2025-05-02 10:00:24
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 19, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 693, "chroma:document": "\u008d Better mother-infant bonding and maternal\nDuratiOn OF KMC\nsatisfaction with the method of care, as\nShort: 4 hours daily* extended: 5-8 hours daily* compared with conventional methods\nlong: 9-12 hours daily*\nAbove review included seven trials that assessed\nContinuous: More than12 hours daily*\nmortality at discharge or 40\u201341weeks and reported\n*Documented on two consecutive days or more a statistically significant reduction in the risk of\nprior to discharge. mortality among KMC infants (3.4%), compared\nwith 5.7% for infants receiving traditional care. the\nDuration to be counted as cumulative completed\nreview ultimately concluded that KMC should be\nhours during a 24 hour period.\nused for all stabilized lBw infants.\nthere is now sufficient evidence to recommend\nlow birth weight (lBw) has been defined by the\nthe routine use of KMC for all low birth weight\nWorld Health organization (WHO) as weight at birth\ninfants. However in our country newborn infants"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 19, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 694, "chroma:document": "World Health organization (WHO) as weight at birth\ninfants. However in our country newborn infants\nless than 2,500 grams which can be a consequence\nweighing less than 2,000 grams should be started\nof preterm birth or due to small size for gestational\non KMC, on priority in view of the high burden of\nage or both. Preterm is defined as born before 37\nlBw infants.\nweeks completed and SGA is defined as weight for\ngestation less than 10th percentile of the gestation\nnorm. Newborn infants weighing less than 2000 grams\nshould be started on KMC on priority.\nEvIDENcE FOR KMc\nother benefits\nevidence of the effectiveness and safety of\nKMC for clinically stable preterm newborns, is KMC is associated with reduced incidence of severe\nnow formally established. In 2011, an updated illness including pneumonia during infancy. In most\nCochrane review (Conde-Agudelo, Diaz-Rossello, of the studies KMC has been found to be more"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: e79da276-addf-43be-a701-8910e50a169c
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 19, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 695, "chroma:document": "Cochrane review (Conde-Agudelo, Diaz-Rossello, of the studies KMC has been found to be more\nBelizan 2011) assessed 35 studies. This review effective than incubator care for stable newborns\ndemonstrated even more convincing results than in: providing adequate thermal care, reducing\nthe previous one published in 2008. Compared nosocomial infections, improving exclusive\nwith conventional neonatal care, KMC was found breastfeeding and weight gain, and fostering greater\nto reduce: maternal and family involvement in care\u2014all at a\nlower cost than incubator care.\n\u008d Mortality at discharge and at the latest\nfollow-up,\n\u008d Severe infection/sepsis, nosocomial infections, KMC satisfies all five senses of the infant. The infant\nlower respiratory tract disease, feels the mother\u2019s warmth through skin-to-skin\ncontact (touch), listens to her voice and heartbeat\n\u008d Hypothermia and length of hospital stay.\n(hearing), sucks breast milk (taste) has eye contact"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 656cc727-3fc3-4e65-ac6d-774c0c456e01
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 19, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 696, "chroma:document": "\u008d Hypothermia and length of hospital stay.\n(hearing), sucks breast milk (taste) has eye contact\nThe 2011 review also revealed that KMC resulted in: with her (vision) and smells her odor (olfaction).\n\u008d Improved weight, length and head\ncircumference,\nManagement of LBW is covered in various training\n\u008d Increased breastfeeding rates, packages under NHM (including, Facility-Based\n4 KANGAROO MOTHER CARE & OPTIMAL FEEDING OF LOW BIRTH WEIGHT INFANTS"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 9297955f-ae8a-400f-95d2-f70ff0867c58
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 20, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 697, "chroma:document": "have special nutritional needs. Evidence based\nHiStOry OF KMC\nprinciples exist which highlight the importance\nl A team of pediatricians started KMC in of \u2018breast milk feeding\u2019 and practical aspects of\nInstituto Materno Infantil (IMI) in Bogota, \u2018enabling LBW infants achieve optimum growth\u2019\nColombia in 1978. through optimum feeding. Therefore there was\nl In 2003, WHO formally endorsed KMC and a need to develop integrated guidelines for\npublished KMC practice guidelines. implementing KMC and feeding of low birth weight\ninfants.\nl KMC was introduced in India, in 1994 in BJ\nMedical College Hospital, Ahmedabad. This\nPuRPOSE OF THE GuIDELINES\nwas followed by experiences in KEM Mumbai\nand at the All India Institute Medical Sciences\nThe purpose of the guidelines is to:\n(AIIMS).\nl A KMC India Network (www.kmcindia.org)\n\u008d Present evidence based technical protocols\nto be observed at the health facilities for\ncomprising six institutions was started in\nKMC and feeding of LBW infants.\n2003."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 6810fc76-adc8-47e7-9be5-996c363b700b
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 20, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 698, "chroma:document": "comprising six institutions was started in\nKMC and feeding of LBW infants.\n2003.\n\u008d Provide appropriate guidance on:\nNewborn Care, Facility-IMNCI) with mention of KMC. l Operationalization of KMC and LBW\nYet the practice of KMC in public health facilities feeding practices at different levels of\n(including SNCUs and medical colleges) as also in health facilities.\nprivate hospitals remains inadequate. A recent\nl Choice of initial feeding method,\nassessment of KMC in selected tertiary care hospitals\nprogression of oral feeds, and nutritional\nin a few states in the western and southern parts of\nsupplementation.\nIndia revealed many bottlenecks in implementing\nThe guidelines discuss not only various protocols,\nKMC including:\nbut also the essential skills and monitoring\n1. Lack of institutionalization\ninvolved. It has been prepared for health\n2. No ownership of KMC even in facilities professionals providing care to LBW and preterm"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: d8df1984-029f-412c-97ed-730099cdafe2
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 20, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 699, "chroma:document": "2. No ownership of KMC even in facilities professionals providing care to LBW and preterm\nproviding care infants in health facilities. Practical instructions\n3. Inadequate continuum of KMC after (or protocols) may be adapted to local norms for\ndischarge different categories of health workers available in\nvarious settings. The guidelines are also aimed at\nThe study recommended the need for strengthening\ndecision-makers and planners at various levels\ntraining of service providers, appropriate job aids\nto help them understand the prerequisites to\nand IEC materials, and appropriate system for follow-\nimplement KMC, optimal feeding and follow-up\nup of LBW infants.\nof LBW infants. These should also be incorporated\nSituation analysis also indicates that KMC and into pre-service and in-service educational\nfeeding go hand-in-hand for LBW infants as they packages on neonatal care.\nIntroduction 5"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 55e36fd6-8801-4735-bda8-d5d6b9d871b2
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 22, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 700, "chroma:document": "Kangaroo Mother\nCare iMpleMentation\nl What is required for implementing KMC\nl Who can provide KMC?\nl How to Provide KMC\nw Counselling\nw Clothing\nw KMC Position\nl Duration of KMC\nl Monitoring of the infant\nl Feeding during KMC\nl Special situations\nl Discharge from hospital and follow-up\nw Follow-up\nFrequency of visits\nn\nl Don\u2019ts of Kangaroo Mother Care"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 0df5aed3-1fb0-4f0e-bec1-05cc3bef3dc7
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 24, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 701, "chroma:document": "Kangaroo Mother Care\niMpleMentation\nEven though KMC is simple, it needs to be initiated most crucial for assisting mothers in KMC practice\nat the hospital under skilled supervision. The and LBW feeding.\nmother needs guidance by a health professional\nc. IEc\nto provide KMC and optimally breastfeed the LBW\ninfant, starting at the facility and continuing on her Ensure adequate IEC material, including video films\nown at home. once the mother goes home, it is on KMC in local language for mothers, families and\nimportant that the continuum of KMC is maintained; community.\ncommunity health workers (ASHAs, ANMs, AWWs)\nCounselling of the mothers, fathers and relatives by\nshould ensure that the mother continues to provide\nservice providers is catalytic in ensuring KMC practice\nkangaroo care at home. It is equally important that\nduring their stay at the hospital and after discharge\nthey should facilitate follow-up visits to the facility\nso that they can continue to practice KMC till the"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: a0262bbc-f90c-416b-8a57-a242c4e5b46d
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 24, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 702, "chroma:document": "so that they can continue to practice KMC till the\nfor review and problem solving as this support is\ninfant requires it. Community awareness activities\ncrucial for the infant\u2019s health after discharge.\nshould be conducted to maximize the benefits of\nKMC and breastfeeding.\nWHAT IS REquIRED FOR\nIMPLEMENTING KMc?\nNurses and other service providers learn to\na. Infrastructure\nappreciate KMC once they observe the health\nDedicated space near Special Newborn Care Unit benefits to the infant and satisfaction of the\n(SNCU), post-natal ward or neonatal ward/ NBSU mother.\nwhich is furnished with comfortable reclining chairs\n& cots, provides privacy for expression of breast milk\nand is equipped with storage facility for expressed\nD. Which infants should be provided KMC\nbreast milk.\nThough all LBW infants should be provided KMC but\nB. human resources:\nconsidering the huge burden at facilities, priority"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 9b1e8a2d-0eed-468e-8c54-9dc33422ff2d
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 24, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 703, "chroma:document": "B. human resources:\nconsidering the huge burden at facilities, priority\nThe availability of adequate number of trained and must be given to infants with birth weight less than\nwilling health service providers for 24x7 services is 2000 grams.\nKANGAROO MOTHER CARE IMPLEMENTATION 9"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: fc236357-ff5f-4921-a113-02505368972e
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 25, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 704, "chroma:document": "The timing of initiation of KMC depends on the birth need care in a Special Newborn Care Unit\nweight and stability of the infant. (SNCU) or a Newborn Intensive Care Unit\n(NICU). Intermittent KMC can be given to a\n1. Birth weight more than 1,800 grams and\nhemodynamically stable infant receiving IV\nless than 2500 g: These infants are generally\nfluids, antibiotics and oxygen. KMC should\nstable at birth. Therefore, in most such cases\nbe practiced under medical supervision. The\nKMC can be initiated soon after birth in the\nduration may be gradually increased and\npostnatal ward. The neonate weighing less\nthereafter the infant may be transferred to a\nthan 2000g should be accorded priority for\ndedicated KMC ward.\ninitiation of KMC considering the huge bur-\n3. Birth weight less than 1,200 g: These\nden of LBW infants in the country.\ninfants frequently experience serious\n2. Birth weight more than 1,200g and less\nprematurity related morbidity often starting\nthan 1800 g: Many infants of this group"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 83fc2d0a-a90a-408a-9201-32d4101846be
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 25, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 705, "chroma:document": "prematurity related morbidity often starting\nthan 1800 g: Many infants of this group\nsoon after birth. It may take days to weeks\nhave significant problems in the neonatal before the infant\u2019s condition allows initiation\nperiod. It might take a few days before of KMC. Duration of KMC should be gradually\nKMC can be initiated. Such infants may increased based on the tolerance of infant.\nFigure 1: Time of Initiation of KMC\nBirth Weight*\nMore than1200 upto less than More than1800 upto less than\nLess than 1200 gram\n1800 grams 2500 grams\nGenerally stable at birth\nMost infants suffer from ) Many infants suffer from\nserious morbidities\nserious morbidities,\ntherefore birth should ) Transfer to a specialized\ntake place in specialized centre, if possible\ncentres\n) Best transported in STS\nwith mother/family\nmember (if transport\nincubator not available)\nMay take days to weeks\nMay take days before KMC KMC can be initiated\nbefore KMC can be\ncan be initiated immediately after birth\ninitiated"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: c35598a4-7f70-4c90-b78b-119960af00b7
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 25, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 706, "chroma:document": "before KMC can be\ncan be initiated immediately after birth\ninitiated\n* Cut-off birth weight for KMC has been based on Operational Guideline of Facility Based Newborn Care\n10 KANGAROO MOTHER CARE & OPTIMAL FEEDING OF LOW BIRTH WEIGHT INFANTS"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 2cb9a113-2b1a-48eb-a968-208aba0c6e19
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 26, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 707, "chroma:document": "WHO cAN PROvIDE KMc? Clothing\nKMC can be provided by mothers, fathers and Mother:\nother adult family members. The KMC provider\nKMC can be provided using any front-open, light\nshould be willing, in good health, free from serious\ndress as per the local culture. KMC works well with\nillness and should maintain basic standards of\nsari-blouse, gown or shawl. A suitable apparel\nhygiene such as hand washing, daily bath, clipped\nlike Kangaroo bag, baby bag, sari, binder that can\nfingernails, tied up hair and clean clothes. It is\nretain the infant for an extended period can be\nrecommended that jewellery, watches and sacred\nadapted locally.\nthreads must be removed as they may be a barrier\nto maintain hygiene and might cause injury to the\nnewborn. It is not mandatory to have any special dress,\ngarment or binder for KMC. It can be provided using\nany clothing that is acceptable to the mother and\nHOW TO PROvIDE KMc?\nthe family.\nCounselling\nEffective counselling for the initiation of KMC is a infant:"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 0c39b9dd-402e-4a51-b01f-b85ade79a9b6
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 26, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 708, "chroma:document": "the family.\nCounselling\nEffective counselling for the initiation of KMC is a infant:\nprerequisite to overcome socio-cultural barriers and\nThe infant should be dressed in cap, socks, disposable\nanxiety regarding handling a LBW infant both by the\ndiapers and front-open sleeveless shirt or \u2018jhabala\u2019\nmother and other care providers.\nmade of a soft natural fabric like cotton.\nWhen the infant is ready for KMC, the first\nFigure 1: Examples of KMC supporter\ncounselling session should be organized at a time\nconvenient to the mother. The first few sessions\nare important and require extended interaction\nto develop a rapport with the mother and\nto alleviate any fear. KMC procedure should be\ndemonstrated to her explaining correct position\nin a caring, gentle manner and with patience.\nHer queries should be answered to allay her\nanxieties. Kangaroo Bag Baby Bag\nEncourage her to bring her mother/mother-in-\nFigure 2: Example of clothing for infants\nlaw, husband or any other member of the family."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: fd6a3f2f-b2aa-4f9b-a01c-7423e27a9cdb
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 26, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 709, "chroma:document": "Figure 2: Example of clothing for infants\nlaw, husband or any other member of the family.\nIt helps in building a positive attitude of the family\nand ensuring family support to the mother which\nis particularly crucial for post-discharge home-\nbased KMC. It is helpful that the mother and family\nmembers starting KMC interact with someone\nalready practicing KMC for her infant.\na supportive family is a very important\npre requisite for successful KMC.\nKANGAROO MOTHER CARE IMPLEMENTATION 11"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 452137d0-d746-4cc9-9de5-dd04116c36fd
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 27, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 710, "chroma:document": "KMC Position\nFigure 3: How to hold the infant in KMC\nHead turned to\nBaby between one side\nmother\u2019s breasts\nFrog-leg position\nSupport baby\u2019s bottom\nBaby: Figure 4: How to handle the baby\n\u008d The infant should be placed between the\nmother\u2019s breasts in an upright position.\n\u008d The head should be turned to one side and\nin a slightly extended position. This slightly\nextended head position keeps the air way\nopen and allows eye to eye contact between\nthe mother and her infant.\nThe hips should be flexed and abducted in a \u201cfrog\u201d\nposition; the arms should also be flexed.\n\u008d The infant\u2019s abdomen should be at the\nlevel of the mother\u2019s epigastrium. Mother\u2019s\nbreathing stimulates the infant, thus\nreducing the occurrence of apnoea.\n\u008d Support the infant from the bottom with a\nsling/binder.\n12 KANGAROO MOTHER CARE & OPTIMAL FEEDING OF LOW BIRTH WEIGHT INFANTS"}


created_at: 2025-05-02 10:00:24
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 28, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 711, "chroma:document": "Health provider should help the mother initiate KMC\nby assisting in positioning the infant and explaining the mother carrying an infant in the KMC position\nhow to handle the infant during KMC. Repeated can walk, stand, sit, or engage in different\ntraining helps the mother overcome the fear of activities. If comfortable, the mother can sleep with\nhandling her newborn and improves her skill related the infant in kangaroo position in a reclined or semi-\nto KMC. recumbent position\nMother:\nDuRATION OF KMc\n\u008d A semi-reclining position (40\u00ba-45\u00ba) is to be\nadopted while sleeping. This can be achieved\nMinimum duration of a KMC session should be one\nwith the help of 3-4 pillows on the hospital\nhour because frequent handling may be stressful for\nbed or special semi-reclining chairs.\nthe infant. The duration of each KMC session should\nbe gradually increased for as long as the mother can\nFigure 5: Examples of various support\ncomfortably provide KMC. The infants in KMC need\nmethods for KMC"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 28, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 712, "chroma:document": "comfortably provide KMC. The infants in KMC need\nmethods for KMC\nto be removed from skin-to-skin contact only for\nchanging diapers and clinical assessment according\nto hospital schedules.\nMONITORING OF THE INFANT\n\u008d Infants receiving KMC should be monitored\ncarefully especially during the initial stages\nto ensure that the infant\u2019s airway is clear,\nbreathing is regular, colour is pink and s/he\nis maintaining temperature. All the above\nclinical observations and duration of KMC\nshould be duly recorded in the newborn\ncase-sheet being used in the unit.\n\u008d Mother should be trained to observe her\ninfant for danger signs, like- hypothermia,\nrespiratory problems, feeding difficulty,\nchange in colour during KMC so that she can\ncontinue monitoring at home.\nFEEDING DuRING KMc\nFeeding and nutrition strategies during the\npostnatal period are very important for ensuring\noptimum growth and development of LBW infants.\nThe nutritional needs of infants with similar birth"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 28, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 713, "chroma:document": "optimum growth and development of LBW infants.\nThe nutritional needs of infants with similar birth\nweight may vary depending upon whether the baby\nis appropriate for gestational age (AGA) or small for\nKANGAROO MOTHER CARE IMPLEMENTATION 13"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 60d9d8c5-e68e-4e6e-8b73-5bf66ac539e2
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 29, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 714, "chroma:document": "gestational age (SGA). Initially, breastfeed is given transport: Ideally, transport incubators with\nat fixed intervals of two hours and not on demand, appropriate monitoring equipment are the best\nto ensure an adequate and assured minimal intake. method to transport sick infants. However, in case\nThe mother should be explained how to breastfeed they are not available, the best method to keep a\nwhile the infant is in KMC position. Holding the infant preterm/LBW infant warm during transport after\nnear the breast stimulates milk production. She may initial stabilisation is by continuous skin-to-skin\nexpress milk while the infant is still in KMC position. contact with the mother/family member.\n(For details on feeding please see the next section\nif some other family member is not available for\non optimal feeding.)\nKMC or KMC is not initiated: Ensure the baby is\nkept in warm room 25oC-28oC, adequately covered\nSPEcIAL SITuATIONS or if below 1800 grams not able to maintain normal"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: fcbafe9b-9fd1-4f43-baf2-09d024f13ac7
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 29, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 715, "chroma:document": "SPEcIAL SITuATIONS or if below 1800 grams not able to maintain normal\ntemperature under a warmer.\nThere may be special situations where despite the\nnewborn being sick KMC can be given with some DIScHARGE FROM HOSPITAL\nprecautions.\nanD FolloW-uP\nSick lBw infants: KMC is recommended for stable\nThe standard policy of the unit for discharge from\nLBW infants. However, it is beneficial even for sick\nthe hospital should be followed. Generally, the\nLBW infants. In such cases kangaroo mother care may\nfollowing criteria are accepted at most centres.\nbe given only under close and constant supervision\nin centres that are well versed with the practice of\nKMC. Hemodynamically stable preterm infants on The infant is\nprolonged ventilation or on CPAP can also be given l Stable and not on parenteral medication\nKMC. Treating MO should use her/his judicious\nl Maintaining temperature in mother\u2019s bed for 3\ndiscretion on case-to-case basis. consecutive days at room temperature"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 29, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 716, "chroma:document": "discretion on case-to-case basis. consecutive days at room temperature\nFigure 6: Health provider explaining the KMC l Gaining 15-20 grams per day for at least 3\nconsecutive days\nposition to mother\nl Accepting feeds directly from breast (preferable)\nor by spoon, paladai or cup\nUsually, the infant\u2019s weight is around 1,500 to 1,600\ngrams at the time of discharge. Infants who are\nabove 1,800 grams birth weight, do not require\nadmission into a nursery/SNCU, are given KMC soon\nafter birth and can be sent home once adequacy of\nbreastfeeding is established.\nAt discharge, the mother and family members must\nbe taught to ensure that the infant is nursed in a warm\nroom and is breastfed (Given expressed milk using\npaladai or cup). They should be adequately told about\nhygiene, danger signs, follow-up visits, immunisation\nand prompt care seeking at a health facility.\nKMC should be continued as long as required and baby\nand mother should not be discharged in a hurry."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: b89f1805-4eb3-46e3-83ef-b594bd28384c
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 29, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 717, "chroma:document": "and mother should not be discharged in a hurry.\n14 KANGAROO MOTHER CARE & OPTIMAL FEEDING OF LOW BIRTH WEIGHT INFANTS"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 43fa3607-1dab-409a-88f8-9c851b3665c6
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 30, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 718, "chroma:document": "At the time of discharge, the infant should be taken \u008d Infants discharged on KMC should be\nhome in KMC position by the mother or relatives so followed up in the regular follow-up OPD\nas to encourage continued KMC at home. of SNCUs and linkage with District Early\nIntervention Centre (DEIC) under RBSK\nAt the time of discharge, the family should be\nfor screening of neurodevelopmental\ncounselled and linked to the ASHA worker of the\nmorbidities should be established.\nvillage who shall provide home based care and\nfollow-up to the baby (as per protocol). \u008d SNCU discharged infants are to be followed\nup till one year while LBW infants are to be\nFollow-up\nfollowed up at home for one year by ASHA\nas per HBNC guidelines\nClose follow-up is a fundamental prerequisite\nof KMC practice to make a regular assessment\nof growth, sensory functions, behaviour and DON\u2019TS OF KANGAROO MOTHER\nneurodevelopment. During the follow-up visits cARE\nanthropometric measurements (e.g., weight, length,"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 957a53dc-345d-43fb-ad8a-517f616f0143
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 30, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 719, "chroma:document": "anthropometric measurements (e.g., weight, length,\nhead circumference) of the infant should be recorded \u008d Do not bathe till infant weighs 2,500 g,\nsponging may be done\nto monitor the growth. More frequent visits should\nbe made if the infant is not growing well or if her/his \u008d Do not handle infant too frequently\ncondition demands. ASHA will continue to provide\n\u008d Do not give bottle feed\ncare to the infant under home based newborn care\nin the community, following discharge. \u008d Do not allow infant to be in contact with sick\npeople\nFirst Follow-up should be at one week, followed by\nfortnightly follow-ups till next two visits. Additional\nfollow-up visits may be done until s/he reaches 40\nwhen should KMC be discontinued?\nweeks of post-conception age or achieves a weight\nOften an infant is taken off kangaroo mother care\nof 2,500 grams.\nwhen gestation reaches term or the weight is around\nIf infant is receiving immunization at a facility where"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: cd3e6040-642a-4366-a746-1cce61e4203d
encoding: FLOAT32
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 30, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 720, "chroma:document": "If infant is receiving immunization at a facility where\n2,500 grams. By this time the infant starts wriggling\nKMC services are available, a follow-up may be\nto show that he or she is uncomfortable, pulls out\nensured.\nthe limbs from the kangaroo garment and cries and\n\u008d Detailed follow-up protocols are attached fusses every time the mother tries to put the infant\nas annexure 3 as per the chapter 17 of the back in skin-to-skin contact. This is the time to wean\nTraining Module for Doctors and Nurses for the infant from KMC.\nFBNC.\nKANGAROO MOTHER CARE IMPLEMENTATION 15"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: f9590a0f-ccf0-4292-a215-287db8e700a8
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 32, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 721, "chroma:document": "optiMal feeding of\nlow birth weight\ninfants\nl What to feed the LBW infant?\nw Breastfeeding\nl Alternative methods of feeding when direct\nbreastfeeding is not possible\nl Deciding the initial method of providing fluids and\nfeeding\nl Feeding progression\nl How often and how much to feed?\nl Special considerations for infants below 1200 grams\nl Adequate weight gain"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 68f2c57d-4e0d-493d-98da-a31cd0b0e502
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 34, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 722, "chroma:document": "optiMal feeding of low\nbirth weight infants\nLow birth weight (LBW) infants need optimal Lower the birth weight, greater is the likelihood of\nnutrition during the neonatal period for proper feeding difficulties.\ngrowth and development. Appropriate feeding of\nThese infants may not be stable enough to\nlow birth weight and very low birth weight infants\ntolerate enteral feeds and are therefore provided\nimproves their chances of survival and is important\nintravenous fluids till such time that enteral feeding\nfor their optimum growth and development.\ncan be established optimally. Direct feeding from\nBreast milk is the ideal food for all infants including the mother\u2019s breast may not be possible or may not\nthose who are LBW. WHO recommends that all LBW be enough to fulfill the need in many others and in\ninfants, irrespective of their gestation be fed breast this situation, feeding may need to be provided by"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: f48ff298-5113-4294-aba3-2774c60d8355
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 34, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 723, "chroma:document": "milk. The goal is to enable every LBW infant to alternative feeding methods such as feeding tube,\nreceive feeding directly and exclusively from her/his spoon, paladai or cup.\nmother\u2019s breast at the earliest.\nLBW infants who are able to breastfeed should be\nHowever, many preterm infants have feeding put to the breast as soon as possible after birth when\ndifficulties initially because of they are clinically stable, and should be exclusively\nbreastfed until six months of age.\n\u008d Inability to coordinate suck, swallow and\nbreathing\nLow-birth-weight infants, who are unable to take\n\u008d Immature and sluggish gut and directly from the breast, should be fed by oro-gastric\ntube, feeding cup, paladai or spoon.\n\u008d Systemic illness.\nFull term small-for-gestational-age infants because\nWHAT TO FEED THE LBW INFANT?\nof being weak or sick may also experience.\n\u008d Poor attachment and sucking effort on the Breastfeeding\nbreast\nMother\u2019s milk is best for LBW infants of all gestational\n\u008d Poor swallowing"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 34, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 724, "chroma:document": "breast\nMother\u2019s milk is best for LBW infants of all gestational\n\u008d Poor swallowing\nages. Breast milk and especially colostrum (the\n\u008d Easy tiredness (and hence poor intake) thick, yellowish milk which is produced in small\n\u008d Vomiting, regurgitation or abdominal distension quantities during the first few days after delivery)\nOPTIMAL FEEDING OF LOW BIRTH WEIGHT INFANTS 19"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 5e12a505-4a30-4b44-9307-3e4b7faa219f
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 35, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 725, "chroma:document": "best assures the survival and well-being of LBW distension or acute serious illness such as\ninfants. asphyxia or sepsis; on life support)\nBreast milk is specially adapted to the nutritional a. Offering expressed breast milk by\nneeds of LBW infants; for example, the breast milk of alternate methods (described below)\na mother who delivers a preterm LBW infant contains b. As the infant improves, putting her on\nextra protein that is necessary for the normal growth the breast to stimulate lactation\nof such an infant.\nc. Initiating Kangaroo Mother Care (KMC)\nonce the infant stabilizes\nBreast milk is the ideal feed for all infants, including\nAnother issue of paramount importance is to\nLBW infants\nensure optimum lactation in the mother who\nhas a small infant. Because of the poor or no suck\neffort on the breast by the LBW infant (due to\nBreast milk provides many anti-infective factors,\nsickness, weakness or poor reflexes) and maternal\na vital component of the immune system of a"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 35, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 726, "chroma:document": "sickness, weakness or poor reflexes) and maternal\na vital component of the immune system of a\nanxiety, the breast milk output may remain low.\nnewborn infant, and growth factors which help\nLactation inadequacy must be prevented and\ngut development. There is strong and consistent\ntackled through counselling. In addition, breast\nevidence that feeding mother\u2019s milk to LBW infants\nmilk should be expressed frequently to provide\nof any gestation is associated with lower incidence\nexpressed breast milk to the infant and to enhance\nof infections and better long-term outcomes.\nmilk output.\nEvery effort should be made to provide breast milk\nto LBW infants. This would require:\nThe best milk for LBW infants is mother\u2019s milk. All\n1. For stable infants else is inferior.\na. Placing infant in skin to skin contact with\nthe mother immediately after delivery\nBreastfeeding is contraindicated when the\nb. Initiating breastfeeding within one hour mother is receiving certain drugs like anti-"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 35, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 727, "chroma:document": "b. Initiating breastfeeding within one hour mother is receiving certain drugs like anti-\nneoplastic agents, immuno-suppressants, anti-\nc. Initiating and providing Kangaroo\nthyroid drugs like thiouracil, amphetamines,\nMother Care (KMC)\ngold salts, etc. Breastfeeding may be avoided\nd. Offering breastfeeding frequently,\nwhen the mother is receiving following drugs-\napproximately, every two hours, and on\natropine, reserpine, and psychotropic drugs.\ndemand\nIn case mother\u2019s milk is not available, then the\ne. Ensuring continued frequent feeding at\nchoices in the order of preference are:\nnight\n\u008d expressed donor milk from other\nf. Ensuring proper positioning and\nlactating mothers- At times, breast milk\nattachment\noutput in the mother of the LBW infant may\ng. Managing breast/nipple problems such not be sufficient, especially in the first few\nas retracted or cracked nipple, and days. Given the importance of breast milk to\nbreast engorgement the infant, the use of breast milk obtained"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 35, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 728, "chroma:document": "breast engorgement the infant, the use of breast milk obtained\n2. For unstable infants (with cardio-respiratory from other lactating women (donor milk)\nproblems, temperature instability, abdominal is recommended. Ideally, this should be\n20 KANGAROO MOTHER CARE & OPTIMAL FEEDING OF LOW BIRTH WEIGHT INFANTS"}


created_at: 2025-05-02 10:00:24
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 36, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 729, "chroma:document": "organized in places where breast milk bank is Figure 7: Spoon-feeding\nestablished. Proper breast milk bank ensures\nthat donated milk is safe and healthy.\n\u008d Formula milk- When not enough breast\nmilk is available to meet the needs of a\nLBW infant, formula milk may be given with\nproper preparation and hygiene. For\ninfants below 1,500 grams birth weight, a\npreterm formula is preferred. The formula\nmilk should be given under the guidance of\na paediatrician. It should be in compliance\nwith IMS act (Annexure 4).\n\u008d animal Milk- Cow or buffalo milk are the\nlast choice when all other options have\nbeen exhausted despite best efforts. Such\nmilks are unsuitable and may be given with\nThe suck-swallow-breathing coordination develops\ngreat caution without dilution with alternate\nby 34 weeks of gestation. Most infants above 34\nmethods of feeding.\nweeks (about 1,800 grams birth weight) should be\nable to feed directly from the breast.\nThere is NO place for bottle feeding in the care of"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 796078ae-38d0-4e16-ad42-a0b185da9760
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 36, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 730, "chroma:document": "able to feed directly from the breast.\nThere is NO place for bottle feeding in the care of\ninfants with a gestation of more than 30 weeks\ninfants\n(birth weight more than 1200 grams) can usually\nswallow well and coordinate breathing, but are not\nable to suck. They can therefore be fed with spoon,\nALTERNATIvE METHODS paladai or cup that is not dependent on sucking\nOF FEEDING WHEN DIREcT action.\nBREASTFEEDING IS NOT Infants below 30 weeks of gestation (birth weight\nPOSSIBLE less than 1200 grams) are not in a position to take\nfeeds even with spoon, paladai or cup. They may be\nFeeding tube, spoon, paladai or cup are the fed with intragastric tube.\nalternative methods of feeding when direct\nFurthermore, sick, unstable infants (of any\nbreastfeeding is not possible. Paladai is a shallow,\ngestation or weight) who do not tolerate enteral\nsteel bowl with a long beak.\nfeeds will require administration of intravenous\nfluids.\nDEcIDING THE INITIAL METHOD\nOF PROvIDING FLuIDS AND\nFEEDING PROGRESSION"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 4de05dab-a6e8-4f77-a75c-d0e99f75e2d3
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 36, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 731, "chroma:document": "fluids.\nDEcIDING THE INITIAL METHOD\nOF PROvIDING FLuIDS AND\nFEEDING PROGRESSION\nFEEDING\nAs an infant\u2019s feeding ability develops, he or she\nThe choice of method of providing fluids and feeds should progress from the initial method through the\nis not only dependent on maturity or birth weight intermediate steps to feeding exclusively from the\nbut also whether the infant is sick or not. breast directly.\nOPTIMAL FEEDING OF LOW BIRTH WEIGHT INFANTS 21"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: e85d25f5-306d-49e8-a590-a65805bc5b46
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 37, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 732, "chroma:document": "Figure 8: Method of providing fluids and feeds for\nlow birth weight infants\n> 34 Weeks 32-34 Weeks 28-31 weeks <28 weeks\n<1200 grams\nInitiate Breastfeeding\nObserve if:\n1. Positioning and attachment are good\n2. Able to suck effectively and long enough\n(about 10-15 min)\nYes\nNo\nBreastfeeding\nStart feeds by spoon/paladai\nObserve if:\n1. Accepting well without spilling/coughing\n2. Able to accept adequate amount\nYes\nNo\nSpoon/Paladai\nfeeding\nStart feeds by OG tube\nNote: F or sick infants start with IV fluids and\ngradually progress to oral feeds Observe if:\n1. Vomiting/abdominal distention occurs\n2. I f the abdominal girth increases 2cm. from the baseline\nNo Yes\nStart IV fluids\nGastric tube feeding\nThe ultimate aim is to ensure direct, exclusive the next feeding method. An infant breastfeeding\nbreastfeeding. effectively on the first day of life should continue to\nbreastfeed exclusively up to 6 months.\nLBW infants would have different methods of initial"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: b2b87920-0a64-4723-9c54-00be6a31586d
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 37, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 733, "chroma:document": "breastfeed exclusively up to 6 months.\nLBW infants would have different methods of initial\nfeeding based on their weight, gestation and feeding An infant given alternative oral feeds (tube, spoon,\nreadiness. For progression of feeding, it is essential paladai, cup) should be given frequent opportunity\nto periodically assess the infant\u2019s ability to accept to suckle at the breast before the next feed. When\n22 KANGAROO MOTHER CARE & OPTIMAL FEEDING OF LOW BIRTH WEIGHT INFANTS"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 8c290f45-1428-435c-af20-ddf8814e7a27
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 38, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 734, "chroma:document": "Figure 5: Principles of advancing feeding modes\nInfants on IV fluids\nIf hemodynamically stable\nStart trophic feeds by OG tube\n& monitor for feed intolerance\nIf accepting well\nGradually increase the feed\nInfant on OG tube\nAt 30-32 weeks PMA\nTry spoon feeds once or twice a day.\nAlso, put on mother\u2019s breast\nIf accepting spoon feeds well\nGradually increase the Infants on spoon/paladai\nfrequency and amount of feeds\nspoon feeds Reduce OG\nfeeds accordingly\nPut them on mother\u2019s breast\nbefore each feed observe for good\nattachment & effective sucking\nIf able to breastfeed effectively\nTaper and stop spoon feeds once\nthe mother is confident\nthe infant can breastfeed effectively, other modes of HOW OFTEN AND HOW MucH TO\nfeeding can be reduced gradually, over a few days, FEED?\nand discontinued.\nLBW infants are usually fed every 2hours at least 12\nAn infant on IV fluids should be given small\ntimes in a day, the amount of each feed volume (to\nintragastric feeds. If the infant tolerates these, the"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: d792e0b9-1983-4174-922a-6bbd667b7f74
encoding: FLOAT32
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 38, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 735, "chroma:document": "intragastric feeds. If the infant tolerates these, the\nbe given every 2 hour) is calculated on the basis of\nvolume can be increased and intravenous fluids\ndaily fluid requirements.\nreduced. When two thirds of the daily requirement\nis tolerated as enteral feed, IV fluids can be It is usual clinical practice to provide LBW infants of\ndiscontinued and enteral feeds increased over the 1500 grams or more about 60 ml/kg fluids on the first\nsubsequent days. When the infant shows readiness day of life. Infants less than 1,500g are usually given\nfor oral feeding, small amounts can be offered by about 80 ml/kg fluids on the first day of life. The feeds/\nan alternative oral feeding method. The infant then fluids are increased by 15 ml/kg/day to a maximum of\nprogresses to breastfeeding as above. 150 ml/kg/day by the end of the first week of life.\nOPTIMAL FEEDING OF LOW BIRTH WEIGHT INFANTS 23"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: c54c9f36-1188-4e38-9b79-9c24ec3c636a
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 39, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 736, "chroma:document": "In stable LBW infants who are tolerating feeds with regard to maintenance of temperature,\nwell, the feed intake may be raised cautiously and prevention of infections, etc. They require constant\ngradually from 150 ml/kg to 180 ml/kg after the first monitoring to help in early identification of clinical\nweek of life. instability.\nThese infants are initially started on intravenous\ntable 1*: Fluid requirements for infants (ml/kg\nfluids as discussed already. The constant flow of\nbody weight/day) These needs are met by enteral\nintravenous fluids must be ensured to prevent\nfeeds and/or by intravenous fluid administration or\nexcess administration or abrupt stoppage of fluids.\na combination of the two\nAlso, strict aseptic precautions should be observed\nwhile giving intravenous fluids.\nDay of Fluid requirement ml/kg/day\nlife\nBirth weight \u2265 1,500 g Birth weight<1,500 g They have to be gradually helped to initiate oral feeding\n1 60 80 so that ultimately they can receive direct, exclusive"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: bfb178bb-468c-4806-84c1-d8564ceda681
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 39, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 737, "chroma:document": "1 60 80 so that ultimately they can receive direct, exclusive\n2 75 95 breastfeeding. Even while on intravenous fluids, they\n3 90 110\ncan be administered small amounts of intragastric\n4 105 125\ntube feeds. This small amount of milk feeds is called\n5 120 140\nminimal enteral nutrition (MEN) or trophic feeds. The\n6 135 150 purpose of trophic feeds is to help in the growth and\n7 150 150\nmaturation of the gastrointestinal tract. Infants started\n* For detail please read FBNC guideline. on MEN progress to full oral feeds faster.\nthe usual total amount of breast milk given as\nSPEcIAL cONSIDERATIONS FOR\nminimal enteral or trophic feeds is only 12 - 24\nINFANTS BELOW 1200 GRAMS\nml/kg/day divided into 4 - 6 feeds given via the\nintragastric route. as the infant stabilises, breast\nInfants with birth weight less than 1,200g\nmilk feeding is advanced to full requirements to\nare usually born premature (before 30 weeks\nmeet her/his nutritional needs.\ngestation) and often have various problems"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: a274fda5-efa2-48ff-a521-379182f5c0a9
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 39, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 738, "chroma:document": "meet her/his nutritional needs.\ngestation) and often have various problems\nsuch as breathing difficulty, hypothermia, and Criteria for discharge from the hospital and\nhypoglycaemia. These infants need special care follow-up will be as mentioned on page 25.\ntable 2: Micronutrient supplementation (as per WHO recommendations)\nMicronutrient Recommended Daily Dosage Duration\nVitamin D 400-1000 IU/day(usually obtained from Six months (starting as soon as\nmultivitamin drops and calcium and possible)\nphosphorus supplement)\nIron 2 mg/kg/day One year (starting at 2 weeks of\nage)\nCalcium* 120 \u2013 160 mg/kg/day Till 40 weeks postmenstrual age\nPhosphorus* 60 \u2013 80 mg/kg/day Till 40 weeks postmenstrual age\n*Infants below 32 weeks of gestation\n24 KANGAROO MOTHER CARE & OPTIMAL FEEDING OF LOW BIRTH WEIGHT INFANTS"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: c191e6ce-d121-4e5d-88a7-9d818739fec8
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metadata:
{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 40, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 739, "chroma:document": "ADEquATE WEIGHT GAIN weeks PMA or 2500 grams. After that the MCP Card\ncan be used to monitor growth.\nMost LBW infants lose weight in the first few days of\nIf the infant has inadequate weight gain, the\nlife. Usually this loss would not exceed 10-15% of the\nprovider should check the amount of intake, and\nbirth weight. They regain their birth weight by about\nassess attachment (if taking direct breastfeeding),\n2 weeks and then start gaining weight at the rate of\nand spluttering / spillage (if on paladai / cup /\n1.0% to 1.5% of body weight per day. Usually this\nspoon feeds). Nipple and breast problems in the\ncorresponds to a gain of 15-20 grams per kilogram\nmother should be looked for. Complications such\nof their own body weight per day.\nas cold stress, sepsis, oral thrush, anaemia and late\nFor small infants below 1,500 grams (less than 32 metabolic acidosis also lead to sub-optimal growth.\nweeks), it is advisable to use a postnatal growth The underlying reasons for inadequate weight gain"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: bd37b15d-6775-47c3-a740-7ff8e9f35616
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 40, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 740, "chroma:document": "weeks), it is advisable to use a postnatal growth The underlying reasons for inadequate weight gain\nchart to plot weight every day until they are of 40 should be addressed.\nEnsuring adequacy of nutrition is perhaps the most important aspect of their care by monitoring\nfrequency of urine (8-12 times for day) and weight gain (15-20 grams per day)\nOPTIMAL FEEDING OF LOW BIRTH WEIGHT INFANTS 25"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 721ad309-8a11-49c7-a0af-7f7d744ac871
encoding: FLOAT32
metadata:
{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 42, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 741, "chroma:document": "aCtion plan for\niMpleMentation and\nsCale-Up\nl KMC Roll-out Plan\nw Structure\nw Capacity building strategy\nw Developing KMC Unit\nSpecifications for Building up a KMC Unit\nn\nl Role of programme managers\nl Monitoring and evaluation\nw Definitions\nw Recording and reporting\nw Communication strategy\nw Evaluation"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 552e5a8e-61f3-4c65-b34c-e35cada019bd
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 44, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 742, "chroma:document": "aCtion plan for\niMpleMentation and sCale-Up\nThis section provides information to the Programme SNCU or the postnatal ward. These units will\nManager and health care providers on how to have provisions for the postnatal mothers\nensure that every LBW infant has access to high- to provide KMC to their infants.\nquality KMC and optimal feeding within the existing\nFacility Based Newborn Care systems.\nThe aim is to advocate KMC to be practiced for\nTo fulfil this vision the roll-out has to be planned\nall infants eligible for KMC at public health\nin phases by the states. Each state will have the\nfacilities.\nflexibility to fix its own target for the next two years\nas per available resources. The state will have two\noptions:\nKMC roll-out Plan\na. Where new SNCUs/MCH wings are planned\nadequate provision for KMC will be an\nStructure\nintegral component of SNCU infrastructure\nand\nThe state will submit the budget proposal for\nb. Where SNCU is already in place, KMC unit"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: e0b2564a-17e1-42e8-acfc-b59e7e5ff33c
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metadata:
{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 44, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 743, "chroma:document": "and\nThe state will submit the budget proposal for\nb. Where SNCU is already in place, KMC unit\nestablishing KMC as an additional expenditure\nwould be added in close proximity to the\nunder SNCU in the State\u2019s Annual Programme\nImplementation Plan of the National Health\nViSiOn KMC Mission. The state lead development partners will\ncollaborate with the state governments for quality\nl Model KMC services to be established in 25\nKMC roll out within the RMNCH+A strategy. Child\nRegional & State Resource Centres by the end\nHealth Division, Ministry of Health and Family\nof 2017\nWelfare GOI will review the progress periodically.\nl KMC services to be provided in all SNCUs and\nThe Collaborative system established under\nwell-functioning NBSUs (at CHCs and FRUs)\nFacility Based Newborn care will provide technical\nacross the country\nsupport.\nACTION PLAN FOR IMPLEMENTATION AND SCALE-UP 29"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 5f7f01b7-9607-45ca-8fac-6558f827b9cb
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 45, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 744, "chroma:document": "Child Health Division, Ministry of Health and Family\nWelfare GOI\nnational Collaborative Centre Private sector participation\nWHO Resource Centre for Training Government of India urges neonatologists,\nand Research for Newborn Care at neonatal nurses and obstetrician-gynecologists\nAIIMS, along with the designated by engaging with their respective professional\nNational Collaborative Centre for bodies. These are:\nFacility Based Newborn Care at\n1. National Neonatology Forum (NNF)\nKSCH & LHMC will be responsible\n2. Indian Association of Neonatal Nurses (IANN)\nfor:\n3. Indian Academy of Peadiatrics (IAP)\n\u008e Providing technical assistance\nfor roll out of KMC & optimal 4. Federation of Obstetric and Gynaecological\nfeeding guideline Societies of India (FOGSI)\n\u008e Capacity building and 5. Trained Nurses Association of India (TNAI)\nMentoring of Regional/State\nThese bodies can orient private facilities and nursing\nCollaborative Centers\nhomes at the national, state and district levels so"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: b063f9e2-9ce0-47e4-b63d-1a7d6de02aa4
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metadata:
{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 45, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 745, "chroma:document": "Collaborative Centers\nhomes at the national, state and district levels so\n\u008e Developing training module that all private facilities in the country align their\nand packages (if required) KMC services and Optimal Feeding for Low Birth\nWeight infants along with the national guidelines.\nregional Collaborative Centres (rCC, Medical colleges/teaching institute)\nExisting FBNC resource centre and centers under KMC India network will serve as RCCs\n\u008e Each centre to have a model KMC unit for hands-on training\n\u008e RCCs to provide training and mentoring to SCCs and district level health providers\n\u008e RCCs will be responsible for monitoring and supervision of SCCs\nState Collaborative Centres (SCC, Medical colleges)\n\u008e Each centre to have a model KMC unit equipped with mannequins (skill stations) for\nhands-on training SCCs\n\u008e To provide monitoring, supervision and mentoring to district level facilities\n30 KANGAROO MOTHER CARE & OPTIMAL FEEDING OF LOW BIRTH WEIGHT INFANTS"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 46, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 746, "chroma:document": "national level\n\u008e Orientation and Dissemination of the guidelines for programme managers and professional\nassociations\n\u008e Regular review by Child Health Division, MoHFW\n\u008e Provide cross-learning facility for programme managers and health providers at model units.\nState level\n\u008e Orientation cum planning workshops at State level\n\u008e Identification of medical colleges as state resource centres\n\u008e Initially, saturate the SNCUs with KMC services on priority\n\u008e Develop resource pool for training\n\u008e Ensure adequate and trained human resource at SNCU\n\u008e Seek support from respective state lead development partners to ensure high quality\nimplementation\n\u008e Provide mentoring and supportive supervision or hands-on training to the providers\n\u008e Review progress of implementation every quarter\n\u008e Developing linkages with RBSK and community follow-up by ASHA\n\u008e Integrate KMC into FBNC\nDistrict level\n\u008e Carry out civil work/refabricating necessary for ensuring KMC"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 46, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 747, "chroma:document": "District level\n\u008e Carry out civil work/refabricating necessary for ensuring KMC\n\u008e Conduct orientation/refresher trainings of counsellors\n\u008e Identify high case load facilities for ensuring KMC services\n\u008e Ensure record keeping and timely reporting at facilities\nCapacity building strategy:\n2. KMC unit should be built as an integral part\nof the new/upcoming SNCUs (20-bed) and\nJob-aids, videos and training agenda for KMC and\nin MCH wings\noptimal feeding of LBW infants are being provided\nalong with the guidelines for state support. The 3. KMC services can also be provided in NBSU\nexisting training modules for F-IMNCI and FBNC may or Postnatal wards. All the stable infants\nbe used for orientation. The checklist for KMC also weighing more than 2000 grams can be easily\nbeing used in skill lab is placed as Annexure V. nursed in the postnatal ward or at NBSUs\nDeveloping a KMC unit 4. The neonatal units at all Medical Colleges\nto be strengthened to provide appropriate"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 46, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 748, "chroma:document": "to be strengthened to provide appropriate\n1. KMC Unit of 8-10 beds is recommended for ev-\nnewborn care including KMC. This will\nery hospital with SNCU or should be located\nenable the undergraduate and postgraduate\nas close to the SNCU as possible in the exist-\nmedical students to learn the best practices.\ning / new premises. Infants weighing less than\n1800 g, who will form the majority of the KMC\nSpecifications for Building up a KMC unit\nbeneficiaries, would be admitted to Special\nNewborn Care Units (SNCUs) at district hospi- As a routine, feeding and other care to unstable or\ntals if their condition warrants admission sick preterm / LBW infants is provided in Special\nACTION PLAN FOR IMPLEMENTATION AND SCALE-UP 31"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 47, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 749, "chroma:document": "Newborn Care Units (SNCUs). Thereafter, when The room should also be well lit, well ventilated and\nthe infants become stable, KMC is initiated under have arrangement for dim light at night.\nsupervision of the nurses/doctors in SNCU. With\nFollowing is the budget for establishing a model\nfurther improvement, infants must be transferred out\nKMC unit, however, provision of KMC should not\nfrom the SNCU to the mother in the postnatal ward\nwait for the establishment of KMCU.\nwhere KMC is continued till discharge. Accordingly,\nit is recommended that each hospital with an SNCU This may also be used as a guide for budgeting\nshould provide KMC and have a KMC unit (KMC Unit) the proposal for setting up KMC in the state PIP.\nState should do need based gap analysis to budget\nKMC units must ensure the room temperature is 24\njudiciously for setting up KMC units.\nto 26 degree Celsius with 50-60% relative humidity.\nS. Unit cost Units Total cost\nHeads Essential Desirable\nNo. (INR) needed (INR)"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 82714fc8-d935-4340-8285-8b7fb469b689
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 47, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 750, "chroma:document": "S. Unit cost Units Total cost\nHeads Essential Desirable\nNo. (INR) needed (INR)\nA. infrastructure:total 1500 square feet; i.e. 140 Sq M: 120 square feet for each bed (120x8 = 960\nsquare feet) and rest will use as ancillary area, toilet, bathing & hand washing area\n1 Renovation or Minor civil work \uf0fc 100000 1 100,000\nB. Furniture\n2 Beds semi-reclining \uf0fc 12000 8 96000\n3 Easy chairs (reclining with foot support) \uf0fc 5000 8 40000\n4 Storage space/locker for mothers \uf0fc 2000 8 16000\n5 Office chairs \uf0fc 500 8 4000\nC. Furnishing\n6 Mattress \uf0fc 3000 8 16000\n7 Pillows \uf0fc 300 16 4800\n8 Bed sheets \uf0fc 200 16 3200\n9 Adult blanket \uf0fc 800 16 12800\n10 Baby blanket \uf0fc 500 16 8000\n11 Mobile screen \uf0fc From regular budget\n12 Dust bins \uf0fc From regular supply\n13 Refrigerator (165L - 230L) \uf0fc 15,000 1 15000\n14 AV aids (Television & CD player) \uf0fc 25,000 1 25,000\nD. equipment\n15 Bag & Mask (Size 0 & 1) \uf0fc 1500 1 1500\n16 Digital Weighing machine \uf0fc 3,000 1 3,000\n17 Paediatric stethoscope \uf0fc 2"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 47, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 751, "chroma:document": "16 Digital Weighing machine \uf0fc 3,000 1 3,000\n17 Paediatric stethoscope \uf0fc 2\n18 Digital & Room thermometers \uf0fc 200X2 2 800\n19 Heater (Radiant/air blower) \uf0fc From regular budget\n20 Oxygen cylinder & Oxygen hoods \uf0fc From regular supply\n32 KANGAROO MOTHER CARE & OPTIMAL FEEDING OF LOW BIRTH WEIGHT INFANTS"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 06d61802-afc4-462e-b498-1d005f9cf22d
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 48, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 752, "chroma:document": "S. Unit cost Units Total cost\nHeads Essential Desirable\nNo. (INR) needed (INR)\n21 Training manikins etc \uf0fc 10000 1 10000\nE. recurring cost per annum\n21 Feeding equipment \uf0fc 100 200* 20000\n(Tubes, Katoris& Spoons)\n22 Clothes for newborns \uf0fc 110 200* 30000\n(Disposable\n(Disposable Diapers, Cap & Socks) Diapers)\n40\n(Cap & Socks)\n23 Gowns for Mothers \uf0fc 100 200* 20000\n24 Soap & other cleaning agents \uf0fc 1000 12 12000\n25 Emergency medicines, cotton, \uf0fc From regular supply\ngauge\n26 Record registers/case sheets From regular supply\n27 Other maintenance cost \uf0fc 1500 12 18000\nF. Human resources**\n28 ANM/GNM/YASHODA/Counsellor \uf0fc 12000X12 4 576000\nGrand total (including cost of desirable heads) 1032110\ntotal (Cost of essential heads) 266100\n# For storing breast milk\n*Available regularly with most SNCUs. Therefore, utilize from regular supply and may budget, if required.\n**States to ensure saturation with adequate and trained HR as per norms including salary . The figures quoted here are normative."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 01ccc3a7-b402-4f39-b3b2-43a29259a05a
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 48, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 753, "chroma:document": "Budgetary provision: To roll out the KMC and optimal 4. Track the progress of implementation of\nfeeding practices at scale, the state will have to make KMC according to the guidelines as per the\nadequate budgetary provisions for state level training final timeline\nworkshops and establishment cost of KMC Unit in state\n5. Link with the National/Regional/State\nPIPs.\ncollaborative centre and Existing Supportive\nSupervision mechanisms in the state\nROLE OF PROGRAMME\nand utilize and modify existing checklists\nMANAGERS and block monitoring formats to include\npractice of KMC\nThe state programme manager/Child Health nodal\nofficer will play the most crucial role. S/He must: All contacts with the technical personnel/service\n1. Know that KMC is an integral part of facility providers should be utilised for promoting KMC\nbased newborn care during mentoring visits. The checklist for training in\nKMC is being attached for reference and is similar to\n2. Ensure orientation of all the district nodal"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 78804c92-5e9d-4236-9abe-d7bf700725a3
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 48, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 754, "chroma:document": "2. Ensure orientation of all the district nodal\nthe one used in skills lab trainings (annexure- ). FBNC\nofficers on KMC\ntrainings need to be expedited by the states with\n3. Issue a Facility wise timeline where KMC\nspecial focus on KMC and optimal feeding in LBW.\nneeds to be started to all the districts\nACTION PLAN FOR IMPLEMENTATION AND SCALE-UP 33"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 4561e63d-d340-4cbe-87ed-5cc115265780
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 49, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 755, "chroma:document": "6. Linking the follow-up with SNCU follow-up 4. Percent (%) of pre-term newborns who\nand DEIC if required extra care received KMC till 40 weeks (Expected\nDelivery Date or full term) = Number of\n7. Willing Professionals from private sector/\npre-term newborns who received KMC till\nProfessional bodies may be involved in\n40 weeks X 100 /Total number of newborns\ntraining programmes as trainees as well\nas trainers for maximizing effect in private delivered preterm.\nsector mentoring and supervision activities\nrecording and reporting\nThe data for above monitoring indicators can be\nMonItorIng anD evaluatIon:\ncompiled at the district level every month and can be\nExisting monitoring frameworks for FBNC are to sent to the state along with the SNCU reports. For states\nbe modified to capture the indicators given below; which have migrated to online reporting mechanism,\nthese indicators will provide information on how the may utilize the same platform for reporting. After"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 2b72be3c-9979-4668-af37-160826272eae
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 49, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 756, "chroma:document": "programme is functioning. compiling and validating the reports at the state level,\nthese can be shared at the national level on a quarterly\nDefinitions\nbasis. During supportive supervision visits the data\nOutput indicators: may be validated from the case sheets and registers.\n1. Percent (%) of health facilities having SN-\nCommunication strategy\nCUs with operational KMC unit= Number\nof health facilities having SNCU with op- Any state specific barriers in implementation should\nerational KMC unit X 100/ Total number of also be identified. The messages should enhance the\nhealth facilities with functional SNCU woman\u2019s ability to use existing services and to make\nappropriate decisions. The communication materials\nOutcome indicators\nshould be consistent with the training materials, so\n1. Percent (%) of newborns with birth weight be-\nthat there is an integrated training-communication\nlow 2,000 grams delivered in the health facili-\npackage. Both, the mass media and interpersonal"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 04c30d93-da6d-48b3-95c6-476e16a1a12b
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 49, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 757, "chroma:document": "low 2,000 grams delivered in the health facili-\npackage. Both, the mass media and interpersonal\nty= Number of low birth weight infants (below\ncommunication are needed. Equally crucial will be\n2,000 grams ) delivered in the facility X 100 /\nall those in the community who have a determining\nTotal number of live births in the facility\ninfluence on the mothers\u2019 behaviour: their husbands\n2. Percent (%) of newborns below 2,000 grams and families, elders, religious leaders and others.\nwho continued KMC till discharge = number Communication messages should also be directed\nof newborns with birth weight below 2,000 at key decision-makers. Communication must be\ngrams who continued KMC till discharge X supplemented by an education programme and\n100 / total newborns with birth weight below synchronised with the health services\n2,000 grams\nWay Forward\n3. Percent (%) of pre-term infants (gestation\nage less than 37 weeks) delivered in the As the two high impact interventions viz. KMC and"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: be275b40-ab14-4d45-a3c6-109529cec137
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 49, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 758, "chroma:document": "age less than 37 weeks) delivered in the As the two high impact interventions viz. KMC and\nhealth facility= Number of pre-term infants feeding of Low Birth Weight infants are being up-\n(gestation age less than 37 weeks) delivered scaled an implementation research will be useful\nin the facility X 100 / Total number of live for sharing the key learning and making midcourse\nbirths in the facility corrections, if required.\n34 KANGAROO MOTHER CARE & OPTIMAL FEEDING OF LOW BIRTH WEIGHT INFANTS"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 253c94fd-64be-4e1d-914a-8d0183ffb350
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 50, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 759, "chroma:document": "annexUres\nAnnexure I: Manual Expression of Breast milk and\nStorage Thereof\nANNEXURE II: Alternative Feeding Methods (Cup/Spoon/\nPaladai Feeding)\nAnnexure III: Follow-up protocol after discharge of a\nhigh-risk infant\nAnnexure IV: Infant Milk Substitutes act\nAnnexure V: Orientation on Kangaroo Mother Care"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 7c954dae-2633-4361-8d1b-defd671947c0
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 52, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 760, "chroma:document": "annex i\nMANuAL EXPRESSION OF BREAST MILK AND STORAGE THEREOF\nFor whom:\nInfants who cannot breastfeed effectively but are \u008d At least 6-8 times in 24 hours, i.e. every 3-4\nable to accept oral feeds by alternative feeding hours, including at night to help ensure an\nmethods and for the purpose of storing breast adequate supply.\nmilk.\nProcedure\nhow often\nThe salient steps of manual expression of breast milk\n\u008d Within 6 hours of delivery to ensure that are shown in the figure below.\ncolostrum is available\nFigure (i): Expression of breast milk\nANNEX I 37"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: b13f40d8-43c3-447d-bd70-c3d506d45c66
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 53, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 761, "chroma:document": "If expressed breast milk (EBM) cannot be given to of bacterial growth. It should be kept in a covered\nthe infant soon after expression, it has to be stored container. Any milk not fed to the infant within 6\nand used when necessary. The expressed milk can hours of expression should be discarded.\nbe stored in one of the following ways:\nin a refrigerator: EBM can be stored in the main\nat room temperature: EBM can be kept at room compartment of a regular refrigerator (2oC to 8oC)\ntemperature for up to 6 hours without significant risk for 24 hours.\nStorage of expressed breast milk\nAt room temperature : 6 hours\nIn refrigerator (2oC to 8oC) : 24 hours\n38 KANGAROO MOTHER CARE & OPTIMAL FEEDING OF LOW BIRTH WEIGHT INFANTS"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 6c7d42fd-f208-4558-a2cc-7b16e9834ccc
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 54, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 762, "chroma:document": "annex ii\nalternatIve FeeDIng MethoDS (CuP/SPoon/PalaDaI FeeDIng)\n1. SPoon-FeeDIng Figure (ii): Feeding a LBW infant with a paladai\nA spoon is appropriate for an infant who is stable and\nis able to co-ordinate breathing and swallowing.\nHOw tO SPOOn-FeeD an inFant\n1. The infant should be awake and held sitting\nsemi-upright on the caregiver\u2019s lap.\n2. Put a measured amount of milk in a wide\nnecked container.\n3. Take some milk from the container into the\nspoon.\n4. Hold the spoon so that it rests lightly on the\ncultures. It is appropriate for an infant who is stable\ninfant\u2019s lower lip.\nand is able to coordinate sucking, breathing and\n5. Tip the spoon so that the milk reaches the swallowing. The advantages of this feeding method\ninfant\u2019s lips. are that it is usually faster than spoon or even cup\n6. If possible allow the infant to take the milk feeding and also that there is less spillage.\nby him or herself and do not pour it into the\nIt has become very popular in neonatal nurseries in"}


created_at: 2025-05-02 10:00:24
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id: 5945730f-0ef1-4906-aebb-1bccc20a5593
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 54, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 763, "chroma:document": "by him or herself and do not pour it into the\nIt has become very popular in neonatal nurseries in\ninfant\u2019s mouth.\nall parts of the country.\n7. Feed the infant slowly, making sure that\nThe steps of \u2018paladai\u2019 feeding are given in the box\nthe milk already given has been swallowed\nbelow:\nbefore giving any more.\n8. When the infant has had enough, he or she HOw tO FeeD an inFant witH a \u2018PalaDai\u2019\nwill close his or her mouth and will not take\n1. The infant should be awake and held sit-\nany more. Do not force-feed an infant.\nting semi-upright on the caregiver\u2019s lap, and\n9. Estimate the amount of milk taken in the wrapped to provide support and to keep the\nsame way as for cup feeding. arms out of the way, as for cup feeding.\n2. Put a measured amount of milk in the\n2. \u201cPALADAI\u201d FEEDING\npaladai.\nA paladai is a small steel bowl with a long pointed tip 3. Hold the paladai so that the pointed tip rests\ntraditionally used for feeding LBW infants in some lightly on the infant\u2019s lower lip.\nANNEX II 39"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 55, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 764, "chroma:document": "4. Tilt the paladai to pour a small amount of\nmilk into the infant\u2019s mouth gently.\n5. Feed the infant slowly.\nHOw tO CuP FeeD an inFant\n6. Make sure that the infant has swallowed\n1. The infant should be awake and held sitting\nthe milk already taken before giving any\nsemi-upright on the caregiver\u2019s lap. Wrap the\nmore.\ninfant in a cloth to provide support and to\n7. When the infant has had enough, she will\nkeep his or her arms out of the way, and put\nclose his or her mouth and will not take\na small cloth on his or her front to catch drips\nany more. Do not force-feed the infant.\nof milk.\n8. Estimate the amount of milk taken.\n2. Put a measured amount of milk in the cup.\n9. Wash the paladai with soap in running\n3. Hold the cup so that it rests lightly on the\nwater and air-dry it before and after each\ninfant\u2019s lower lip.\nuse.\n4. Tilt the cup so that the milk reaches the\ninfant\u2019s lips.\n3. cuP FEEDING\n5. Allow the infant to take the milk himself. (A"}


created_at: 2025-05-02 10:00:24
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 55, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 765, "chroma:document": "infant\u2019s lips.\n3. cuP FEEDING\n5. Allow the infant to take the milk himself. (A\nIt is appropriate for an infant who is stable and is able younger infant will initially lap the milk into\nto coordinate sucking, breathing and swallowing. his mouth with his tongue. A full term or\nThe advantages of this feeding method are that it older infant will suck the milk.)\nenables an infant to control his own intake in time\n6. Do not pour the milk into the infant\u2019s mouth.\nand quantity.\nHold the cup to the infant\u2019s lips so that and\nThe cups used and the method of cup feeding is he or she can take it himself or herself.\ndepicted in the figures below: 7. Feed the infant slowly. Some milk may spill\nfrom the infant\u2019s mouth. Spilling is commoner\nFigure iii: Feeding a LBW infant by cup\nwith more mature infants.\n8. Make sure that the infant has swallowed the\nmilk before offering more. When the infant\nhas had enough, he or she will close his or\nher mouth and will not take any more. Do not"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: ed9e646b-49d7-4ab8-87a9-9126a2ce1e7d
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 55, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 766, "chroma:document": "has had enough, he or she will close his or\nher mouth and will not take any more. Do not\nforce-feed the infant.\n9. To estimate the amount of milk taken,\nsubtract the milk left in the cup from the\noriginal amount. Also subtract the estimated\nspillage, if any.\n10. Wash each utensil with soap in running water\nand air-dry it before and after each use.\n40 KANGAROO MOTHER CARE & OPTIMAL FEEDING OF LOW BIRTH WEIGHT INFANTS"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 2f087410-316c-48c7-a2bc-91d8cc1452c8
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 56, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 767, "chroma:document": "4. Intra-gaStrIC tuBe FeeDIng PROcEDuRE\nIntra-gastric feeding is provided to the stable infants Selecting the correct tube size\nwho are not able to accept oral feeds (not able to co- The correct tube size for intra-gastric feeding of\nordinate breathing with swallowing). Intra-gastric small infants is shown in below:\ntube feeding can be given by two routes, namely,\nrecommended intra-gastric tube sizes\nnaso-gastric or oro-gastric. Naso-gastric tube has\nWeight Tube size\nthe advantage that it is more easily fixed in place.\n< 2000g French 6\nBut by blocking one nostril it may lead to apnoea or\n\u22652000g French 8\nbreathing difficulty. Oro-gastric tubes is preferred\nfor smaller infants. Inserting an intra-gastric tube\ninSertinG an intra-GaStriC tuBe\n1. Estimate the length of gastric tube required\nl Hold the tip of the feeding tube at the tip of the infant\u2019s nose, then hold the length of the tube\nup to the ear lobe and then on to the infant\u2019s abdomen to a point between the xiphisternum and"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 44d1390c-bf52-4395-b615-5c5dbb3ec4a3
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 56, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 768, "chroma:document": "up to the ear lobe and then on to the infant\u2019s abdomen to a point between the xiphisternum and\numbilicus.\nl Mark the measured length of the tube with a pen or piece of tape.\n2. Inserting the gastric tube\nl Flex the infant\u2019s neck slightly and pass the tube gently through the mouth or one nostril to the\nrequired distance.\n3. Checking the position of gastric tube\nl Take 1-2 ml of air into the syringe. Listen over the infant\u2019s stomach with a stethoscope while\nquickly injecting the air down the tube. If the end of the tube is in the stomach, you will hear a\nwhistling sound as the air passes through.\nOR\nl Attach a syringe to the open end of the tube and aspirate the contents of the stomach. The\naspirate should look like curdled milk\n4. Secure the tube on the infant\u2019s cheek with adhesive tape.\nANNEX II 41"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 57, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 769, "chroma:document": "The steps of insertion and fixation of oro-gastric tube are illustrated in figure A and figure B respectively The\nFigure a: Inserting an oro-gastric tube\nFigure B: Fixing oro-gastric tube\noro-gastric tube has to be replaced every 3 days or earlier if it is pulled or blocked.\nThe procedure of giving a gastric tube feed is explained in the box below:\nPrOCeDure FOr GiVinG a GaStriC tuBe FeeD\n1. Remove the plunger of a 10 or 20 ml sterile syringe.\n2. Connect the barrel of the syringe to the end of the gastric tube.\n3. Fill the barrel of the syringe with the required volume of milk.\n4. Let the milk run from the syringe through the gastric tube under gravity.\n5. DO NOT force milk through the gastric tube by using the plunger of the syringe.\n6. Hold the syringe 5-10 cm above the infant until the syringe is empty.\n7. It should take a few minutes for the milk to flow into the infant\u2019s stomach. Changing the height of the"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 5b5939a0-b242-46ba-a100-dcea8c5eb83a
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 57, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 770, "chroma:document": "syringe will also affect the speed of milk flow. Lowering the syringe slows the milk flow, raising the\nsyringe makes the milk flow faster.\n8. Observe the infant during the entire gastric tube feed. Do not leave the infant unattended. Stop\nthe tube feed if the infant shows any of the following signs: breathing difficulty, color change (looks\nblue), becomes floppy or vomits.\n9. Cap the end of the gastric tube after the milk has been instilled. there is no need to rinse the tube\nwith water. Keep tube capped between feeds.\n42 KANGAROO MOTHER CARE & OPTIMAL FEEDING OF LOW BIRTH WEIGHT INFANTS"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: f98bb2c2-fde4-4861-a3ce-e83d60651fda
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 58, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 771, "chroma:document": "annex iii\nFolloW-uP ProtoCol aFter DISCharge oF a hIgh-rISK InFant\nS. No Area Frequency Details Remarks\nA Anthropometry Every visit Weight HC L Always estimate if the\ngain is adequate\nB Breastfeeding Every visit Attachment Positioning Observe a breastfeeding\nProblems session if possible\nC Counselling Every visit Feeding Hygiene KMC Ask mother about her\nInnocuous issues concerns\nD Development 3, 6, 9 , 12 months Use TD screening chart Fill up the chart and refer\nscreening where needed for detailed\ndevelopmental evaluation\nE Eye 1 month for infants Emphasize on getting Review in next visit\n<1750 grams to a retinopathy (ROP)\n<2000 grams with screening from a skilled\nstormy NICU course. ophthalmologist\nDetailed examina-\ntion at 9-12 months\nof age\nF Follow-up USG At discharge and at To rule out PVL and\n40 weeks PMA other abnormalities\nG Growth Monitoring Every Visit Plot the growth of the Use of the Fenton chart till\ninfant on the WHO the infant is 40 wks PMA"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 58, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 772, "chroma:document": "infant on the WHO the infant is 40 wks PMA\ngrowth charts and WHO charts thereafter\nH Hearing At 40 wks PMA One can use the OAE/\nand in case BERA or combination as\nquestionable, at 6 per the policy\nweeks of age\nI Immunization As per schedule\nJ Others Language/speech Any delay detected\nat 1,2 3 years should prompt early\nBehavior at/after 1 intervention\nyear\nIQ testing at 3\nyears of age\nANNEX III 43"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 59, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 773, "chroma:document": "Fetal-infant Growth Chart for Preterm Infants (WHO Growth Standards version)\n65 65\n60 60\n55 55\n50 50\n45 45\n40 40\n35 6\n30 5.5\n25 5\n20 4.5\n4 4\n3.5 3.5\n3 3\n2.5 2.5\n2 2\n1.5 1.5\n1 1\n0.5 0.5\n0 0\n22 24 26 28 30 32 34 36 38 40 42 44 46 48 50\n44 KANGAROO MOTHER CARE & OPTIMAL FEEDING OF LOW BIRTH WEIGHT INFANTS\nsretemitneC\n)smargoliK(\nthgieW\nsretemitneC\n)smargoliK(\nthgieW\n156 Annexures\nAnnexure 17: Fentons chart\nFenton Chart\n97\u00b0\n90\u00b0\nL e n\ngth 50\u00b0\n10\u00b0\n3\u00b0\nH e a d\nCirc u\nmfere n c e\n1\n5\n9 9\n0\n0\n0 7\n\u00b0\n\u00b0\n\u00b0 \u00b0\n3\u00b0\n97\u00b0\n90\u00b0\n50\u00b0\nht\ng\nei\nW 10\u00b0\n3\u00b0\nPlot growth in terms of completed\nweeks of gestation\nSource: Intrautenine weight - Kramer MS et al\n(ePediatr 2001); Length and Head circumference-\nNiklassonA et al (J Paediatr Child Health 1996);\nPost term sections-the WHO Growth Chats, 2006.\nThe Smoothing of the disjunction between the pre\nand post term sections generally occurs between 36\nand 46 weeks. TR Fenion\nDate:\nGestational age (weeks)"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 60, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 774, "chroma:document": "Annexure 18: TDS chart\nIn 2013 WHO revised it and separate charts for boys and girls are available. To avoid confusion\nwith the message in FBNC training module only single chart is being referred .\nTD Screening Chart\nANNEX III 45\n)straP\n3(\nllod\nfo\nstrap\not\nstnioP\npleh\nhtiw\nsriatspu\nklaW\nsdrawkcab\nklaW\nsdrow\nowt\nsyaS\nenola\nsklaW llab\nsworhT\npleh\nhtiw\nklaW\nekac\na\ntaP\ntellep\nnoisneherp\neniF\nerutinruf\nyb pu\ngnidnatS\nnoitisop\ngnittis\not\nfles\nsesiaR\ndnah\not dnah\nstcejbo\nrefsnarT\nelttar/lleb\nfo\ndnuos\not\ndaeh\nsnruT\nhcamots\not\nkcab\nmorf\nslloR\nydaets\ndaeh\nsdloH\nlicnep/nep\nwollof\nseyE\nelims\nlaicoS\n42\n32\n22\n12\n02\n91\n81\n71\n61\n51\n41\n31\n21\n11\n01\n9\n8\n7\n6\n5\n4\n3\n2\n1\nshtnoM\not\nsliaf\ndlihc\neht\nfI\n.detset\ngnieb\n)shtnom\nni(\ndlihc\neht\nfo ega\neht\nfo level\neht\nta\n,yllacitrev\ntpek\nsi\nlicnep\na\nro\n,nwod\nsi\nenil\nlacitrev\nA\nyaled\nlatnempoleved\na\nevah\not\nderedisnoc\nsi\ndlihc\neht\n,enil\nlacitrev\neht\nfo\nedis\ntfel\neht\nno\ntrohs\nsllaf\ntaht\nmeti\nyna\neveihca\nAnnexures 157"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 09595254-0b6b-470d-b28a-84a62e06bc06
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 61, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 775, "chroma:document": "annex iV\nINFANT MILK SuBSTITuTES AcT\nThe Infant Milk Substitutes, Feeding Bottles and can give educational material to health\nInfant Foods (regulation of production, Supply and professionals like doctors, nurses etc\nDistribution) Act, 1992 and as amended act in 2003 provided it has information prescribed in\nclause 7 of the IMS Amendment Act, 2003.\nThis Act provides for the regulation of production,\nThe education material should have only\nsupply and distribution of infant milk substitutes,\nfactual information and should not promote\nfeeding bottles and infant foods with a view to the\nthe products of the company).\nprotection and promotion of breastfeeding and\nensuring the proper use of infant foods and for 8. Gives tins, cartons, accompanied leaflets of\nmatters connected to it. It extends to the whole these products having pictures of mothers\nof India. It also lays the responsibility of health or infants, cartoons or any other such images"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 61, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 776, "chroma:document": "of India. It also lays the responsibility of health or infants, cartoons or any other such images\nworkers and of the government to provide accurate to increase saleability.\ninformation to people. Following are the basic 9. Displays placards, posters in a hospital,\nprovisions of the IMS Act. nursing home, chemist shop etc. for\npromoting these products.\nTHE IMS AcT PROvISIONS\n10. Provides direct or indirect inducements to\nIMS act is violated if any baby Food Company, its\nhealth workers\ndistributor or supplier, or any person\n11. Demonstrates to mothers or their family\n1. Promotes any food by whatever name, for\nmembers how to feed these products.\nchildren up to two years.\nHowever, a doctor can demonstrate this to\n2. Promotes use of infant foods before the age the mother.\nof six months.\n12. Gives benefits to doctors, nurses or\n3. Advertises by any means--television, associations like IAP, IMA, NNF etc, for\nnewspapers, magazines, journals, through example, funds for organizing seminars,"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 61, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 777, "chroma:document": "newspapers, magazines, journals, through example, funds for organizing seminars,\nSMS, emails, radio, pamphlets etc. meeting, conferences, contest, fee of\neducational course, sponsoring for projects,\n4. Distributes the product or samples to any\nresearch work or tours.\nperson.\n13. Fixes commission of employees on the basis\n5. Contacts pregnant or lactating mothers\nof volume of sales of these products.\nusing any person.\n6. Gives any kind of inducements like free gifts, HIGHLIGHTS OF THE AcT\ntied sales, to anyone.\n1. Prohibits all persons from any kind of pro-\n7. Distributes information and educational motion of infant milk substitutes, infant\nmaterial to mothers, families etc. (They foods or feeding bottles\n46 KANGAROO MOTHER CARE & OPTIMAL FEEDING OF LOW BIRTH WEIGHT INFANTS"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 62, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 778, "chroma:document": "2. Prohibits the advertisement of infant milk 5. Prohibits display of posters at health care\nsubstitutes and feeding bottles to\u201d ensure facilities / hospitals /health centres.\nthat no impression is given that feeding of\n6. The Act also prescribes that all labels of IMS\nthese products is equivalent to, or better\n/Infant food, must say in English and local,\nthan, breastfeeding.\nlanguages that breastfeeding is the best.\n3. Prohibits providing free samples and gifts Also, the labels must not have pictures of\nto pregnant women, mothers of infants and infants or women or phrases designed to\nmembers of the families. increase the sale of the product.\n4. Prohibits donation of free or subsided 7. Prohibits any contact of employers\nsupplies of products for health care manufacturing and distributing company\ninstitutions and prohibits incentives and with pregnant women, even for providing\ngifts to health workers. educational material to them.\nANNEX iV 47"}


created_at: 2025-05-02 10:00:24
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 63, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 779, "chroma:document": "annex V\nORIENTATION ON KANGAROO MOTHER cARE\nobjective Key Points\nBy the end of this exercise the participant should be Eligibility criteria for KMC\nable to demonstrate Kangaroo Mother Care\n\u008d All LBW infants.\nSteps for providing Kangaroo Mother Care \u008d Sick hemodynamically stable infants\nneeding special care (even those on IV Fluid\n1 Counsel the mother, provides privacy to the\nor on Oxygen)\nmother. Request the mother to sit or recline\ncomfortably The two components of KMC are:\n2 Undress the baby gently, except for cap, \u008d Skin-to-skin contact\nnappy and socks\n\u008d Exclusive breastfeeding\n3 Place the baby prone on mother\u2019s chest in\nThe two prerequisites of KMC are:\nan upright position with the head slightly\nextended, between her breasts in skin to skin \u008d Support to the mother in hospital and at\ncontact in a frog like position; turn baby\u2019s home\nhead to one side to keep airway clear. Support\n\u008d Post-discharge follow-up\nthe baby\u2019s bottom with a sling/binder.\nBenefits of KMC"}


created_at: 2025-05-02 10:00:24
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 63, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 780, "chroma:document": "\u008d Post-discharge follow-up\nthe baby\u2019s bottom with a sling/binder.\nBenefits of KMC\n4 Cover the baby with mother\u2019s \u2018pallu\u2019 or gown;\nwrap the baby-mother duo with an added \u008d Reduces risk of hypothermia\nblanket or shawl depending upon the room\n\u008d Promotes lactation and weight gain\ntemperature\n\u008d Reducing infections and hospital stay\n5 Advise mother to breastfeed the baby\nfrequently \u008d Better bonding between Mother and\nnewborn\n6 Ensure warm room with room temperature\nmaintained between 25 \u2013 28\u00b0 C.\n7 Advise the mother to provide KMC for at least\n1 hour per session. The length of skin-to-skin\ncontact should be as long as possible\nPOintS tO reMeMBer\n1. Ensure room is warm (25 -28\u00b0 C)\n2. Health professionals should be skilled for providing immediate emergency care, in case required\n48 KANGAROO MOTHER CARE & OPTIMAL FEEDING OF LOW BIRTH WEIGHT INFANTS"}


created_at: 2025-05-02 10:00:24
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 64, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 781, "chroma:document": "referenCes\nCattaneo A, Davanzo R, Bergman N, Charpak N. income countries: a pooled country analysis.\nKangaroo mother care in low-income countries. Lancet. Aug 3 2013; 382(9890):417-425.World\nInternational Network in Kangaroo Mother Care. J Health Organization. Kangaroo mother care: a\nTrop Pediatr. 1998 Oct; 44(5):279-82. practical guide. Department of Reproductive\nHealth and Research, WHO, Geneva. 2003.\nCharpak N, Ruiz-Pelaez JG, Charpak Y. Rey-Martinez\nKangaroo Mother Program: an alternative way Kiran Kumar BV, Udani RH. Analgesic effect of skin-\nof caring for low birth weight infants. One year to-skin contact in kangaroo position in preterm\nmortality in a cohort study. Pediatrics. 1994 Dec; newborns. Abstracts XXII Annual Convention of\n94(6 Pt1):804-10. National Neonatology Forum, December19-22nd\n2002. P-48,pg158.\nCharpak N ,Ruiz-Pelaez JG, Figueroade CZ,\nCharpak Y. A randomized, controlled trial of Ramanathan K, Paul VK, Deorari AK, Taneja U,"}


created_at: 2025-05-02 10:00:24
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 64, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 782, "chroma:document": "Charpak Y. A randomized, controlled trial of Ramanathan K, Paul VK, Deorari AK, Taneja U,\nkangaroo mother care: results of follow-up at George G. Kangaroo Mother Care in very low\n1 year of corrected age. Pediatrics. 2001Nov; birth weight infants. Indian J Pediatr.2001Nov;\n108(5):1072-9. 68(11):1019-23.\nChwo MJ, Anderson GC, Good M, Dowling DA, Sloan NL, Camacho LW, Rojas EP, Stern C. Kangaroo\nShiau SH, Chu DM. A randomized controlled trial mother method: randomized controlled trial of an\nof early kangaroo care for preterm infants: effects alternative method of care for stabilized low-birth\non temperature, weight, behavior and acuity. J weight infants. Maternidad Isidro Ayora Study\nNurs Res.2002 Jun; 10(2):129-42. Team. Lancet. 1994 Sep17; 344(8925):782-5.\nConde-Agudelo, Diaz-Rosello JL, Belizan JM. Tessier R, Cristo M, Velez S, Giron M, de Calume ZF,\nKangaroo mother care to reduce morbidity and Ruiz-Palaez JG, Charpak Y, Charpak N. Kangaroo"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 64, "total_pages": 68, "CreationDate": "D:20140905095413+05'30'", "Creator": "Adobe InDesign CS3 (5.0)", "Producer": "Adobe PDF Library 8.0", "ModDate": "D:20140905095525+05'30'", "Trapped": "False", "chunk_index": 783, "chroma:document": "Kangaroo mother care to reduce morbidity and Ruiz-Palaez JG, Charpak Y, Charpak N. Kangaroo\nmortality in low birth weight infants. Cochrane mother care and the bonding hypothesis.\nDatabase Syst Rev 2003;(2):CD002771 Pediatrics. 1998Aug; 102(2):e17.\nGoel A, Vani SN. Kangaroo-mother method for WHO/UNICEF Join t Statement-Home visits for\nthe care of low birth weight infants \u2013 An Indian the newborn child: a strategy to improve survival.\nexperience. Abstracts XVIII Annual Convention of 2009\nNational Neonatology Forum, November 6-8th\nEvaluation of Kangaroo Mother Care Services in\n1998. fMortality risk in preterm and small-for-\nIndia, 2013\ngestational-age infants in low-income and middle-\nReferences 49"}


created_at: 2025-05-02 10:00:24
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created_at: 2025-05-02 10:00:24
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