# migrations

dir: embeddings_queue
filename: 00001-embeddings.sqlite.sql
hash: d3755dfd232be8e8301f4d7fcfb3a486
sql:
CREATE TABLE embeddings_queue (
    seq_id INTEGER PRIMARY KEY,
    created_at TIMESTAMP NOT NULL DEFAULT CURRENT_TIMESTAMP,
    operation INTEGER NOT NULL,
    topic TEXT NOT NULL,
    id TEXT NOT NULL,
    vector BLOB,
    encoding TEXT,
    metadata TEXT
);


dir: sysdb
filename: 00001-collections.sqlite.sql
hash: 38352d725ad1c16074fac420b22b4633
sql:
CREATE TABLE collections (
    id TEXT PRIMARY KEY,
    name TEXT NOT NULL,
    topic TEXT NOT NULL,
    UNIQUE (name)
);

CREATE TABLE collection_metadata (
    collection_id TEXT REFERENCES collections(id) ON DELETE CASCADE,
    key TEXT NOT NULL,
    str_value TEXT,
    int_value INTEGER,
    float_value REAL,
    PRIMARY KEY (collection_id, key)
);


dir: sysdb
filename: 00002-segments.sqlite.sql
hash: 2913cb6a503055a95f625448037e8912
sql:
CREATE TABLE segments (
    id TEXT PRIMARY KEY,
    type TEXT NOT NULL,
    scope TEXT NOT NULL,
    topic TEXT,
    collection TEXT REFERENCES collection(id)
);

CREATE TABLE segment_metadata (
    segment_id TEXT  REFERENCES segments(id) ON DELETE CASCADE,
    key TEXT NOT NULL,
    str_value TEXT,
    int_value INTEGER,
    float_value REAL,
    PRIMARY KEY (segment_id, key)
);


dir: sysdb
filename: 00004-tenants-databases.sqlite.sql
hash: 048867ce8fcdefe4023c7110e4433591
sql:
CREATE TABLE IF NOT EXISTS tenants (
    id TEXT PRIMARY KEY,
    UNIQUE (id)
);

CREATE TABLE IF NOT EXISTS databases (
    id TEXT PRIMARY KEY, -- unique globally
    name TEXT NOT NULL, -- unique per tenant
    tenant_id TEXT NOT NULL REFERENCES tenants(id) ON DELETE CASCADE,
    UNIQUE (tenant_id, name) -- Ensure that a tenant has only one database with a given name
);

CREATE TABLE IF NOT EXISTS collections_tmp (
    id TEXT PRIMARY KEY, -- unique globally
    name TEXT NOT NULL, -- unique per database
    topic TEXT NOT NULL,
    dimension INTEGER,
    database_id TEXT NOT NULL REFERENCES databases(id) ON DELETE CASCADE,
    UNIQUE (name, database_id)
);

-- Create default tenant and database
INSERT OR REPLACE INTO tenants (id) VALUES ('default_tenant'); -- The default tenant id is 'default_tenant' others are UUIDs
INSERT OR REPLACE INTO databases (id, name, tenant_id) VALUES ('00000000-0000-0000-0000-000000000000', 'default_database', 'default_tenant');

INSERT OR REPLACE INTO collections_tmp (id, name, topic, dimension, database_id)
    SELECT id, name, topic, dimension, '00000000-0000-0000-0000-000000000000' FROM collections;
DROP TABLE collections;
ALTER TABLE collections_tmp RENAME TO collections;


dir: sysdb
filename: 00005-remove-topic.sqlite.sql
hash: b1367c826b8fba5f96f27befdc1d42d2
sql:
-- Remove the topic column from the Collections and Segments tables

ALTER TABLE collections DROP COLUMN topic;
ALTER TABLE segments DROP COLUMN topic;


dir: sysdb
filename: 00006-collection-segment-metadata.sqlite.sql
hash: 4eea7468935bf25d4604a0fed2366116
sql:
-- SQLite does not support adding check with alter table, as a result, adding a check
-- involve creating a new table and copying the data over. It is over kill with adding
-- a boolean type column. The application write to the table needs to ensure the data
-- integrity.
ALTER TABLE collection_metadata ADD COLUMN bool_value INTEGER;
ALTER TABLE segment_metadata ADD COLUMN bool_value INTEGER;


dir: sysdb
filename: 00007-collection-config.sqlite.sql
hash: 1c7e63bba346a42a18b6ab7f1c989bed
sql:
-- Stores collection configuration dictionaries.
ALTER TABLE collections ADD COLUMN config_json_str TEXT;


dir: sysdb
filename: 00008-maintenance-log.sqlite.sql
hash: 0a0e7e93111a01789addf64961c6127c
sql:
-- Records when database maintenance operations are performed.
-- At time of creation, this table is only used to record vacuum operations.
CREATE TABLE maintenance_log (
  id INT PRIMARY KEY,
  timestamp INT NOT NULL,
  operation TEXT NOT NULL
);


dir: sysdb
filename: 00009-segment-collection-not-null.sqlite.sql
hash: 054355aef9e63702bf54ea29e61563f1
sql:
-- This makes segments.collection non-nullable.
CREATE TABLE segments_temp (
    id TEXT PRIMARY KEY,
    type TEXT NOT NULL,
    scope TEXT NOT NULL,
    collection TEXT REFERENCES collection(id) NOT NULL
);

INSERT INTO segments_temp SELECT * FROM segments;
DROP TABLE segments;
ALTER TABLE segments_temp RENAME TO segments;


dir: metadb
filename: 00001-embedding-metadata.sqlite.sql
hash: 2b4cf52c4bb2676e21d6860a4409f856
sql:
CREATE TABLE embeddings (
    id INTEGER PRIMARY KEY,
    segment_id TEXT NOT NULL,
    embedding_id TEXT NOT NULL,
    seq_id BLOB NOT NULL,
    created_at TIMESTAMP NOT NULL DEFAULT CURRENT_TIMESTAMP,
    UNIQUE (segment_id, embedding_id)
);

CREATE TABLE embedding_metadata (
    id INTEGER REFERENCES embeddings(id),
    key TEXT NOT NULL,
    string_value TEXT,
    int_value INTEGER,
    float_value REAL,
    PRIMARY KEY (id, key)
);

CREATE TABLE max_seq_id (
    segment_id TEXT PRIMARY KEY,
    seq_id BLOB NOT NULL
);

CREATE VIRTUAL TABLE embedding_fulltext USING fts5(id, string_value);


dir: metadb
filename: 00002-embedding-metadata.sqlite.sql
hash: 12a570f7121b3a8ce750a2a7c36da20f
sql:
-- SQLite does not support adding check with alter table, as a result, adding a check
-- involve creating a new table and copying the data over. It is over kill with adding
-- a boolean type column. The application write to the table needs to ensure the data
-- integrity.
ALTER TABLE embedding_metadata ADD COLUMN bool_value INTEGER


dir: metadb
filename: 00003-full-text-tokenize.sqlite.sql
hash: f97ad6334aeaa8f419f01110b648b97a
sql:
CREATE VIRTUAL TABLE embedding_fulltext_search USING fts5(string_value, tokenize='trigram');
INSERT INTO embedding_fulltext_search (rowid, string_value) SELECT rowid, string_value FROM embedding_metadata;
DROP TABLE embedding_fulltext;


dir: metadb
filename: 00004-metadata-indices.sqlite.sql
hash: fb36603a45ee2cd0254cef3ef86585e8
sql:
CREATE INDEX IF NOT EXISTS embedding_metadata_int_value ON embedding_metadata (key, int_value) WHERE int_value IS NOT NULL;
CREATE INDEX IF NOT EXISTS embedding_metadata_float_value ON embedding_metadata (key, float_value) WHERE float_value IS NOT NULL;
CREATE INDEX IF NOT EXISTS embedding_metadata_string_value ON embedding_metadata (key, string_value) WHERE string_value IS NOT NULL;


# embeddings_queue

created_at: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: ae4a8173-fb57-4cb4-9b75-34905ab0b593
encoding: FLOAT32
metadata:
{"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": 0, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 9573ef19-1999-4a89-ac1a-3cebc27c5134
encoding: FLOAT32
metadata:
{"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": 1, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: e3d043cd-db43-4d49-9bf8-dd76fc5284fa
encoding: FLOAT32
metadata:
{"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": 2, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: c821ac1d-ffad-4492-a5da-48785584464f
encoding: FLOAT32
metadata:
{"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": 3, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: b8da4ef7-e27b-4eba-ac76-3702f225ce3e
encoding: FLOAT32
metadata:
{"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": 4, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 93a46e79-e079-4d28-87e0-dc9253b6c390
encoding: FLOAT32
metadata:
{"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": 5, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 10377a20-f69d-4050-ab39-f4561e206690
encoding: FLOAT32
metadata:
{"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": 6, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 489adbb5-05e0-4978-94f1-30abed7c46cb
encoding: FLOAT32
metadata:
{"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": 7, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: aedace4d-17ca-4ee2-af66-254c2292d360
encoding: FLOAT32
metadata:
{"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": 8, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 4aabcd18-2436-413b-9173-cedb5ae33ff3
encoding: FLOAT32
metadata:
{"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": 9, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: de88d6ae-3667-4dbf-8b30-ce68cb3b877f
encoding: FLOAT32
metadata:
{"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": 10, "chroma:document": "References ........................................................................................................................................................................................49\nLISTTA OBFL EC OONF TCROIBNUTTEONRTSS xi"}


created_at: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: c20e592a-c777-4ff7-a868-efff8c17d645
encoding: FLOAT32
metadata:
{"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": 11, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: eaa5586d-3afd-4cdb-8dfb-21c4744095b1
encoding: FLOAT32
metadata:
{"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": 12, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 45a83efd-6bee-4347-8f2c-fcf261bf6659
encoding: FLOAT32
metadata:
{"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": 13, "chroma:document": "introdUCtion\nl KANGAROO MOTHER CARE (KMC)\nl DEFINITIONS\nl EVIDENCE FOR KMC\nl PURPOSE OF THE GUIDELINES"}


created_at: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 43949c37-a824-42d7-8b26-5ef7ebcfc321
encoding: FLOAT32
metadata:
{"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": 14, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: c57b4ca8-3acb-4231-9781-c327724fc17c
encoding: FLOAT32
metadata:
{"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": 15, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 100abfe5-cc4f-4916-b6fe-0f59d25508f6
encoding: FLOAT32
metadata:
{"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": 16, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 891c9c2d-dcbf-40d5-990b-687754e9a946
encoding: FLOAT32
metadata:
{"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": 17, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 8fd87e16-9675-4f77-9d0b-b3e036c3ce52
encoding: FLOAT32
metadata:
{"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": 18, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: a43183ce-6c32-4d67-af6e-065c9684eb54
encoding: FLOAT32
metadata:
{"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": 19, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: a0ca2289-96fd-412a-87a9-c2b2f5c46093
encoding: FLOAT32
metadata:
{"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": 20, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 7a5f5664-6a0e-4607-b4e2-0269ed0e51bd
encoding: FLOAT32
metadata:
{"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": 21, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: b7906fc0-4e8f-4fa5-966a-de0aa8a64e3b
encoding: FLOAT32
metadata:
{"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": 22, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: c6cacf8f-447b-45e6-b473-9baf036b3b47
encoding: FLOAT32
metadata:
{"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": 23, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: f3830c34-e740-4fc4-b90e-a0dfc565eb27
encoding: FLOAT32
metadata:
{"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": 24, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: de4219a7-5b20-490e-aae3-4847c9f9fd74
encoding: FLOAT32
metadata:
{"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": 25, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 1edd16e9-f960-495a-9bd1-f46ffbd49612
encoding: FLOAT32
metadata:
{"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": 26, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 43eccc24-e766-4ded-8cde-9d34e67c09f1
encoding: FLOAT32
metadata:
{"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": 27, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 47f02104-cfb9-41e7-9e11-2416fb937672
encoding: FLOAT32
metadata:
{"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": 28, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: bc05b142-21e6-461a-b9eb-f45fb9d6b709
encoding: FLOAT32
metadata:
{"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": 29, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: aa73a236-e6a0-4b75-84a4-632a37a66236
encoding: FLOAT32
metadata:
{"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": 30, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: dd615486-6e05-484e-bbf5-3d3de52e1f6e
encoding: FLOAT32
metadata:
{"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": 31, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 4dffc460-37f4-41ee-a357-463baad336f7
encoding: FLOAT32
metadata:
{"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": 32, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: eebcad99-08b6-4d6e-87cb-6d3fe4617c37
encoding: FLOAT32
metadata:
{"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": 33, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: d0909cb6-e4eb-4ffd-bb55-c8e813ae1821
encoding: FLOAT32
metadata:
{"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": 34, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 89d6be18-6cab-47af-a8df-81a9cc8bc1d6
encoding: FLOAT32
metadata:
{"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": 35, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 1c2f0f07-8df0-4747-8bec-dd02089af884
encoding: FLOAT32
metadata:
{"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": 36, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 53c9bd82-d8ea-4c5d-8b6c-646743aae4df
encoding: FLOAT32
metadata:
{"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": 37, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: bd389b48-b8bf-4f28-baec-34016a05eedb
encoding: FLOAT32
metadata:
{"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": 38, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 1dd295df-bf3c-4f4a-a634-d1b2f0eb9ccb
encoding: FLOAT32
metadata:
{"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": 39, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 39bf19c5-2597-40c5-ba94-781fa6943042
encoding: FLOAT32
metadata:
{"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": 40, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 56892b39-a93f-47b6-ac87-f4987da9e8a6
encoding: FLOAT32
metadata:
{"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": 41, "chroma:document": "and mother should not be discharged in a hurry.\n14 KANGAROO MOTHER CARE & OPTIMAL FEEDING OF LOW BIRTH WEIGHT INFANTS"}


created_at: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: ededfe4a-e880-44d0-a3d9-e74a6a68d351
encoding: FLOAT32
metadata:
{"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": 42, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: a07be56f-4f5e-4799-8b5e-af43c7bdaa56
encoding: FLOAT32
metadata:
{"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": 43, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 634a5112-8be5-4af5-9341-b2678f90ee64
encoding: FLOAT32
metadata:
{"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": 44, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 553dc213-a419-48c4-8668-a40c70aa1117
encoding: FLOAT32
metadata:
{"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": 45, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 150810f3-6179-4e0b-9847-2d220a521388
encoding: FLOAT32
metadata:
{"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": 46, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: d4077dfe-172d-4b05-b911-b1bac15bb18a
encoding: FLOAT32
metadata:
{"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": 47, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 812c2358-c687-46d8-a863-8f9984c5a469
encoding: FLOAT32
metadata:
{"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": 48, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 5ba49c26-1209-491e-afe4-4f39ea9d06a5
encoding: FLOAT32
metadata:
{"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": 49, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: f1941cfd-251c-42df-b1cb-7530cf6ecf34
encoding: FLOAT32
metadata:
{"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": 50, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 44ab9f52-08a0-4f5f-9796-c7e7e1380b65
encoding: FLOAT32
metadata:
{"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": 51, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: bb78d51c-db56-4c7e-a531-9532bcc04d30
encoding: FLOAT32
metadata:
{"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": 52, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: bb920707-7a5e-4680-8a72-7a2e9676ef9b
encoding: FLOAT32
metadata:
{"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": 53, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 2728ce13-c853-491e-9f4f-1ef03ca4e85f
encoding: FLOAT32
metadata:
{"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": 54, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 1a62f1af-7284-46f8-81cd-2459244086fd
encoding: FLOAT32
metadata:
{"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": 55, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 37deec15-cbb9-48ec-a60d-e4ff189fa816
encoding: FLOAT32
metadata:
{"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": 56, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 3646946d-adc9-4eea-9716-fccc25176cc7
encoding: FLOAT32
metadata:
{"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": 57, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: f33960b4-1231-4909-8c18-3b7237a9df31
encoding: FLOAT32
metadata:
{"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": 58, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 221693b7-28bb-4f64-8751-a69c0a9b2c9d
encoding: FLOAT32
metadata:
{"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": 59, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 017a4667-658d-4e76-abd4-31613d60e954
encoding: FLOAT32
metadata:
{"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": 60, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 3dd3d58a-b397-4997-976b-8dc6b174618f
encoding: FLOAT32
metadata:
{"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": 61, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: df057c09-74ab-4d87-9403-5f0762a6ea55
encoding: FLOAT32
metadata:
{"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": 62, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 828e4625-f63b-4dee-9f54-512debdebca7
encoding: FLOAT32
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": 63, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: a40533fd-e4f1-4261-82e7-1b25b5b7aee2
encoding: FLOAT32
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": 64, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 5064d897-d422-467c-8b72-dd387d3c513c
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": 65, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 492a36ac-6dc5-4a52-a68c-374da2449ee1
encoding: FLOAT32
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": 66, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 30637ccc-774d-478b-a265-5494db7c29d4
encoding: FLOAT32
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": 67, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 25beeedf-98d9-4fdb-838c-0164d7a8f562
encoding: FLOAT32
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": 68, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 290a02f9-129a-4d82-b78a-f76aa1b3d56a
encoding: FLOAT32
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": 69, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 62497d34-94ba-48b9-8322-564fcda4ca57
encoding: FLOAT32
metadata:
{"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": 70, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 384bedcd-4974-4239-8916-c82415eab5f4
encoding: FLOAT32
metadata:
{"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": 71, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 6fd06536-1554-44b1-84e6-51b965a96424
encoding: FLOAT32
metadata:
{"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": 72, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 807bf127-bdda-4f42-8ce9-dd2b1cdadcfc
encoding: FLOAT32
metadata:
{"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": 73, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: c9f910be-723b-4d62-95bb-d39bc8c11837
encoding: FLOAT32
metadata:
{"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": 74, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 85ce2050-6751-49d5-8297-6d4430bfdb18
encoding: FLOAT32
metadata:
{"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": 75, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: afa5a828-a2e6-4039-95d8-9349732a994d
encoding: FLOAT32
metadata:
{"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": 76, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: cb29f396-4d9f-4977-8829-f60a390467b8
encoding: FLOAT32
metadata:
{"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": 77, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 07d27cf3-51a8-4ea0-a25a-7fb4a3340ad4
encoding: FLOAT32
metadata:
{"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": 78, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: c6194c7c-d7c0-4d9f-9215-664e2b6289d0
encoding: FLOAT32
metadata:
{"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": 79, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 8b9cf481-bddd-47e6-9f2e-9b864f912b9a
encoding: FLOAT32
metadata:
{"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": 80, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: fecaa534-7f47-4978-959a-8eb8cc7c4aba
encoding: FLOAT32
metadata:
{"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": 81, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 8fcc3d65-90bc-4c0a-b80f-b61cb8539b73
encoding: FLOAT32
metadata:
{"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": 82, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: c92e71a6-21ff-4381-aa6d-a81d6f590380
encoding: FLOAT32
metadata:
{"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": 83, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: e16fd58b-b8ea-48eb-bfce-63b0014ea931
encoding: FLOAT32
metadata:
{"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": 84, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 9860e4bb-ecd5-41cc-b9e1-39ae33feac4a
encoding: FLOAT32
metadata:
{"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": 85, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 39e96817-40e3-413f-96da-063f4afef40c
encoding: FLOAT32
metadata:
{"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": 86, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: c084d6fd-0820-480e-ae42-cdb32145af8a
encoding: FLOAT32
metadata:
{"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": 87, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: cff9581c-442a-4c20-9dea-c4a0c1851c4c
encoding: FLOAT32
metadata:
{"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": 88, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: bbd3febf-6908-4d27-af52-03910e8d3de8
encoding: FLOAT32
metadata:
{"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": 89, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 106dcf99-e8d3-4428-b9ff-8b65500434b7
encoding: FLOAT32
metadata:
{"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": 90, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 7a8f0236-c6f0-429c-9699-33f5b39be8f4
encoding: FLOAT32
metadata:
{"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": 91, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 6d3f95d4-7bf0-4a0f-914c-26021fadc710
encoding: FLOAT32
metadata:
{"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": 92, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: e5cf3584-b9cb-4189-b8ba-f6821b71fb82
encoding: FLOAT32
metadata:
{"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": 93, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 3432f0d7-f0ff-4219-8dbb-7d8a4ca981e6
encoding: FLOAT32
metadata:
{"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": 94, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: db79bef0-820f-453a-9586-84b30b59dd91
encoding: FLOAT32
metadata:
{"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": 95, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 14bd5c9d-be8c-4369-901a-fe4504c064aa
encoding: FLOAT32
metadata:
{"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": 96, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 58277429-6b75-4046-9dd7-4f1302cee4f7
encoding: FLOAT32
metadata:
{"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": 97, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: dd1c7217-4995-4b6b-b11a-95e3290ddf79
encoding: FLOAT32
metadata:
{"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": 98, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 36ae7171-b100-4370-a8f1-1888c9724da3
encoding: FLOAT32
metadata:
{"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": 99, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 6aa9ae31-f49d-4390-a423-461b97ce385a
encoding: FLOAT32
metadata:
{"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": 100, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 6b4c0da1-dba4-467e-9b22-a541b2c19714
encoding: FLOAT32
metadata:
{"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": 101, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 966d0b28-b8f4-44c8-a5e0-899886ee96d3
encoding: FLOAT32
metadata:
{"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": 102, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: af8b23a6-2e28-4c37-97b3-bbdf439eccb1
encoding: FLOAT32
metadata:
{"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": 103, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 68338d91-4fcd-42ce-8f6b-606921490849
encoding: FLOAT32
metadata:
{"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": 104, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: fa9acc3c-4c25-4042-81b1-7b8f47a06eaf
encoding: FLOAT32
metadata:
{"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": 105, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 7fd6285a-e4f3-44d3-88ab-0977044761a8
encoding: FLOAT32
metadata:
{"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": 106, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: dd5754d1-b706-49b0-9014-cb28e0421935
encoding: FLOAT32
metadata:
{"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": 107, "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: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 35dc0da9-585b-4fdc-bc1d-69cd14a68902
encoding: FLOAT32
metadata:
{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 65, "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": 108, "chroma:document": "KanGarOO MOtHer Care\nPreParatiOn FOr KMC COunSellinG & DeMOnStratiOn\nFOr KMC\nKMC POSitiOn\nwHO Can PrOViDe KMC (FatHer anD OtHer relatiVeS)"}


created_at: 2025-04-05 09:58:38
topic: persistent://default/default/82c4a9c4-72d6-4741-bf1c-eaf1d187e842
id: 27876977-25dc-4269-a456-a5cdc6660e82
encoding: FLOAT32
metadata:
{"source": "pdfs\\Operational-Guidelines_KMC_file.pdf", "file_path": "pdfs\\Operational-Guidelines_KMC_file.pdf", "page": 66, "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": 109, "chroma:document": "FeeDinG MetHODS FOr lBw inFantS\nCuP, SPOOn anD PalaDai\ntuBe FeeDinG"}


# collections

id: 82c4a9c4-72d6-4741-bf1c-eaf1d187e842
name: pdf-chatbot
database_id: 00000000-0000-0000-0000-000000000000
config_json_str:
{"hnsw_configuration": {"space": "l2", "ef_construction": 100, "ef_search": 100, "num_threads": 8, "M": 16, "resize_factor": 1.2, "batch_size": 100, "sync_threshold": 1000, "_type": "HNSWConfigurationInternal"}, "_type": "CollectionConfigurationInternal"}


# embedding_metadata

key: chroma:document
string_value:
Kangaroo Mother Care
&
optiMal feeding of low birth weight infants
Operational Guidelines | September 2014
For Programme Managers & Service Provider
Child Health Division
Ministry of Health and Family Welfare
Government of India


key: chroma:document
string_value:
FOrewOrD
Birth Weight is a reliable and sensitive indicator for predicting the immediate and long term
outcome of a newborn. Low Birth Weight (LBW) is a challenging multifaceted public health
problem because it is associated with increased risk of morbidity and mortality in infants.
Low Birth Weight newborns are four times more likely to die from common childhood
diseases in the first year of life, than their normal counterpart. The public health significance
of Low Birth Weight is accentuated by its association with mental retardation, specialized
institutional care and intensive care units. There is also emerging evidence that Low Birth
Weight neonates are more prone to Non-Communicable Diseases (NCDs) like Diabetes
Mellitus, Hypertension and Coronary Artery Disease in later life.
Kangaroo Mother Care(KMC) and optimal feeding in Low Birth Weight infants are evidence
based cost-effective interventions which, when upscaled and implemented across all facilities


key: chroma:document
string_value:
based cost-effective interventions which, when upscaled and implemented across all facilities
can save up to half a million newborns. Despite the KMC network having been established in
India in 1990s, this simple technique is still not being practiced universally across the country.
“Kangaroo Mother Care and Optimal Feeding of Low Birth Weight Infants” guidelines have
been designed to emphasize the implementation of KMC in SNCUs and Medical Colleges on
priority.
This guideline I am sure will help the service providers and programme managers alike to
implement KMC and optimal feeding and will go a long way in improving the survival and
development of low birth infants.
C.K. Mishra


key: chroma:document
string_value:
PreFaCe
Preterm births and intra-uterine growth retardation lead to low birth weight (LBW),
which is an important indirect cause of neonatal deaths. The global prevalence of
LBW is 15.5% and in India, 27% of all live births are LBW.
Kangaroo Mother Care (KMC) is a simple, cost-effective way of caring for low birth
weight infants and has been included in many guidelines and training modules
released by Government of India. It has been observed that despite undergoing
training, service providers are not adept at providing Kangaroo Mother Care for
LBW newborns. It was therefore the need of the hour to have an implementation
guideline for rolling out KMC at the facility level.
These guidelines will give a clear idea to service providers on what exactly KMC is
and how KMC techniques can be implemented when caring for low birth weight
infants. I am confident that the guidelines will also be used by programme managers


key: chroma:document
string_value:
infants. I am confident that the guidelines will also be used by programme managers
and health facility managers to establish KMC units across the country and help in
reducing neonatal mortality.
(Dr. rakesh Kumar)


key: chroma:document
string_value:
aCKnOwleDGeMent
In India, Low Birth Weight (LBW) is an important underlying cause of neonatal
mortality. Experience from world over shows that appropriate care of LBW infants,
which encompasses feeding, temperature maintenance, hygienic care, early
detection of infections and treatment of complications can substantially reduce
mortality rates.
“Kangaroo mother care”-a simple and cost effective technique was introduced
in India in 1994 and KMC Network of India was also established. Though this
intervention finds a place in various training modules it is not being implemented
across the facilities in the country.
Child Health Division, Ministry of Health & Family Welfare (MOHFW), Govt. of India
has taken a decision to implement Kangaroo Mother Care at facility level. Operational
Guidelines for “Kangaroo Mother Care and Optimal Feeding of Low birth Weight
infants” is a step towards this direction.
Dr. P.K. Prabhakar, Deputy Commissioner, MOHFW coordinated the development of


key: chroma:document
string_value:
Dr. P.K. Prabhakar, Deputy Commissioner, MOHFW coordinated the development of
these guidelines and led the team of Child Health Division and experts from various
institutions and development partners. Contribution of all experts is gratefully
acknowledged. Special thanks are due to Dr. Vinod K. Paul, Dr. A. Deorari, Dr. Rekha
Udani, Dr. Sushma Nangia and Dr. Sadhana Mehta for reviewing the draft and
helping in finalizing the guidelines. Contribution of USAID-MCHIP in coordinating
the development and printing of this guideline is also acknowledged.
(Dr. ajay Khera)


key: chroma:document
string_value:
list of ContribUtors
MINISTRY OF HEALTH AND FAMILY WELFARE
Dr. Ajay Khera
Dr. P.K. Prabhakar
Dr. Renu Srivastava
Dr. Nimisha Goel
Mr. Sharad Singh
EXPERTS
Dr. Vinod K. Paul Dr. Arun Kumar Singh Dr. Reeta Raisaily
Dr. Shashi Vani Dr. Harish Chellani Dr. R. Srinivasan
Dr. Siddharth Ram Ji Dr. Harish Kumar Prof. A.T. Arasar Seeralar
Dr. Rekha H. Udani Dr. Sachin Gupta Dr. Anju Puri
Dr. Ashok Deorari Dr. Gagan Gupta Dr. Pawan Pathak
Dr. Sushma Nangia Dr. Kanya Mukhopadhyay Dr. Rajesh Khanna
Dr. Sadhana Mehta Dr. Suman Rao Dr. Javvad Suri
Dr. J. Kumutha Dr. Rita Bora Dr. Sebanti Ghosh
Dr. Ruchi Nanavati Dr. Ramesh Agarwal Dr. Lata Bhat
LIST OF CONTRIBUTORS ix


key: chroma:document
string_value:
table of Contents
Acronyms .........................................................................................................................................................................................xiii
Introduction .......................................................................................................................................................................................1
Kangaroo Mother Care Implementation .................................................................................................................................7
Optimal Feeding of Low Birth Weight Infants .....................................................................................................................17
Action Plan for Implementation and Scale-up ...................................................................................................................27


key: chroma:document
string_value:
Annexure ..........................................................................................................................................................................................35
Annexure I: Manual Expression of Breast milk and Storage thereof ...........................................................................37
Annexure II: Alternative Feeding Methods (Cup/Spoon/Paladai Feeding) ..............................................................39
Annexure III: Follow-up Protocol after Discharge of a High-risk infant......................................................................43
Annexure IV: Infant Milk Substitutes Act ..............................................................................................................................46
Annexure V: Orientation on Kangaroo Mother Care ........................................................................................................48


key: chroma:document
string_value:
References ........................................................................................................................................................................................49
LISTTA OBFL EC OONF TCROIBNUTTEONRTSS xi


key: chroma:document
string_value:
aCronYMs
AIIMS All India Institute of Medical Sciences KMC Kangaroo Mother Care
ANM Auxiliary Nurse & Midwife KMCU Kangaroo Mother Care Unit
ASHA Accredited Social Health Activist KSCH Kalawati Saran Children’s hospital
AV aids Audio Visual aids LBW Low Birth weight
BERA Brainstem evoked response LHMC Lady Hardinge Medical College
audiometry MCH Maternal and Child Health
CC Chest Circumference MCHIP Maternal and Child Health
DEIC District Early Intervention Centre Integrated Program
FBNC Facility Based Newborn Care MEN Minimal Enteral Nutrition
F-IMNCI Facility based Integrated NHM National Health Mission
Management of Neonatal and NICU Newborn Intensive Care Unit
Childhood Illnesses
NNF National Neonatology Forum
FOGSI Federation of Obstetric and
OAE Otoacoustic Emissions
Gynaecological Societies of India
PMA Post Menstrual Age
GNM General Nursing and Midwifery
PVL Periventricular leukomalacia
HBNC Home Based Newborn Care
RBSK Rashtriya Bal Swasthya Karyakram
HC Head Circumference


key: chroma:document
string_value:
HBNC Home Based Newborn Care
RBSK Rashtriya Bal Swasthya Karyakram
HC Head Circumference
RCC Regional Collaborative Centre
Hib Haemophilus influenzae type B
RMNCH+A Reproductive, Maternal, Newborn,
IANN Indian Association of Neonatal
Child and Adolescent Health
Nurses
SGA Small for Gestational Age
IAP Indian Academy of Paediatrics
SNCU Sick Newborn Care Unit
IM Intramuscular
STS Skin-to-Skin
IMS Act Infant Milk Substitutes Act
USAID United States Agency for
IQ Intelligence Quotient
Internation Development
JSSK Janani Shishu Suraksha Karyakram
WHO-CC World Health Organization
KEM King Edward Medical College Collaborative Centre
ACRONYMS xiii


key: chroma:document
string_value:
introdUCtion
l KANGAROO MOTHER CARE (KMC)
l DEFINITIONS
l EVIDENCE FOR KMC
l PURPOSE OF THE GUIDELINES


key: chroma:document
string_value:
iinnttrrooddUUCCttiioonn
Introduction
Of the 20 million low birth weight infants born globally stabilizes body temperature, promotes breast feeding,
every year, about 8 million are in India. Over 80% of prevents infection and other morbidities. This also
neonatal deaths occur among small infants - 65% leads to early discharge, better neurodevelopment
are attributable to preterm infants and 19% to term- and encourages bonding between mother and
small for gestational age, (SGA) (Lawn Every Newborn infant. KMC is initiated in the hospital and continued
Lancet Series 2014). India has the highest number at home until the infant needs it and for optimum
of preterm births and also accounts for maximum care a regular follow-up must be ensured.
number of neonatal deaths due to prematurity.
Kangaroo mother care has following components:
Incidence of LBW in India is about 27% of total live
births. 1. Skin-to-skin contact
2. Exclusive breast feeding
Kangaroo Mother Care (KMC)


key: chroma:document
string_value:
births. 1. Skin-to-skin contact
2. Exclusive breast feeding
Kangaroo Mother Care (KMC)
However, KMC should not be confused with routine
skin-to-skin care at birth. World Health Organization
Kangaroo Mother Care is a low resource, evidence
(WHO) recommends skin-to-skin care immediately
based, high impact intervention and standardised
after delivery for every newborn, irrespective of the
care for low birth weight infants which, like
birth weight to ensure warmth and early initiation of
breastfeeding, should be part of routine care. It can
breast feeding in the delivery room KMC is meant for
prevent up to half of all deaths in infants weighing
stable LBW infants and denotes a sustained, long-
<2000g (Lawn et al, 2010).
duration skin-to-skin contact.
DEFINITIONS
Kangaroo is an animal found in Australia. She
Kangaroo Mother Care (KMC) is a simple method of
invariably delivers a premature baby. The premature,
care for low birth weight infants that includes early


key: chroma:document
string_value:
care for low birth weight infants that includes early
baby kangaroo stays in the pouch of her mother,
and prolonged skin-to-skin contact with the mother
where it gets warmth and exclusive breast feeding
(or a substitute caregiver) and exclusive and frequent
till it is mature enough to survive outside.
breastfeeding. This natural form of human care
Introduction 3


key: chroma:document
string_value:
 Better mother-infant bonding and maternal
DuratiOn OF KMC
satisfaction with the method of care, as
Short: 4 hours daily* extended: 5-8 hours daily* compared with conventional methods
long: 9-12 hours daily*
Above review included seven trials that assessed
Continuous: More than12 hours daily*
mortality at discharge or 40–41weeks and reported
*Documented on two consecutive days or more a statistically significant reduction in the risk of
prior to discharge. mortality among KMC infants (3.4%), compared
with 5.7% for infants receiving traditional care. the
Duration to be counted as cumulative completed
review ultimately concluded that KMC should be
hours during a 24 hour period.
used for all stabilized lBw infants.
there is now sufficient evidence to recommend
low birth weight (lBw) has been defined by the
the routine use of KMC for all low birth weight
World Health organization (WHO) as weight at birth
infants. However in our country newborn infants


key: chroma:document
string_value:
World Health organization (WHO) as weight at birth
infants. However in our country newborn infants
less than 2,500 grams which can be a consequence
weighing less than 2,000 grams should be started
of preterm birth or due to small size for gestational
on KMC, on priority in view of the high burden of
age or both. Preterm is defined as born before 37
lBw infants.
weeks completed and SGA is defined as weight for
gestation less than 10th percentile of the gestation
norm. Newborn infants weighing less than 2000 grams
should be started on KMC on priority.
EvIDENcE FOR KMc
other benefits
evidence of the effectiveness and safety of
KMC for clinically stable preterm newborns, is KMC is associated with reduced incidence of severe
now formally established. In 2011, an updated illness including pneumonia during infancy. In most
Cochrane review (Conde-Agudelo, Diaz-Rossello, of the studies KMC has been found to be more


key: chroma:document
string_value:
Cochrane review (Conde-Agudelo, Diaz-Rossello, of the studies KMC has been found to be more
Belizan 2011) assessed 35 studies. This review effective than incubator care for stable newborns
demonstrated even more convincing results than in: providing adequate thermal care, reducing
the previous one published in 2008. Compared nosocomial infections, improving exclusive
with conventional neonatal care, KMC was found breastfeeding and weight gain, and fostering greater
to reduce: maternal and family involvement in care—all at a
lower cost than incubator care.
 Mortality at discharge and at the latest
follow-up,
 Severe infection/sepsis, nosocomial infections, KMC satisfies all five senses of the infant. The infant
lower respiratory tract disease, feels the mother’s warmth through skin-to-skin
contact (touch), listens to her voice and heartbeat
 Hypothermia and length of hospital stay.
(hearing), sucks breast milk (taste) has eye contact


key: chroma:document
string_value:
 Hypothermia and length of hospital stay.
(hearing), sucks breast milk (taste) has eye contact
The 2011 review also revealed that KMC resulted in: with her (vision) and smells her odor (olfaction).
 Improved weight, length and head
circumference,
Management of LBW is covered in various training
 Increased breastfeeding rates, packages under NHM (including, Facility-Based
4 KANGAROO MOTHER CARE & OPTIMAL FEEDING OF LOW BIRTH WEIGHT INFANTS


key: chroma:document
string_value:
have special nutritional needs. Evidence based
HiStOry OF KMC
principles exist which highlight the importance
l A team of pediatricians started KMC in of ‘breast milk feeding’ and practical aspects of
Instituto Materno Infantil (IMI) in Bogota, ‘enabling LBW infants achieve optimum growth’
Colombia in 1978. through optimum feeding. Therefore there was
l In 2003, WHO formally endorsed KMC and a need to develop integrated guidelines for
published KMC practice guidelines. implementing KMC and feeding of low birth weight
infants.
l KMC was introduced in India, in 1994 in BJ
Medical College Hospital, Ahmedabad. This
PuRPOSE OF THE GuIDELINES
was followed by experiences in KEM Mumbai
and at the All India Institute Medical Sciences
The purpose of the guidelines is to:
(AIIMS).
l A KMC India Network (www.kmcindia.org)
 Present evidence based technical protocols
to be observed at the health facilities for
comprising six institutions was started in
KMC and feeding of LBW infants.
2003.


key: chroma:document
string_value:
comprising six institutions was started in
KMC and feeding of LBW infants.
2003.
 Provide appropriate guidance on:
Newborn Care, Facility-IMNCI) with mention of KMC. l Operationalization of KMC and LBW
Yet the practice of KMC in public health facilities feeding practices at different levels of
(including SNCUs and medical colleges) as also in health facilities.
private hospitals remains inadequate. A recent
l Choice of initial feeding method,
assessment of KMC in selected tertiary care hospitals
progression of oral feeds, and nutritional
in a few states in the western and southern parts of
supplementation.
India revealed many bottlenecks in implementing
The guidelines discuss not only various protocols,
KMC including:
but also the essential skills and monitoring
1. Lack of institutionalization
involved. It has been prepared for health
2. No ownership of KMC even in facilities professionals providing care to LBW and preterm


key: chroma:document
string_value:
2. No ownership of KMC even in facilities professionals providing care to LBW and preterm
providing care infants in health facilities. Practical instructions
3. Inadequate continuum of KMC after (or protocols) may be adapted to local norms for
discharge different categories of health workers available in
various settings. The guidelines are also aimed at
The study recommended the need for strengthening
decision-makers and planners at various levels
training of service providers, appropriate job aids
to help them understand the prerequisites to
and IEC materials, and appropriate system for follow-
implement KMC, optimal feeding and follow-up
up of LBW infants.
of LBW infants. These should also be incorporated
Situation analysis also indicates that KMC and into pre-service and in-service educational
feeding go hand-in-hand for LBW infants as they packages on neonatal care.
Introduction 5


key: chroma:document
string_value:
Kangaroo Mother
Care iMpleMentation
l What is required for implementing KMC
l Who can provide KMC?
l How to Provide KMC
w Counselling
w Clothing
w KMC Position
l Duration of KMC
l Monitoring of the infant
l Feeding during KMC
l Special situations
l Discharge from hospital and follow-up
w Follow-up
Frequency of visits
n
l Don’ts of Kangaroo Mother Care


key: chroma:document
string_value:
Kangaroo Mother Care
iMpleMentation
Even though KMC is simple, it needs to be initiated most crucial for assisting mothers in KMC practice
at the hospital under skilled supervision. The and LBW feeding.
mother needs guidance by a health professional
c. IEc
to provide KMC and optimally breastfeed the LBW
infant, starting at the facility and continuing on her Ensure adequate IEC material, including video films
own at home. once the mother goes home, it is on KMC in local language for mothers, families and
important that the continuum of KMC is maintained; community.
community health workers (ASHAs, ANMs, AWWs)
Counselling of the mothers, fathers and relatives by
should ensure that the mother continues to provide
service providers is catalytic in ensuring KMC practice
kangaroo care at home. It is equally important that
during their stay at the hospital and after discharge
they should facilitate follow-up visits to the facility
so that they can continue to practice KMC till the


key: chroma:document
string_value:
so that they can continue to practice KMC till the
for review and problem solving as this support is
infant requires it. Community awareness activities
crucial for the infant’s health after discharge.
should be conducted to maximize the benefits of
KMC and breastfeeding.
WHAT IS REquIRED FOR
IMPLEMENTING KMc?
Nurses and other service providers learn to
a. Infrastructure
appreciate KMC once they observe the health
Dedicated space near Special Newborn Care Unit benefits to the infant and satisfaction of the
(SNCU), post-natal ward or neonatal ward/ NBSU mother.
which is furnished with comfortable reclining chairs
& cots, provides privacy for expression of breast milk
and is equipped with storage facility for expressed
D. Which infants should be provided KMC
breast milk.
Though all LBW infants should be provided KMC but
B. human resources:
considering the huge burden at facilities, priority


key: chroma:document
string_value:
B. human resources:
considering the huge burden at facilities, priority
The availability of adequate number of trained and must be given to infants with birth weight less than
willing health service providers for 24x7 services is 2000 grams.
KANGAROO MOTHER CARE IMPLEMENTATION 9


key: chroma:document
string_value:
The timing of initiation of KMC depends on the birth need care in a Special Newborn Care Unit
weight and stability of the infant. (SNCU) or a Newborn Intensive Care Unit
(NICU). Intermittent KMC can be given to a
1. Birth weight more than 1,800 grams and
hemodynamically stable infant receiving IV
less than 2500 g: These infants are generally
fluids, antibiotics and oxygen. KMC should
stable at birth. Therefore, in most such cases
be practiced under medical supervision. The
KMC can be initiated soon after birth in the
duration may be gradually increased and
postnatal ward. The neonate weighing less
thereafter the infant may be transferred to a
than 2000g should be accorded priority for
dedicated KMC ward.
initiation of KMC considering the huge bur-
3. Birth weight less than 1,200 g: These
den of LBW infants in the country.
infants frequently experience serious
2. Birth weight more than 1,200g and less
prematurity related morbidity often starting
than 1800 g: Many infants of this group


key: chroma:document
string_value:
prematurity related morbidity often starting
than 1800 g: Many infants of this group
soon after birth. It may take days to weeks
have significant problems in the neonatal before the infant’s condition allows initiation
period. It might take a few days before of KMC. Duration of KMC should be gradually
KMC can be initiated. Such infants may increased based on the tolerance of infant.
Figure 1: Time of Initiation of KMC
Birth Weight*
More than1200 upto less than More than1800 upto less than
Less than 1200 gram
1800 grams 2500 grams
Generally stable at birth
Most infants suffer from ) Many infants suffer from
serious morbidities
serious morbidities,
therefore birth should ) Transfer to a specialized
take place in specialized centre, if possible
centres
) Best transported in STS
with mother/family
member (if transport
incubator not available)
May take days to weeks
May take days before KMC KMC can be initiated
before KMC can be
can be initiated immediately after birth
initiated


key: chroma:document
string_value:
before KMC can be
can be initiated immediately after birth
initiated
* Cut-off birth weight for KMC has been based on Operational Guideline of Facility Based Newborn Care
10 KANGAROO MOTHER CARE & OPTIMAL FEEDING OF LOW BIRTH WEIGHT INFANTS


key: chroma:document
string_value:
WHO cAN PROvIDE KMc? Clothing
KMC can be provided by mothers, fathers and Mother:
other adult family members. The KMC provider
KMC can be provided using any front-open, light
should be willing, in good health, free from serious
dress as per the local culture. KMC works well with
illness and should maintain basic standards of
sari-blouse, gown or shawl. A suitable apparel
hygiene such as hand washing, daily bath, clipped
like Kangaroo bag, baby bag, sari, binder that can
fingernails, tied up hair and clean clothes. It is
retain the infant for an extended period can be
recommended that jewellery, watches and sacred
adapted locally.
threads must be removed as they may be a barrier
to maintain hygiene and might cause injury to the
newborn. It is not mandatory to have any special dress,
garment or binder for KMC. It can be provided using
any clothing that is acceptable to the mother and
HOW TO PROvIDE KMc?
the family.
Counselling
Effective counselling for the initiation of KMC is a infant:


key: chroma:document
string_value:
the family.
Counselling
Effective counselling for the initiation of KMC is a infant:
prerequisite to overcome socio-cultural barriers and
The infant should be dressed in cap, socks, disposable
anxiety regarding handling a LBW infant both by the
diapers and front-open sleeveless shirt or ‘jhabala’
mother and other care providers.
made of a soft natural fabric like cotton.
When the infant is ready for KMC, the first
Figure 1: Examples of KMC supporter
counselling session should be organized at a time
convenient to the mother. The first few sessions
are important and require extended interaction
to develop a rapport with the mother and
to alleviate any fear. KMC procedure should be
demonstrated to her explaining correct position
in a caring, gentle manner and with patience.
Her queries should be answered to allay her
anxieties. Kangaroo Bag Baby Bag
Encourage her to bring her mother/mother-in-
Figure 2: Example of clothing for infants
law, husband or any other member of the family.


key: chroma:document
string_value:
Figure 2: Example of clothing for infants
law, husband or any other member of the family.
It helps in building a positive attitude of the family
and ensuring family support to the mother which
is particularly crucial for post-discharge home-
based KMC. It is helpful that the mother and family
members starting KMC interact with someone
already practicing KMC for her infant.
a supportive family is a very important
pre requisite for successful KMC.
KANGAROO MOTHER CARE IMPLEMENTATION 11


key: chroma:document
string_value:
KMC Position
Figure 3: How to hold the infant in KMC
Head turned to
Baby between one side
mother’s breasts
Frog-leg position
Support baby’s bottom
Baby: Figure 4: How to handle the baby
 The infant should be placed between the
mother’s breasts in an upright position.
 The head should be turned to one side and
in a slightly extended position. This slightly
extended head position keeps the air way
open and allows eye to eye contact between
the mother and her infant.
The hips should be flexed and abducted in a “frog”
position; the arms should also be flexed.
 The infant’s abdomen should be at the
level of the mother’s epigastrium. Mother’s
breathing stimulates the infant, thus
reducing the occurrence of apnoea.
 Support the infant from the bottom with a
sling/binder.
12 KANGAROO MOTHER CARE & OPTIMAL FEEDING OF LOW BIRTH WEIGHT INFANTS


key: chroma:document
string_value:
Health provider should help the mother initiate KMC
by assisting in positioning the infant and explaining the mother carrying an infant in the KMC position
how to handle the infant during KMC. Repeated can walk, stand, sit, or engage in different
training helps the mother overcome the fear of activities. If comfortable, the mother can sleep with
handling her newborn and improves her skill related the infant in kangaroo position in a reclined or semi-
to KMC. recumbent position
Mother:
DuRATION OF KMc
 A semi-reclining position (40º-45º) is to be
adopted while sleeping. This can be achieved
Minimum duration of a KMC session should be one
with the help of 3-4 pillows on the hospital
hour because frequent handling may be stressful for
bed or special semi-reclining chairs.
the infant. The duration of each KMC session should
be gradually increased for as long as the mother can
Figure 5: Examples of various support
comfortably provide KMC. The infants in KMC need
methods for KMC


key: chroma:document
string_value:
comfortably provide KMC. The infants in KMC need
methods for KMC
to be removed from skin-to-skin contact only for
changing diapers and clinical assessment according
to hospital schedules.
MONITORING OF THE INFANT
 Infants receiving KMC should be monitored
carefully especially during the initial stages
to ensure that the infant’s airway is clear,
breathing is regular, colour is pink and s/he
is maintaining temperature. All the above
clinical observations and duration of KMC
should be duly recorded in the newborn
case-sheet being used in the unit.
 Mother should be trained to observe her
infant for danger signs, like- hypothermia,
respiratory problems, feeding difficulty,
change in colour during KMC so that she can
continue monitoring at home.
FEEDING DuRING KMc
Feeding and nutrition strategies during the
postnatal period are very important for ensuring
optimum growth and development of LBW infants.
The nutritional needs of infants with similar birth


key: chroma:document
string_value:
optimum growth and development of LBW infants.
The nutritional needs of infants with similar birth
weight may vary depending upon whether the baby
is appropriate for gestational age (AGA) or small for
KANGAROO MOTHER CARE IMPLEMENTATION 13


key: chroma:document
string_value:
gestational age (SGA). Initially, breastfeed is given transport: Ideally, transport incubators with
at fixed intervals of two hours and not on demand, appropriate monitoring equipment are the best
to ensure an adequate and assured minimal intake. method to transport sick infants. However, in case
The mother should be explained how to breastfeed they are not available, the best method to keep a
while the infant is in KMC position. Holding the infant preterm/LBW infant warm during transport after
near the breast stimulates milk production. She may initial stabilisation is by continuous skin-to-skin
express milk while the infant is still in KMC position. contact with the mother/family member.
(For details on feeding please see the next section
if some other family member is not available for
on optimal feeding.)
KMC or KMC is not initiated: Ensure the baby is
kept in warm room 25oC-28oC, adequately covered
SPEcIAL SITuATIONS or if below 1800 grams not able to maintain normal


key: chroma:document
string_value:
SPEcIAL SITuATIONS or if below 1800 grams not able to maintain normal
temperature under a warmer.
There may be special situations where despite the
newborn being sick KMC can be given with some DIScHARGE FROM HOSPITAL
precautions.
anD FolloW-uP
Sick lBw infants: KMC is recommended for stable
The standard policy of the unit for discharge from
LBW infants. However, it is beneficial even for sick
the hospital should be followed. Generally, the
LBW infants. In such cases kangaroo mother care may
following criteria are accepted at most centres.
be given only under close and constant supervision
in centres that are well versed with the practice of
KMC. Hemodynamically stable preterm infants on The infant is
prolonged ventilation or on CPAP can also be given l Stable and not on parenteral medication
KMC. Treating MO should use her/his judicious
l Maintaining temperature in mother’s bed for 3
discretion on case-to-case basis. consecutive days at room temperature


key: chroma:document
string_value:
discretion on case-to-case basis. consecutive days at room temperature
Figure 6: Health provider explaining the KMC l Gaining 15-20 grams per day for at least 3
consecutive days
position to mother
l Accepting feeds directly from breast (preferable)
or by spoon, paladai or cup
Usually, the infant’s weight is around 1,500 to 1,600
grams at the time of discharge. Infants who are
above 1,800 grams birth weight, do not require
admission into a nursery/SNCU, are given KMC soon
after birth and can be sent home once adequacy of
breastfeeding is established.
At discharge, the mother and family members must
be taught to ensure that the infant is nursed in a warm
room and is breastfed (Given expressed milk using
paladai or cup). They should be adequately told about
hygiene, danger signs, follow-up visits, immunisation
and prompt care seeking at a health facility.
KMC should be continued as long as required and baby
and mother should not be discharged in a hurry.


key: chroma:document
string_value:
and mother should not be discharged in a hurry.
14 KANGAROO MOTHER CARE & OPTIMAL FEEDING OF LOW BIRTH WEIGHT INFANTS


key: chroma:document
string_value:
At the time of discharge, the infant should be taken  Infants discharged on KMC should be
home in KMC position by the mother or relatives so followed up in the regular follow-up OPD
as to encourage continued KMC at home. of SNCUs and linkage with District Early
Intervention Centre (DEIC) under RBSK
At the time of discharge, the family should be
for screening of neurodevelopmental
counselled and linked to the ASHA worker of the
morbidities should be established.
village who shall provide home based care and
follow-up to the baby (as per protocol).  SNCU discharged infants are to be followed
up till one year while LBW infants are to be
Follow-up
followed up at home for one year by ASHA
as per HBNC guidelines
Close follow-up is a fundamental prerequisite
of KMC practice to make a regular assessment
of growth, sensory functions, behaviour and DON’TS OF KANGAROO MOTHER
neurodevelopment. During the follow-up visits cARE
anthropometric measurements (e.g., weight, length,


key: chroma:document
string_value:
anthropometric measurements (e.g., weight, length,
head circumference) of the infant should be recorded  Do not bathe till infant weighs 2,500 g,
sponging may be done
to monitor the growth. More frequent visits should
be made if the infant is not growing well or if her/his  Do not handle infant too frequently
condition demands. ASHA will continue to provide
 Do not give bottle feed
care to the infant under home based newborn care
in the community, following discharge.  Do not allow infant to be in contact with sick
people
First Follow-up should be at one week, followed by
fortnightly follow-ups till next two visits. Additional
follow-up visits may be done until s/he reaches 40
when should KMC be discontinued?
weeks of post-conception age or achieves a weight
Often an infant is taken off kangaroo mother care
of 2,500 grams.
when gestation reaches term or the weight is around
If infant is receiving immunization at a facility where


key: chroma:document
string_value:
If infant is receiving immunization at a facility where
2,500 grams. By this time the infant starts wriggling
KMC services are available, a follow-up may be
to show that he or she is uncomfortable, pulls out
ensured.
the limbs from the kangaroo garment and cries and
 Detailed follow-up protocols are attached fusses every time the mother tries to put the infant
as annexure 3 as per the chapter 17 of the back in skin-to-skin contact. This is the time to wean
Training Module for Doctors and Nurses for the infant from KMC.
FBNC.
KANGAROO MOTHER CARE IMPLEMENTATION 15


key: chroma:document
string_value:
optiMal feeding of
low birth weight
infants
l What to feed the LBW infant?
w Breastfeeding
l Alternative methods of feeding when direct
breastfeeding is not possible
l Deciding the initial method of providing fluids and
feeding
l Feeding progression
l How often and how much to feed?
l Special considerations for infants below 1200 grams
l Adequate weight gain


key: chroma:document
string_value:
optiMal feeding of low
birth weight infants
Low birth weight (LBW) infants need optimal Lower the birth weight, greater is the likelihood of
nutrition during the neonatal period for proper feeding difficulties.
growth and development. Appropriate feeding of
These infants may not be stable enough to
low birth weight and very low birth weight infants
tolerate enteral feeds and are therefore provided
improves their chances of survival and is important
intravenous fluids till such time that enteral feeding
for their optimum growth and development.
can be established optimally. Direct feeding from
Breast milk is the ideal food for all infants including the mother’s breast may not be possible or may not
those who are LBW. WHO recommends that all LBW be enough to fulfill the need in many others and in
infants, irrespective of their gestation be fed breast this situation, feeding may need to be provided by


key: chroma:document
string_value:
milk. The goal is to enable every LBW infant to alternative feeding methods such as feeding tube,
receive feeding directly and exclusively from her/his spoon, paladai or cup.
mother’s breast at the earliest.
LBW infants who are able to breastfeed should be
However, many preterm infants have feeding put to the breast as soon as possible after birth when
difficulties initially because of they are clinically stable, and should be exclusively
breastfed until six months of age.
 Inability to coordinate suck, swallow and
breathing
Low-birth-weight infants, who are unable to take
 Immature and sluggish gut and directly from the breast, should be fed by oro-gastric
tube, feeding cup, paladai or spoon.
 Systemic illness.
Full term small-for-gestational-age infants because
WHAT TO FEED THE LBW INFANT?
of being weak or sick may also experience.
 Poor attachment and sucking effort on the Breastfeeding
breast
Mother’s milk is best for LBW infants of all gestational
 Poor swallowing


key: chroma:document
string_value:
breast
Mother’s milk is best for LBW infants of all gestational
 Poor swallowing
ages. Breast milk and especially colostrum (the
 Easy tiredness (and hence poor intake) thick, yellowish milk which is produced in small
 Vomiting, regurgitation or abdominal distension quantities during the first few days after delivery)
OPTIMAL FEEDING OF LOW BIRTH WEIGHT INFANTS 19


key: chroma:document
string_value:
best assures the survival and well-being of LBW distension or acute serious illness such as
infants. asphyxia or sepsis; on life support)
Breast milk is specially adapted to the nutritional a. Offering expressed breast milk by
needs of LBW infants; for example, the breast milk of alternate methods (described below)
a mother who delivers a preterm LBW infant contains b. As the infant improves, putting her on
extra protein that is necessary for the normal growth the breast to stimulate lactation
of such an infant.
c. Initiating Kangaroo Mother Care (KMC)
once the infant stabilizes
Breast milk is the ideal feed for all infants, including
Another issue of paramount importance is to
LBW infants
ensure optimum lactation in the mother who
has a small infant. Because of the poor or no suck
effort on the breast by the LBW infant (due to
Breast milk provides many anti-infective factors,
sickness, weakness or poor reflexes) and maternal
a vital component of the immune system of a


key: chroma:document
string_value:
sickness, weakness or poor reflexes) and maternal
a vital component of the immune system of a
anxiety, the breast milk output may remain low.
newborn infant, and growth factors which help
Lactation inadequacy must be prevented and
gut development. There is strong and consistent
tackled through counselling. In addition, breast
evidence that feeding mother’s milk to LBW infants
milk should be expressed frequently to provide
of any gestation is associated with lower incidence
expressed breast milk to the infant and to enhance
of infections and better long-term outcomes.
milk output.
Every effort should be made to provide breast milk
to LBW infants. This would require:
The best milk for LBW infants is mother’s milk. All
1. For stable infants else is inferior.
a. Placing infant in skin to skin contact with
the mother immediately after delivery
Breastfeeding is contraindicated when the
b. Initiating breastfeeding within one hour mother is receiving certain drugs like anti-


key: chroma:document
string_value:
b. Initiating breastfeeding within one hour mother is receiving certain drugs like anti-
neoplastic agents, immuno-suppressants, anti-
c. Initiating and providing Kangaroo
thyroid drugs like thiouracil, amphetamines,
Mother Care (KMC)
gold salts, etc. Breastfeeding may be avoided
d. Offering breastfeeding frequently,
when the mother is receiving following drugs-
approximately, every two hours, and on
atropine, reserpine, and psychotropic drugs.
demand
In case mother’s milk is not available, then the
e. Ensuring continued frequent feeding at
choices in the order of preference are:
night
 expressed donor milk from other
f. Ensuring proper positioning and
lactating mothers- At times, breast milk
attachment
output in the mother of the LBW infant may
g. Managing breast/nipple problems such not be sufficient, especially in the first few
as retracted or cracked nipple, and days. Given the importance of breast milk to
breast engorgement the infant, the use of breast milk obtained


key: chroma:document
string_value:
breast engorgement the infant, the use of breast milk obtained
2. For unstable infants (with cardio-respiratory from other lactating women (donor milk)
problems, temperature instability, abdominal is recommended. Ideally, this should be
20 KANGAROO MOTHER CARE & OPTIMAL FEEDING OF LOW BIRTH WEIGHT INFANTS


key: chroma:document
string_value:
organized in places where breast milk bank is Figure 7: Spoon-feeding
established. Proper breast milk bank ensures
that donated milk is safe and healthy.
 Formula milk- When not enough breast
milk is available to meet the needs of a
LBW infant, formula milk may be given with
proper preparation and hygiene. For
infants below 1,500 grams birth weight, a
preterm formula is preferred. The formula
milk should be given under the guidance of
a paediatrician. It should be in compliance
with IMS act (Annexure 4).
 animal Milk- Cow or buffalo milk are the
last choice when all other options have
been exhausted despite best efforts. Such
milks are unsuitable and may be given with
The suck-swallow-breathing coordination develops
great caution without dilution with alternate
by 34 weeks of gestation. Most infants above 34
methods of feeding.
weeks (about 1,800 grams birth weight) should be
able to feed directly from the breast.
There is NO place for bottle feeding in the care of


key: chroma:document
string_value:
able to feed directly from the breast.
There is NO place for bottle feeding in the care of
infants with a gestation of more than 30 weeks
infants
(birth weight more than 1200 grams) can usually
swallow well and coordinate breathing, but are not
able to suck. They can therefore be fed with spoon,
ALTERNATIvE METHODS paladai or cup that is not dependent on sucking
OF FEEDING WHEN DIREcT action.
BREASTFEEDING IS NOT Infants below 30 weeks of gestation (birth weight
POSSIBLE less than 1200 grams) are not in a position to take
feeds even with spoon, paladai or cup. They may be
Feeding tube, spoon, paladai or cup are the fed with intragastric tube.
alternative methods of feeding when direct
Furthermore, sick, unstable infants (of any
breastfeeding is not possible. Paladai is a shallow,
gestation or weight) who do not tolerate enteral
steel bowl with a long beak.
feeds will require administration of intravenous
fluids.
DEcIDING THE INITIAL METHOD
OF PROvIDING FLuIDS AND
FEEDING PROGRESSION


key: chroma:document
string_value:
fluids.
DEcIDING THE INITIAL METHOD
OF PROvIDING FLuIDS AND
FEEDING PROGRESSION
FEEDING
As an infant’s feeding ability develops, he or she
The choice of method of providing fluids and feeds should progress from the initial method through the
is not only dependent on maturity or birth weight intermediate steps to feeding exclusively from the
but also whether the infant is sick or not. breast directly.
OPTIMAL FEEDING OF LOW BIRTH WEIGHT INFANTS 21


key: chroma:document
string_value:
Figure 8: Method of providing fluids and feeds for
low birth weight infants
> 34 Weeks 32-34 Weeks 28-31 weeks <28 weeks
<1200 grams
Initiate Breastfeeding
Observe if:
1. Positioning and attachment are good
2. Able to suck effectively and long enough
(about 10-15 min)
Yes
No
Breastfeeding
Start feeds by spoon/paladai
Observe if:
1. Accepting well without spilling/coughing
2. Able to accept adequate amount
Yes
No
Spoon/Paladai
feeding
Start feeds by OG tube
Note: F or sick infants start with IV fluids and
gradually progress to oral feeds Observe if:
1. Vomiting/abdominal distention occurs
2. I f the abdominal girth increases 2cm. from the baseline
No Yes
Start IV fluids
Gastric tube feeding
The ultimate aim is to ensure direct, exclusive the next feeding method. An infant breastfeeding
breastfeeding. effectively on the first day of life should continue to
breastfeed exclusively up to 6 months.
LBW infants would have different methods of initial


key: chroma:document
string_value:
breastfeed exclusively up to 6 months.
LBW infants would have different methods of initial
feeding based on their weight, gestation and feeding An infant given alternative oral feeds (tube, spoon,
readiness. For progression of feeding, it is essential paladai, cup) should be given frequent opportunity
to periodically assess the infant’s ability to accept to suckle at the breast before the next feed. When
22 KANGAROO MOTHER CARE & OPTIMAL FEEDING OF LOW BIRTH WEIGHT INFANTS


key: chroma:document
string_value:
Figure 5: Principles of advancing feeding modes
Infants on IV fluids
If hemodynamically stable
Start trophic feeds by OG tube
& monitor for feed intolerance
If accepting well
Gradually increase the feed
Infant on OG tube
At 30-32 weeks PMA
Try spoon feeds once or twice a day.
Also, put on mother’s breast
If accepting spoon feeds well
Gradually increase the Infants on spoon/paladai
frequency and amount of feeds
spoon feeds Reduce OG
feeds accordingly
Put them on mother’s breast
before each feed observe for good
attachment & effective sucking
If able to breastfeed effectively
Taper and stop spoon feeds once
the mother is confident
the infant can breastfeed effectively, other modes of HOW OFTEN AND HOW MucH TO
feeding can be reduced gradually, over a few days, FEED?
and discontinued.
LBW infants are usually fed every 2hours at least 12
An infant on IV fluids should be given small
times in a day, the amount of each feed volume (to
intragastric feeds. If the infant tolerates these, the


key: chroma:document
string_value:
intragastric feeds. If the infant tolerates these, the
be given every 2 hour) is calculated on the basis of
volume can be increased and intravenous fluids
daily fluid requirements.
reduced. When two thirds of the daily requirement
is tolerated as enteral feed, IV fluids can be It is usual clinical practice to provide LBW infants of
discontinued and enteral feeds increased over the 1500 grams or more about 60 ml/kg fluids on the first
subsequent days. When the infant shows readiness day of life. Infants less than 1,500g are usually given
for oral feeding, small amounts can be offered by about 80 ml/kg fluids on the first day of life. The feeds/
an alternative oral feeding method. The infant then fluids are increased by 15 ml/kg/day to a maximum of
progresses to breastfeeding as above. 150 ml/kg/day by the end of the first week of life.
OPTIMAL FEEDING OF LOW BIRTH WEIGHT INFANTS 23


key: chroma:document
string_value:
In stable LBW infants who are tolerating feeds with regard to maintenance of temperature,
well, the feed intake may be raised cautiously and prevention of infections, etc. They require constant
gradually from 150 ml/kg to 180 ml/kg after the first monitoring to help in early identification of clinical
week of life. instability.
These infants are initially started on intravenous
table 1*: Fluid requirements for infants (ml/kg
fluids as discussed already. The constant flow of
body weight/day) These needs are met by enteral
intravenous fluids must be ensured to prevent
feeds and/or by intravenous fluid administration or
excess administration or abrupt stoppage of fluids.
a combination of the two
Also, strict aseptic precautions should be observed
while giving intravenous fluids.
Day of Fluid requirement ml/kg/day
life
Birth weight ≥ 1,500 g Birth weight<1,500 g They have to be gradually helped to initiate oral feeding
1 60 80 so that ultimately they can receive direct, exclusive


key: chroma:document
string_value:
1 60 80 so that ultimately they can receive direct, exclusive
2 75 95 breastfeeding. Even while on intravenous fluids, they
3 90 110
can be administered small amounts of intragastric
4 105 125
tube feeds. This small amount of milk feeds is called
5 120 140
minimal enteral nutrition (MEN) or trophic feeds. The
6 135 150 purpose of trophic feeds is to help in the growth and
7 150 150
maturation of the gastrointestinal tract. Infants started
* For detail please read FBNC guideline. on MEN progress to full oral feeds faster.
the usual total amount of breast milk given as
SPEcIAL cONSIDERATIONS FOR
minimal enteral or trophic feeds is only 12 - 24
INFANTS BELOW 1200 GRAMS
ml/kg/day divided into 4 - 6 feeds given via the
intragastric route. as the infant stabilises, breast
Infants with birth weight less than 1,200g
milk feeding is advanced to full requirements to
are usually born premature (before 30 weeks
meet her/his nutritional needs.
gestation) and often have various problems


key: chroma:document
string_value:
meet her/his nutritional needs.
gestation) and often have various problems
such as breathing difficulty, hypothermia, and Criteria for discharge from the hospital and
hypoglycaemia. These infants need special care follow-up will be as mentioned on page 25.
table 2: Micronutrient supplementation (as per WHO recommendations)
Micronutrient Recommended Daily Dosage Duration
Vitamin D 400-1000 IU/day(usually obtained from Six months (starting as soon as
multivitamin drops and calcium and possible)
phosphorus supplement)
Iron 2 mg/kg/day One year (starting at 2 weeks of
age)
Calcium* 120 – 160 mg/kg/day Till 40 weeks postmenstrual age
Phosphorus* 60 – 80 mg/kg/day Till 40 weeks postmenstrual age
*Infants below 32 weeks of gestation
24 KANGAROO MOTHER CARE & OPTIMAL FEEDING OF LOW BIRTH WEIGHT INFANTS


key: chroma:document
string_value:
ADEquATE WEIGHT GAIN weeks PMA or 2500 grams. After that the MCP Card
can be used to monitor growth.
Most LBW infants lose weight in the first few days of
If the infant has inadequate weight gain, the
life. Usually this loss would not exceed 10-15% of the
provider should check the amount of intake, and
birth weight. They regain their birth weight by about
assess attachment (if taking direct breastfeeding),
2 weeks and then start gaining weight at the rate of
and spluttering / spillage (if on paladai / cup /
1.0% to 1.5% of body weight per day. Usually this
spoon feeds). Nipple and breast problems in the
corresponds to a gain of 15-20 grams per kilogram
mother should be looked for. Complications such
of their own body weight per day.
as cold stress, sepsis, oral thrush, anaemia and late
For small infants below 1,500 grams (less than 32 metabolic acidosis also lead to sub-optimal growth.
weeks), it is advisable to use a postnatal growth The underlying reasons for inadequate weight gain


key: chroma:document
string_value:
weeks), it is advisable to use a postnatal growth The underlying reasons for inadequate weight gain
chart to plot weight every day until they are of 40 should be addressed.
Ensuring adequacy of nutrition is perhaps the most important aspect of their care by monitoring
frequency of urine (8-12 times for day) and weight gain (15-20 grams per day)
OPTIMAL FEEDING OF LOW BIRTH WEIGHT INFANTS 25


key: chroma:document
string_value:
aCtion plan for
iMpleMentation and
sCale-Up
l KMC Roll-out Plan
w Structure
w Capacity building strategy
w Developing KMC Unit
Specifications for Building up a KMC Unit
n
l Role of programme managers
l Monitoring and evaluation
w Definitions
w Recording and reporting
w Communication strategy
w Evaluation


key: chroma:document
string_value:
aCtion plan for
iMpleMentation and sCale-Up
This section provides information to the Programme SNCU or the postnatal ward. These units will
Manager and health care providers on how to have provisions for the postnatal mothers
ensure that every LBW infant has access to high- to provide KMC to their infants.
quality KMC and optimal feeding within the existing
Facility Based Newborn Care systems.
The aim is to advocate KMC to be practiced for
To fulfil this vision the roll-out has to be planned
all infants eligible for KMC at public health
in phases by the states. Each state will have the
facilities.
flexibility to fix its own target for the next two years
as per available resources. The state will have two
options:
KMC roll-out Plan
a. Where new SNCUs/MCH wings are planned
adequate provision for KMC will be an
Structure
integral component of SNCU infrastructure
and
The state will submit the budget proposal for
b. Where SNCU is already in place, KMC unit


key: chroma:document
string_value:
and
The state will submit the budget proposal for
b. Where SNCU is already in place, KMC unit
establishing KMC as an additional expenditure
would be added in close proximity to the
under SNCU in the State’s Annual Programme
Implementation Plan of the National Health
ViSiOn KMC Mission. The state lead development partners will
collaborate with the state governments for quality
l Model KMC services to be established in 25
KMC roll out within the RMNCH+A strategy. Child
Regional & State Resource Centres by the end
Health Division, Ministry of Health and Family
of 2017
Welfare GOI will review the progress periodically.
l KMC services to be provided in all SNCUs and
The Collaborative system established under
well-functioning NBSUs (at CHCs and FRUs)
Facility Based Newborn care will provide technical
across the country
support.
ACTION PLAN FOR IMPLEMENTATION AND SCALE-UP 29


key: chroma:document
string_value:
Child Health Division, Ministry of Health and Family
Welfare GOI
national Collaborative Centre Private sector participation
WHO Resource Centre for Training Government of India urges neonatologists,
and Research for Newborn Care at neonatal nurses and obstetrician-gynecologists
AIIMS, along with the designated by engaging with their respective professional
National Collaborative Centre for bodies. These are:
Facility Based Newborn Care at
1. National Neonatology Forum (NNF)
KSCH & LHMC will be responsible
2. Indian Association of Neonatal Nurses (IANN)
for:
3. Indian Academy of Peadiatrics (IAP)
 Providing technical assistance
for roll out of KMC & optimal 4. Federation of Obstetric and Gynaecological
feeding guideline Societies of India (FOGSI)
 Capacity building and 5. Trained Nurses Association of India (TNAI)
Mentoring of Regional/State
These bodies can orient private facilities and nursing
Collaborative Centers
homes at the national, state and district levels so


key: chroma:document
string_value:
Collaborative Centers
homes at the national, state and district levels so
 Developing training module that all private facilities in the country align their
and packages (if required) KMC services and Optimal Feeding for Low Birth
Weight infants along with the national guidelines.
regional Collaborative Centres (rCC, Medical colleges/teaching institute)
Existing FBNC resource centre and centers under KMC India network will serve as RCCs
 Each centre to have a model KMC unit for hands-on training
 RCCs to provide training and mentoring to SCCs and district level health providers
 RCCs will be responsible for monitoring and supervision of SCCs
State Collaborative Centres (SCC, Medical colleges)
 Each centre to have a model KMC unit equipped with mannequins (skill stations) for
hands-on training SCCs
 To provide monitoring, supervision and mentoring to district level facilities
30 KANGAROO MOTHER CARE & OPTIMAL FEEDING OF LOW BIRTH WEIGHT INFANTS


key: chroma:document
string_value:
national level
 Orientation and Dissemination of the guidelines for programme managers and professional
associations
 Regular review by Child Health Division, MoHFW
 Provide cross-learning facility for programme managers and health providers at model units.
State level
 Orientation cum planning workshops at State level
 Identification of medical colleges as state resource centres
 Initially, saturate the SNCUs with KMC services on priority
 Develop resource pool for training
 Ensure adequate and trained human resource at SNCU
 Seek support from respective state lead development partners to ensure high quality
implementation
 Provide mentoring and supportive supervision or hands-on training to the providers
 Review progress of implementation every quarter
 Developing linkages with RBSK and community follow-up by ASHA
 Integrate KMC into FBNC
District level
 Carry out civil work/refabricating necessary for ensuring KMC


key: chroma:document
string_value:
District level
 Carry out civil work/refabricating necessary for ensuring KMC
 Conduct orientation/refresher trainings of counsellors
 Identify high case load facilities for ensuring KMC services
 Ensure record keeping and timely reporting at facilities
Capacity building strategy:
2. KMC unit should be built as an integral part
of the new/upcoming SNCUs (20-bed) and
Job-aids, videos and training agenda for KMC and
in MCH wings
optimal feeding of LBW infants are being provided
along with the guidelines for state support. The 3. KMC services can also be provided in NBSU
existing training modules for F-IMNCI and FBNC may or Postnatal wards. All the stable infants
be used for orientation. The checklist for KMC also weighing more than 2000 grams can be easily
being used in skill lab is placed as Annexure V. nursed in the postnatal ward or at NBSUs
Developing a KMC unit 4. The neonatal units at all Medical Colleges
to be strengthened to provide appropriate


key: chroma:document
string_value:
to be strengthened to provide appropriate
1. KMC Unit of 8-10 beds is recommended for ev-
newborn care including KMC. This will
ery hospital with SNCU or should be located
enable the undergraduate and postgraduate
as close to the SNCU as possible in the exist-
medical students to learn the best practices.
ing / new premises. Infants weighing less than
1800 g, who will form the majority of the KMC
Specifications for Building up a KMC unit
beneficiaries, would be admitted to Special
Newborn Care Units (SNCUs) at district hospi- As a routine, feeding and other care to unstable or
tals if their condition warrants admission sick preterm / LBW infants is provided in Special
ACTION PLAN FOR IMPLEMENTATION AND SCALE-UP 31


key: chroma:document
string_value:
Newborn Care Units (SNCUs). Thereafter, when The room should also be well lit, well ventilated and
the infants become stable, KMC is initiated under have arrangement for dim light at night.
supervision of the nurses/doctors in SNCU. With
Following is the budget for establishing a model
further improvement, infants must be transferred out
KMC unit, however, provision of KMC should not
from the SNCU to the mother in the postnatal ward
wait for the establishment of KMCU.
where KMC is continued till discharge. Accordingly,
it is recommended that each hospital with an SNCU This may also be used as a guide for budgeting
should provide KMC and have a KMC unit (KMC Unit) the proposal for setting up KMC in the state PIP.
State should do need based gap analysis to budget
KMC units must ensure the room temperature is 24
judiciously for setting up KMC units.
to 26 degree Celsius with 50-60% relative humidity.
S. Unit cost Units Total cost
Heads Essential Desirable
No. (INR) needed (INR)


key: chroma:document
string_value:
S. Unit cost Units Total cost
Heads Essential Desirable
No. (INR) needed (INR)
A. infrastructure:total 1500 square feet; i.e. 140 Sq M: 120 square feet for each bed (120x8 = 960
square feet) and rest will use as ancillary area, toilet, bathing & hand washing area
1 Renovation or Minor civil work  100000 1 100,000
B. Furniture
2 Beds semi-reclining  12000 8 96000
3 Easy chairs (reclining with foot support)  5000 8 40000
4 Storage space/locker for mothers  2000 8 16000
5 Office chairs  500 8 4000
C. Furnishing
6 Mattress  3000 8 16000
7 Pillows  300 16 4800
8 Bed sheets  200 16 3200
9 Adult blanket  800 16 12800
10 Baby blanket  500 16 8000
11 Mobile screen  From regular budget
12 Dust bins  From regular supply
13 Refrigerator (165L - 230L)  15,000 1 15000
14 AV aids (Television & CD player)  25,000 1 25,000
D. equipment
15 Bag & Mask (Size 0 & 1)  1500 1 1500
16 Digital Weighing machine  3,000 1 3,000
17 Paediatric stethoscope  2


key: chroma:document
string_value:
16 Digital Weighing machine  3,000 1 3,000
17 Paediatric stethoscope  2
18 Digital & Room thermometers  200X2 2 800
19 Heater (Radiant/air blower)  From regular budget
20 Oxygen cylinder & Oxygen hoods  From regular supply
32 KANGAROO MOTHER CARE & OPTIMAL FEEDING OF LOW BIRTH WEIGHT INFANTS


key: chroma:document
string_value:
S. Unit cost Units Total cost
Heads Essential Desirable
No. (INR) needed (INR)
21 Training manikins etc  10000 1 10000
E. recurring cost per annum
21 Feeding equipment  100 200* 20000
(Tubes, Katoris& Spoons)
22 Clothes for newborns  110 200* 30000
(Disposable
(Disposable Diapers, Cap & Socks) Diapers)
40
(Cap & Socks)
23 Gowns for Mothers  100 200* 20000
24 Soap & other cleaning agents  1000 12 12000
25 Emergency medicines, cotton,  From regular supply
gauge
26 Record registers/case sheets From regular supply
27 Other maintenance cost  1500 12 18000
F. Human resources**
28 ANM/GNM/YASHODA/Counsellor  12000X12 4 576000
Grand total (including cost of desirable heads) 1032110
total (Cost of essential heads) 266100
# For storing breast milk
*Available regularly with most SNCUs. Therefore, utilize from regular supply and may budget, if required.
**States to ensure saturation with adequate and trained HR as per norms including salary . The figures quoted here are normative.


key: chroma:document
string_value:
Budgetary provision: To roll out the KMC and optimal 4. Track the progress of implementation of
feeding practices at scale, the state will have to make KMC according to the guidelines as per the
adequate budgetary provisions for state level training final timeline
workshops and establishment cost of KMC Unit in state
5. Link with the National/Regional/State
PIPs.
collaborative centre and Existing Supportive
Supervision mechanisms in the state
ROLE OF PROGRAMME
and utilize and modify existing checklists
MANAGERS and block monitoring formats to include
practice of KMC
The state programme manager/Child Health nodal
officer will play the most crucial role. S/He must: All contacts with the technical personnel/service
1. Know that KMC is an integral part of facility providers should be utilised for promoting KMC
based newborn care during mentoring visits. The checklist for training in
KMC is being attached for reference and is similar to
2. Ensure orientation of all the district nodal


key: chroma:document
string_value:
2. Ensure orientation of all the district nodal
the one used in skills lab trainings (annexure- ). FBNC
officers on KMC
trainings need to be expedited by the states with
3. Issue a Facility wise timeline where KMC
special focus on KMC and optimal feeding in LBW.
needs to be started to all the districts
ACTION PLAN FOR IMPLEMENTATION AND SCALE-UP 33


key: chroma:document
string_value:
6. Linking the follow-up with SNCU follow-up 4. Percent (%) of pre-term newborns who
and DEIC if required extra care received KMC till 40 weeks (Expected
Delivery Date or full term) = Number of
7. Willing Professionals from private sector/
pre-term newborns who received KMC till
Professional bodies may be involved in
40 weeks X 100 /Total number of newborns
training programmes as trainees as well
as trainers for maximizing effect in private delivered preterm.
sector mentoring and supervision activities
recording and reporting
The data for above monitoring indicators can be
MonItorIng anD evaluatIon:
compiled at the district level every month and can be
Existing monitoring frameworks for FBNC are to sent to the state along with the SNCU reports. For states
be modified to capture the indicators given below; which have migrated to online reporting mechanism,
these indicators will provide information on how the may utilize the same platform for reporting. After


key: chroma:document
string_value:
programme is functioning. compiling and validating the reports at the state level,
these can be shared at the national level on a quarterly
Definitions
basis. During supportive supervision visits the data
Output indicators: may be validated from the case sheets and registers.
1. Percent (%) of health facilities having SN-
Communication strategy
CUs with operational KMC unit= Number
of health facilities having SNCU with op- Any state specific barriers in implementation should
erational KMC unit X 100/ Total number of also be identified. The messages should enhance the
health facilities with functional SNCU woman’s ability to use existing services and to make
appropriate decisions. The communication materials
Outcome indicators
should be consistent with the training materials, so
1. Percent (%) of newborns with birth weight be-
that there is an integrated training-communication
low 2,000 grams delivered in the health facili-
package. Both, the mass media and interpersonal


key: chroma:document
string_value:
low 2,000 grams delivered in the health facili-
package. Both, the mass media and interpersonal
ty= Number of low birth weight infants (below
communication are needed. Equally crucial will be
2,000 grams ) delivered in the facility X 100 /
all those in the community who have a determining
Total number of live births in the facility
influence on the mothers’ behaviour: their husbands
2. Percent (%) of newborns below 2,000 grams and families, elders, religious leaders and others.
who continued KMC till discharge = number Communication messages should also be directed
of newborns with birth weight below 2,000 at key decision-makers. Communication must be
grams who continued KMC till discharge X supplemented by an education programme and
100 / total newborns with birth weight below synchronised with the health services
2,000 grams
Way Forward
3. Percent (%) of pre-term infants (gestation
age less than 37 weeks) delivered in the As the two high impact interventions viz. KMC and


key: chroma:document
string_value:
age less than 37 weeks) delivered in the As the two high impact interventions viz. KMC and
health facility= Number of pre-term infants feeding of Low Birth Weight infants are being up-
(gestation age less than 37 weeks) delivered scaled an implementation research will be useful
in the facility X 100 / Total number of live for sharing the key learning and making midcourse
births in the facility corrections, if required.
34 KANGAROO MOTHER CARE & OPTIMAL FEEDING OF LOW BIRTH WEIGHT INFANTS


key: chroma:document
string_value:
annexUres
Annexure I: Manual Expression of Breast milk and
Storage Thereof
ANNEXURE II: Alternative Feeding Methods (Cup/Spoon/
Paladai Feeding)
Annexure III: Follow-up protocol after discharge of a
high-risk infant
Annexure IV: Infant Milk Substitutes act
Annexure V: Orientation on Kangaroo Mother Care


key: chroma:document
string_value:
annex i
MANuAL EXPRESSION OF BREAST MILK AND STORAGE THEREOF
For whom:
Infants who cannot breastfeed effectively but are  At least 6-8 times in 24 hours, i.e. every 3-4
able to accept oral feeds by alternative feeding hours, including at night to help ensure an
methods and for the purpose of storing breast adequate supply.
milk.
Procedure
how often
The salient steps of manual expression of breast milk
 Within 6 hours of delivery to ensure that are shown in the figure below.
colostrum is available
Figure (i): Expression of breast milk
ANNEX I 37


key: chroma:document
string_value:
If expressed breast milk (EBM) cannot be given to of bacterial growth. It should be kept in a covered
the infant soon after expression, it has to be stored container. Any milk not fed to the infant within 6
and used when necessary. The expressed milk can hours of expression should be discarded.
be stored in one of the following ways:
in a refrigerator: EBM can be stored in the main
at room temperature: EBM can be kept at room compartment of a regular refrigerator (2oC to 8oC)
temperature for up to 6 hours without significant risk for 24 hours.
Storage of expressed breast milk
At room temperature : 6 hours
In refrigerator (2oC to 8oC) : 24 hours
38 KANGAROO MOTHER CARE & OPTIMAL FEEDING OF LOW BIRTH WEIGHT INFANTS


key: chroma:document
string_value:
annex ii
alternatIve FeeDIng MethoDS (CuP/SPoon/PalaDaI FeeDIng)
1. SPoon-FeeDIng Figure (ii): Feeding a LBW infant with a paladai
A spoon is appropriate for an infant who is stable and
is able to co-ordinate breathing and swallowing.
HOw tO SPOOn-FeeD an inFant
1. The infant should be awake and held sitting
semi-upright on the caregiver’s lap.
2. Put a measured amount of milk in a wide
necked container.
3. Take some milk from the container into the
spoon.
4. Hold the spoon so that it rests lightly on the
cultures. It is appropriate for an infant who is stable
infant’s lower lip.
and is able to coordinate sucking, breathing and
5. Tip the spoon so that the milk reaches the swallowing. The advantages of this feeding method
infant’s lips. are that it is usually faster than spoon or even cup
6. If possible allow the infant to take the milk feeding and also that there is less spillage.
by him or herself and do not pour it into the
It has become very popular in neonatal nurseries in


key: chroma:document
string_value:
by him or herself and do not pour it into the
It has become very popular in neonatal nurseries in
infant’s mouth.
all parts of the country.
7. Feed the infant slowly, making sure that
The steps of ‘paladai’ feeding are given in the box
the milk already given has been swallowed
below:
before giving any more.
8. When the infant has had enough, he or she HOw tO FeeD an inFant witH a ‘PalaDai’
will close his or her mouth and will not take
1. The infant should be awake and held sit-
any more. Do not force-feed an infant.
ting semi-upright on the caregiver’s lap, and
9. Estimate the amount of milk taken in the wrapped to provide support and to keep the
same way as for cup feeding. arms out of the way, as for cup feeding.
2. Put a measured amount of milk in the
2. “PALADAI” FEEDING
paladai.
A paladai is a small steel bowl with a long pointed tip 3. Hold the paladai so that the pointed tip rests
traditionally used for feeding LBW infants in some lightly on the infant’s lower lip.
ANNEX II 39


key: chroma:document
string_value:
4. Tilt the paladai to pour a small amount of
milk into the infant’s mouth gently.
5. Feed the infant slowly.
HOw tO CuP FeeD an inFant
6. Make sure that the infant has swallowed
1. The infant should be awake and held sitting
the milk already taken before giving any
semi-upright on the caregiver’s lap. Wrap the
more.
infant in a cloth to provide support and to
7. When the infant has had enough, she will
keep his or her arms out of the way, and put
close his or her mouth and will not take
a small cloth on his or her front to catch drips
any more. Do not force-feed the infant.
of milk.
8. Estimate the amount of milk taken.
2. Put a measured amount of milk in the cup.
9. Wash the paladai with soap in running
3. Hold the cup so that it rests lightly on the
water and air-dry it before and after each
infant’s lower lip.
use.
4. Tilt the cup so that the milk reaches the
infant’s lips.
3. cuP FEEDING
5. Allow the infant to take the milk himself. (A


key: chroma:document
string_value:
infant’s lips.
3. cuP FEEDING
5. Allow the infant to take the milk himself. (A
It is appropriate for an infant who is stable and is able younger infant will initially lap the milk into
to coordinate sucking, breathing and swallowing. his mouth with his tongue. A full term or
The advantages of this feeding method are that it older infant will suck the milk.)
enables an infant to control his own intake in time
6. Do not pour the milk into the infant’s mouth.
and quantity.
Hold the cup to the infant’s lips so that and
The cups used and the method of cup feeding is he or she can take it himself or herself.
depicted in the figures below: 7. Feed the infant slowly. Some milk may spill
from the infant’s mouth. Spilling is commoner
Figure iii: Feeding a LBW infant by cup
with more mature infants.
8. Make sure that the infant has swallowed the
milk before offering more. When the infant
has had enough, he or she will close his or
her mouth and will not take any more. Do not


key: chroma:document
string_value:
has had enough, he or she will close his or
her mouth and will not take any more. Do not
force-feed the infant.
9. To estimate the amount of milk taken,
subtract the milk left in the cup from the
original amount. Also subtract the estimated
spillage, if any.
10. Wash each utensil with soap in running water
and air-dry it before and after each use.
40 KANGAROO MOTHER CARE & OPTIMAL FEEDING OF LOW BIRTH WEIGHT INFANTS


key: chroma:document
string_value:
4. Intra-gaStrIC tuBe FeeDIng PROcEDuRE
Intra-gastric feeding is provided to the stable infants Selecting the correct tube size
who are not able to accept oral feeds (not able to co- The correct tube size for intra-gastric feeding of
ordinate breathing with swallowing). Intra-gastric small infants is shown in below:
tube feeding can be given by two routes, namely,
recommended intra-gastric tube sizes
naso-gastric or oro-gastric. Naso-gastric tube has
Weight Tube size
the advantage that it is more easily fixed in place.
< 2000g French 6
But by blocking one nostril it may lead to apnoea or
≥2000g French 8
breathing difficulty. Oro-gastric tubes is preferred
for smaller infants. Inserting an intra-gastric tube
inSertinG an intra-GaStriC tuBe
1. Estimate the length of gastric tube required
l Hold the tip of the feeding tube at the tip of the infant’s nose, then hold the length of the tube
up to the ear lobe and then on to the infant’s abdomen to a point between the xiphisternum and


key: chroma:document
string_value:
up to the ear lobe and then on to the infant’s abdomen to a point between the xiphisternum and
umbilicus.
l Mark the measured length of the tube with a pen or piece of tape.
2. Inserting the gastric tube
l Flex the infant’s neck slightly and pass the tube gently through the mouth or one nostril to the
required distance.
3. Checking the position of gastric tube
l Take 1-2 ml of air into the syringe. Listen over the infant’s stomach with a stethoscope while
quickly injecting the air down the tube. If the end of the tube is in the stomach, you will hear a
whistling sound as the air passes through.
OR
l Attach a syringe to the open end of the tube and aspirate the contents of the stomach. The
aspirate should look like curdled milk
4. Secure the tube on the infant’s cheek with adhesive tape.
ANNEX II 41


key: chroma:document
string_value:
The steps of insertion and fixation of oro-gastric tube are illustrated in figure A and figure B respectively The
Figure a: Inserting an oro-gastric tube
Figure B: Fixing oro-gastric tube
oro-gastric tube has to be replaced every 3 days or earlier if it is pulled or blocked.
The procedure of giving a gastric tube feed is explained in the box below:
PrOCeDure FOr GiVinG a GaStriC tuBe FeeD
1. Remove the plunger of a 10 or 20 ml sterile syringe.
2. Connect the barrel of the syringe to the end of the gastric tube.
3. Fill the barrel of the syringe with the required volume of milk.
4. Let the milk run from the syringe through the gastric tube under gravity.
5. DO NOT force milk through the gastric tube by using the plunger of the syringe.
6. Hold the syringe 5-10 cm above the infant until the syringe is empty.
7. It should take a few minutes for the milk to flow into the infant’s stomach. Changing the height of the


key: chroma:document
string_value:
syringe will also affect the speed of milk flow. Lowering the syringe slows the milk flow, raising the
syringe makes the milk flow faster.
8. Observe the infant during the entire gastric tube feed. Do not leave the infant unattended. Stop
the tube feed if the infant shows any of the following signs: breathing difficulty, color change (looks
blue), becomes floppy or vomits.
9. Cap the end of the gastric tube after the milk has been instilled. there is no need to rinse the tube
with water. Keep tube capped between feeds.
42 KANGAROO MOTHER CARE & OPTIMAL FEEDING OF LOW BIRTH WEIGHT INFANTS


key: chroma:document
string_value:
annex iii
FolloW-uP ProtoCol aFter DISCharge oF a hIgh-rISK InFant
S. No Area Frequency Details Remarks
A Anthropometry Every visit Weight HC L Always estimate if the
gain is adequate
B Breastfeeding Every visit Attachment Positioning Observe a breastfeeding
Problems session if possible
C Counselling Every visit Feeding Hygiene KMC Ask mother about her
Innocuous issues concerns
D Development 3, 6, 9 , 12 months Use TD screening chart Fill up the chart and refer
screening where needed for detailed
developmental evaluation
E Eye 1 month for infants Emphasize on getting Review in next visit
<1750 grams to a retinopathy (ROP)
<2000 grams with screening from a skilled
stormy NICU course. ophthalmologist
Detailed examina-
tion at 9-12 months
of age
F Follow-up USG At discharge and at To rule out PVL and
40 weeks PMA other abnormalities
G Growth Monitoring Every Visit Plot the growth of the Use of the Fenton chart till
infant on the WHO the infant is 40 wks PMA


key: chroma:document
string_value:
infant on the WHO the infant is 40 wks PMA
growth charts and WHO charts thereafter
H Hearing At 40 wks PMA One can use the OAE/
and in case BERA or combination as
questionable, at 6 per the policy
weeks of age
I Immunization As per schedule
J Others Language/speech Any delay detected
at 1,2 3 years should prompt early
Behavior at/after 1 intervention
year
IQ testing at 3
years of age
ANNEX III 43


key: chroma:document
string_value:
Fetal-infant Growth Chart for Preterm Infants (WHO Growth Standards version)
65 65
60 60
55 55
50 50
45 45
40 40
35 6
30 5.5
25 5
20 4.5
4 4
3.5 3.5
3 3
2.5 2.5
2 2
1.5 1.5
1 1
0.5 0.5
0 0
22 24 26 28 30 32 34 36 38 40 42 44 46 48 50
44 KANGAROO MOTHER CARE & OPTIMAL FEEDING OF LOW BIRTH WEIGHT INFANTS
sretemitneC
)smargoliK(
thgieW
sretemitneC
)smargoliK(
thgieW
156 Annexures
Annexure 17: Fentons chart
Fenton Chart
97°
90°
L e n
gth 50°
10°
3°
H e a d
Circ u
mfere n c e
1
5
9 9
0
0
0 7
°
°
° °
3°
97°
90°
50°
ht
g
ei
W 10°
3°
Plot growth in terms of completed
weeks of gestation
Source: Intrautenine weight - Kramer MS et al
(ePediatr 2001); Length and Head circumference-
NiklassonA et al (J Paediatr Child Health 1996);
Post term sections-the WHO Growth Chats, 2006.
The Smoothing of the disjunction between the pre
and post term sections generally occurs between 36
and 46 weeks. TR Fenion
Date:
Gestational age (weeks)


key: chroma:document
string_value:
Annexure 18: TDS chart
In 2013 WHO revised it and separate charts for boys and girls are available. To avoid confusion
with the message in FBNC training module only single chart is being referred .
TD Screening Chart
ANNEX III 45
)straP
3(
llod
fo
strap
ot
stnioP
pleh
htiw
sriatspu
klaW
sdrawkcab
klaW
sdrow
owt
syaS
enola
sklaW llab
sworhT
pleh
htiw
klaW
ekac
a
taP
tellep
noisneherp
eniF
erutinruf
yb pu
gnidnatS
noitisop
gnittis
ot
fles
sesiaR
dnah
ot dnah
stcejbo
refsnarT
elttar/lleb
fo
dnuos
ot
daeh
snruT
hcamots
ot
kcab
morf
slloR
ydaets
daeh
sdloH
licnep/nep
wollof
seyE
elims
laicoS
42
32
22
12
02
91
81
71
61
51
41
31
21
11
01
9
8
7
6
5
4
3
2
1
shtnoM
ot
sliaf
dlihc
eht
fI
.detset
gnieb
)shtnom
ni(
dlihc
eht
fo ega
eht
fo level
eht
ta
,yllacitrev
tpek
si
licnep
a
ro
,nwod
si
enil
lacitrev
A
yaled
latnempoleved
a
evah
ot
deredisnoc
si
dlihc
eht
,enil
lacitrev
eht
fo
edis
tfel
eht
no
trohs
sllaf
taht
meti
yna
eveihca
Annexures 157


key: chroma:document
string_value:
annex iV
INFANT MILK SuBSTITuTES AcT
The Infant Milk Substitutes, Feeding Bottles and can give educational material to health
Infant Foods (regulation of production, Supply and professionals like doctors, nurses etc
Distribution) Act, 1992 and as amended act in 2003 provided it has information prescribed in
clause 7 of the IMS Amendment Act, 2003.
This Act provides for the regulation of production,
The education material should have only
supply and distribution of infant milk substitutes,
factual information and should not promote
feeding bottles and infant foods with a view to the
the products of the company).
protection and promotion of breastfeeding and
ensuring the proper use of infant foods and for 8. Gives tins, cartons, accompanied leaflets of
matters connected to it. It extends to the whole these products having pictures of mothers
of India. It also lays the responsibility of health or infants, cartoons or any other such images


key: chroma:document
string_value:
of India. It also lays the responsibility of health or infants, cartoons or any other such images
workers and of the government to provide accurate to increase saleability.
information to people. Following are the basic 9. Displays placards, posters in a hospital,
provisions of the IMS Act. nursing home, chemist shop etc. for
promoting these products.
THE IMS AcT PROvISIONS
10. Provides direct or indirect inducements to
IMS act is violated if any baby Food Company, its
health workers
distributor or supplier, or any person
11. Demonstrates to mothers or their family
1. Promotes any food by whatever name, for
members how to feed these products.
children up to two years.
However, a doctor can demonstrate this to
2. Promotes use of infant foods before the age the mother.
of six months.
12. Gives benefits to doctors, nurses or
3. Advertises by any means--television, associations like IAP, IMA, NNF etc, for
newspapers, magazines, journals, through example, funds for organizing seminars,


key: chroma:document
string_value:
newspapers, magazines, journals, through example, funds for organizing seminars,
SMS, emails, radio, pamphlets etc. meeting, conferences, contest, fee of
educational course, sponsoring for projects,
4. Distributes the product or samples to any
research work or tours.
person.
13. Fixes commission of employees on the basis
5. Contacts pregnant or lactating mothers
of volume of sales of these products.
using any person.
6. Gives any kind of inducements like free gifts, HIGHLIGHTS OF THE AcT
tied sales, to anyone.
1. Prohibits all persons from any kind of pro-
7. Distributes information and educational motion of infant milk substitutes, infant
material to mothers, families etc. (They foods or feeding bottles
46 KANGAROO MOTHER CARE & OPTIMAL FEEDING OF LOW BIRTH WEIGHT INFANTS


key: chroma:document
string_value:
2. Prohibits the advertisement of infant milk 5. Prohibits display of posters at health care
substitutes and feeding bottles to” ensure facilities / hospitals /health centres.
that no impression is given that feeding of
6. The Act also prescribes that all labels of IMS
these products is equivalent to, or better
/Infant food, must say in English and local,
than, breastfeeding.
languages that breastfeeding is the best.
3. Prohibits providing free samples and gifts Also, the labels must not have pictures of
to pregnant women, mothers of infants and infants or women or phrases designed to
members of the families. increase the sale of the product.
4. Prohibits donation of free or subsided 7. Prohibits any contact of employers
supplies of products for health care manufacturing and distributing company
institutions and prohibits incentives and with pregnant women, even for providing
gifts to health workers. educational material to them.
ANNEX iV 47


key: chroma:document
string_value:
annex V
ORIENTATION ON KANGAROO MOTHER cARE
objective Key Points
By the end of this exercise the participant should be Eligibility criteria for KMC
able to demonstrate Kangaroo Mother Care
 All LBW infants.
Steps for providing Kangaroo Mother Care  Sick hemodynamically stable infants
needing special care (even those on IV Fluid
1 Counsel the mother, provides privacy to the
or on Oxygen)
mother. Request the mother to sit or recline
comfortably The two components of KMC are:
2 Undress the baby gently, except for cap,  Skin-to-skin contact
nappy and socks
 Exclusive breastfeeding
3 Place the baby prone on mother’s chest in
The two prerequisites of KMC are:
an upright position with the head slightly
extended, between her breasts in skin to skin  Support to the mother in hospital and at
contact in a frog like position; turn baby’s home
head to one side to keep airway clear. Support
 Post-discharge follow-up
the baby’s bottom with a sling/binder.
Benefits of KMC


key: chroma:document
string_value:
 Post-discharge follow-up
the baby’s bottom with a sling/binder.
Benefits of KMC
4 Cover the baby with mother’s ‘pallu’ or gown;
wrap the baby-mother duo with an added  Reduces risk of hypothermia
blanket or shawl depending upon the room
 Promotes lactation and weight gain
temperature
 Reducing infections and hospital stay
5 Advise mother to breastfeed the baby
frequently  Better bonding between Mother and
newborn
6 Ensure warm room with room temperature
maintained between 25 – 28° C.
7 Advise the mother to provide KMC for at least
1 hour per session. The length of skin-to-skin
contact should be as long as possible
POintS tO reMeMBer
1. Ensure room is warm (25 -28° C)
2. Health professionals should be skilled for providing immediate emergency care, in case required
48 KANGAROO MOTHER CARE & OPTIMAL FEEDING OF LOW BIRTH WEIGHT INFANTS


key: chroma:document
string_value:
referenCes
Cattaneo A, Davanzo R, Bergman N, Charpak N. income countries: a pooled country analysis.
Kangaroo mother care in low-income countries. Lancet. Aug 3 2013; 382(9890):417-425.World
International Network in Kangaroo Mother Care. J Health Organization. Kangaroo mother care: a
Trop Pediatr. 1998 Oct; 44(5):279-82. practical guide. Department of Reproductive
Health and Research, WHO, Geneva. 2003.
Charpak N, Ruiz-Pelaez JG, Charpak Y. Rey-Martinez
Kangaroo Mother Program: an alternative way Kiran Kumar BV, Udani RH. Analgesic effect of skin-
of caring for low birth weight infants. One year to-skin contact in kangaroo position in preterm
mortality in a cohort study. Pediatrics. 1994 Dec; newborns. Abstracts XXII Annual Convention of
94(6 Pt1):804-10. National Neonatology Forum, December19-22nd
2002. P-48,pg158.
Charpak N ,Ruiz-Pelaez JG, Figueroade CZ,
Charpak Y. A randomized, controlled trial of Ramanathan K, Paul VK, Deorari AK, Taneja U,


key: chroma:document
string_value:
Charpak Y. A randomized, controlled trial of Ramanathan K, Paul VK, Deorari AK, Taneja U,
kangaroo mother care: results of follow-up at George G. Kangaroo Mother Care in very low
1 year of corrected age. Pediatrics. 2001Nov; birth weight infants. Indian J Pediatr.2001Nov;
108(5):1072-9. 68(11):1019-23.
Chwo MJ, Anderson GC, Good M, Dowling DA, Sloan NL, Camacho LW, Rojas EP, Stern C. Kangaroo
Shiau SH, Chu DM. A randomized controlled trial mother method: randomized controlled trial of an
of early kangaroo care for preterm infants: effects alternative method of care for stabilized low-birth
on temperature, weight, behavior and acuity. J weight infants. Maternidad Isidro Ayora Study
Nurs Res.2002 Jun; 10(2):129-42. Team. Lancet. 1994 Sep17; 344(8925):782-5.
Conde-Agudelo, Diaz-Rosello JL, Belizan JM. Tessier R, Cristo M, Velez S, Giron M, de Calume ZF,
Kangaroo mother care to reduce morbidity and Ruiz-Palaez JG, Charpak Y, Charpak N. Kangaroo


key: chroma:document
string_value:
Kangaroo mother care to reduce morbidity and Ruiz-Palaez JG, Charpak Y, Charpak N. Kangaroo
mortality in low birth weight infants. Cochrane mother care and the bonding hypothesis.
Database Syst Rev 2003;(2):CD002771 Pediatrics. 1998Aug; 102(2):e17.
Goel A, Vani SN. Kangaroo-mother method for WHO/UNICEF Join t Statement-Home visits for
the care of low birth weight infants – An Indian the newborn child: a strategy to improve survival.
experience. Abstracts XVIII Annual Convention of 2009
National Neonatology Forum, November 6-8th
Evaluation of Kangaroo Mother Care Services in
1998. fMortality risk in preterm and small-for-
India, 2013
gestational-age infants in low-income and middle-
References 49


key: chroma:document
string_value:
KanGarOO MOtHer Care
PreParatiOn FOr KMC COunSellinG & DeMOnStratiOn
FOr KMC
KMC POSitiOn
wHO Can PrOViDe KMC (FatHer anD OtHer relatiVeS)


