Procedure
hand-foot, NEC, shock, congenital malformations, Breast milk, Breast milk fortification, respiratory distress, breast milk, obstructions
MULTIPLE ORGAN FAILURE, DYSFUNCTION, SHOCK
Before including them in the study, the researcher met with the family and the infant. The study's aim and KMC application were explained to the family. An informed consent form was given to the families who wanted to take part in the study, and the family read it and approved it. The infant's group was determined according to the urn method. The Mother and Infant Descriptive Information Form among the data collection forms was filled out.All interventions in the KMC and SC groups were performed by two independent observers simultaneously, YÇ (also a nutrition nurse) and MS (also an infant care nurse), who are among the study authors and are currently working in the day shift in the Neonatal Intensive Care Unit.Enteral (with OGT/NGT) nutrition is started in preterm infants with a gestational age of <3234 weeks, with sucking/swallowing dysfunction, or who cannot be fed orally. If the infant's weight is between 1000 and 1500 g, it is increased to feed the infant as 15–20 ml/kg/day (for 1–2 days) and then 30 ml/kg/day every 2–3 h. If the infant's weight is between 1500 and 1800 g, he/she is fed as 20 ml/kg for 1 day and then 30 ml/kg/day every 3 h. Breast milk fortification is initiated when feeding reaches 50–100 ml/kg (recommended 80 ml/kg) [The breast milk of mothers with premature babies may be insufficient in the first days. Therefore, as breast milk increases, the formula is stopped and the mother's expressed breast milk is enriched with eoprotein. In order to evaluate the effect on the infant's feeding tolerance, KMC was performed when the mother's milk reached a sufficient level for her baby (15–20 cc breast milk in each expressing) (72 h after the earliest birth). Hence, KMC was carried out while infants were fed only with breast milk. Minimal enteral nutrition is started with colostrum. Breast milk is expressed at least 6 times, preferably 8–12 times, and given to the infant with an OG/NG tube.Enteral feeding is stopped in case of severe respiratory distress (respiratory rate>80/min), GIS obstructions due to congenital malformations, diagnosis of NEC, hemodynamics, irregularity and shock requiring high inotropic treatment support, or multiple organ failure.Infants in both groups were fed in the supine position with their heads raised at 30–45° after the position control in preterm infants with an OG or NG tube inserted.Before the procedure, eoprotein was added to the breast milk of the preterm infant (one measure of eoprotein to 25 cc of breast milk) and heated in a standard food warmer. Feed volumes were the same for each infant.The vital signs of the infants in both groups were checked before feeding, and the study was continued with stable (heart rate 100–160 beats/min, respiration rate <60/min, and axillary temperature 36.5–37.4°C) infants [KMC was applied to the infants in the intervention group with stable vital signs after feeding for 60 min [Overall mean time for initiate KMC is 3.74 ± 0.79 days (min: 3, max: 5)]. KMC is the practice of placing an infant with only a hat and diaper on the parent's open chest in a prone, upright position (approximately 45°) and providing skin-to-skin contact.KMC was applied on one of the visiting days at 14.00. Attention was paid to the mother's privacy.In the hospital routine, a nest is created with rolled up cloths in the incubator (the newborn's hand-foot coordination is supported by the nest, and stress and energy consumption are reduced due to a decrease in swaying and involuntary movements).To ensure homogeneity between the groups and evaluate the effectiveness of KMC, while infants in the intervention group received KMC after feeding, infants in the SC group were placed in the prone position after feeding. The prone position after feeding is currently practiced in infants receiving standard care in the ward. When studies assessing the effect of the position given after feeding on GRV in newborns are reviewed, it has been proven that the prone position is superior to other positions with low GRV and high nutrient absorption probability [Infants in the standard care group were placed in the prone position after feeding.YÇ and MS checked vital signs after 60 min in both groups. They evaluated the residual volume of infants in both groups prior to the next feeding (approximately 3 h later).All interventions were performed under the same environmental conditions (quiet, calm and low-lit environment).