title: Kangaroo supported diagonal flexion positioning: New insights into skin-to-skin contact for communication between mothers and very preterm infants.
abstract: OBJECTIVE
  Skin-to-skin contact shows benefits in the relationship developed between a mother and her premature infant. In the skin-to-skin session, face-to-face exchanges are impossible in vertical infant positioning. We therefore undertook an observational, prospective, single-center study using kangaroo "supported diagonal flexion" (SDF) positioning. The first aim was to evaluate the safety of kangaroo SDF positioning compared to the usual vertical positioning. The second aim was to evaluate SDF positioning on early communication between the mother and her infant and to improve their well-being.
  
  
  METHODS
  Fifteen mothers and their very premature infants (birth 26<32 weeks' gestation) were assigned to one of the two kangaroo positioning modes, either the current vertical positioning (n=7) or SDF positioning (n=8).
  
  
  METHODS
  Physiological variables and critical events were recorded before, during, and after ten successive skin-to-skin contact sessions. The first and last sessions were videotaped to allow later behavioral measurements. Mothers' risk for depression and feelings about the way they experienced communication with their infant were assessed through questionnaires.
  
  
  RESULTS
  In terms of the infant's physiology, no negative effects were associated with SDF positioning in comparison with the usual vertical positioning. SDF positioning led to fewer disorganized gestures, negative vocalizations, and drowsiness, in favor of more deep sleep. SDF led to more mother-infant eye-to-eye contact as well as maternal vocalizations, smiles, and caressing, although these differences did not reach significance. The score for the risk of postnatal depression decreased significantly between the first and the last session in the SDF group, whereas it did not change in the vertical positioning group.
  
  
  CONCLUSIONS
  These results support the idea that the kangaroo SDF positioning technique is physiologically safe, has obvious immediate benefits on mothers' infant-directed communicative behaviors, and respects the baby's naturally flexed and asymmetrical tonic neck posture. It is an innovative, inexpensive, easy-to-use technique in daily practice, by all healthcare professionals working in a neonatal intensive care unit. These data suggest that the current kangaroo positioning technique could be improved. More studies are needed to confirm the benefits and safety of the kangaroo SDF positioning in larger groups of preterm infants.
authors.affiliation: Centre hospitalier sud francilien, 116, boulevard Jean-Jaures, 91106 Corbeil Essonnes cedex, France; Université Paris Descartes, Laboratoire LPPS, EA4057, 71, avenue Edouard-Vaillant, 92774 Boulogne Billancourt, France. Electronic address: audebuil11@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Buil
authors.affiliation: Ecole Pratique des Hautes Etudes, Laboratoire CHART, 4-14, rue Ferrus, 75014 Paris, France.
authors.forename: I
authors.initials: I
authors.lastname: Carchon
authors.affiliation: EPS Erasme, Laboratoire RePPEr, 14, rue de l'Abbaye, 92160 Antony, France.
authors.forename: G
authors.initials: G
authors.lastname: Apter
authors.affiliation: Centre hospitalier sud francilien, 116, boulevard Jean-Jaures, 91106 Corbeil Essonnes cedex, France.
authors.forename: F X
authors.initials: FX
authors.lastname: Laborne
authors.affiliation: Centre hospitalier sud francilien, 116, boulevard Jean-Jaures, 91106 Corbeil Essonnes cedex, France.
authors.forename: M
authors.initials: M
authors.lastname: Granier
authors.affiliation: EPS Erasme, Laboratoire RePPEr, 14, rue de l'Abbaye, 92160 Antony, France.
authors.forename: E
authors.initials: E
authors.lastname: Devouche
mesh_terms: D000328:Adult; D003142:Communication; D019052:Depression, Postpartum / Q000517:prevention & control; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D060127:Kangaroo-Mother Care Method / Q000379:methods*; D009034:Mother-Child Relations; D011446:Prospective Studies; D055815:Young Adult