Abstract and Introduction
Abstract
To encourage use of skin-to-skin contact with all healthy term infants during the first two hours of life and throughout their mothers' postpartum hospitalization, an easy, rapid newborn assessment tool, the "RAPP", has been developed to enhance labor and delivery and mother-baby nurses' ability to swiftly and accurately assess newborn physiologic condition. The "RAPP" assessment (respiratory activity, perfusion, and position) tool is being proposed as a way to swiftly evaluate infants' physiologic condition and position. Position of the infant is a key factor in minimizing risk of Sudden Unexpected Postnatal Collapse (SUPC). SUPC is an emerging complication of skin-to-skin contact and breastfeeding in the first hours and days post-birth. The "RAPP" assessment parameters and flow sheet are discussed, risk factors for SUPC are enumerated, and a checklist to prevent SUPC is presented so skin-to-skin contact can be safely provided.
Introduction
Skin-to-skin contact, also known as Kangaroo Care, has been recommended for all healthy term newborns by the American Academy of Pediatrics,[1] the American College of Obstetricians and Gynecologists,[2] the Centers for Disease Control and Prevention,[3] and the Academy of Breastfeeding Medicine[4] because of its numerous positive effects on infants and their families.[5] Skin-to-skin contact's (SSC) ability to regulate the infant's temperature and prevent hypothermia and hypoglycemia has earned SSC recognition in the Neonatal Resuscitation Program as the first step for all healthy term infants who do not require resuscitation.[6] The Neonatal Resuscitation Program guidelines state that "term infants who have good muscle tone and cry or breathe spontaneously should not be separated from the mother, but should be dried and placed in skin-to-skin contact with the mother, with both of them covered with dry linen." (6, p. S910).
Other profound and undisputed effects of SSC are improvement in initiation, duration, and exclusivity of breastfeeding and enhanced milk production.[7] Because of these lactation effects, provision of SSC immediately after birth until the first feeding at the breast is finished has been identified as the essential first step for meeting Healthy People 2020 breastfeeding goals,[8] for meeting the Association of Women's Health, Obstetric and Neonatal Nurses' perinatal core measures for excellent care,[9] and for meeting the new Joint Commission mandate that all healthy term infants born in hospitals delivering 1100 or more infants/year are exclusively breast milk fed by discharge.[10,11] Continuing SSC throughout postpartum may yield exclusive breast milk feedings at discharge.[1,12] Despite these recommendations and the Joint Commission mandate, the practice of SSC at birth is not widespread.[13–15] Reasons for slow adoption of SSC at birth are lack of knowledge/education about skin-to-skin at birth,[15,16] no standardized method or uniform practice for skin-to-skin contact,[16,17] occasional unfamiliarity with how to assess the newborn, unfamiliarity about how to position the infant for safety, discomfort with being responsible for newborn wellness – especially the infant's physiologic condition, and how to minimize risk of infant complications that can occur when infants go to breast.[18] The purposes of the manuscript are to share with maternity nursing staff how to conduct an easy newborn assessment that helps the nurse identify immediate newborn physiologic condition and to share nursing interventions designed to minimize the risk of the newly-emerging complication called Sudden Unexpected Postnatal Collapse (SUPC).[19] Assessment and documentation tools are presented that can facilitate comfort, comprehensiveness, and competence in assessing infants and ensuring their safety during SSC.
NAINR. 2014;14(1):28-33. © 2014 Elsevier Science, Inc.
