The Construction of a Kangaroo Unit at Latifa Hospital in Dubai

Introduction

Latifa hospital specializes in maternal care for babies and mothers; as a result, being ranked among the best hospitals in Dubai. The Neonatal Intensive Care Unit (NICU) facilitates newborn babies with underlying conditions such as breathing and incomplete development during gestation. With the advancement of the kangaroo unit, parents can hold their babies, providing basic requirements for children's development and fulfilling the parents' desire to engage in the baby's development. For instance, babies are provided with warmth and comfort and can access their parents like other children who have completed their gestation period. Being a reputable healthcare organization, many women with varying conditions are admitted in preparation for childbirth. Over 300 women are admitted to the NICU, preparing for either vaginal birth or cesarean section. Since the number of beds and units in the hospital is consistently at full capacity, comorbidity can endanger admitted women or unborn children because the NICU usually has women with other health conditions. Additionally, expanding the kangaroo unit will increase hospital capacity, resulting in more admissions and better healthcare. Through the advancement of the kangaroo unit and its expansion, optimum attention and healthcare can be provided to admitted mothers and babies. Furthermore, mothers have expressed their unwillingness to leave hospitals without their babies and request additional days to watch their babies in the NICU, which can be resolved by increasing its capacity. Therefore, the development of the Kangaroo unit within Latifah hospital will increase its capacity, reassuring mothers of their children's safety and development while allowing hospital staff to provide optimal healthcare to the mothers and children.

Objectives

Main Objective/Aim

To construct a fully-developed kangaroo unit in Latifa Hospital, Dubai.

Specific Objectives

1.    To improve the treatment plans for neonates and mothers in the existing maternal block.

2.    To evaluate the estimated number of admitted maternal-infant patients before constructing a kangaroo unit.

3.    To improve staff development programs, including increasing the number of healthcare workers in the kangaroo unit.

Literature Review

Neonatal Intensive Care Units are essential for making life decisions and providing basic care to neonates. They exceed the care of babies who have underlying medical conditions at the time of birth. Some babies have health conditions that cannot be resolved, resulting in tough decisions from parents and healthcare providers. 'Moral decisions' are a common term describing the choice parents have to make regarding their babies' lives, or where a family member decides between a mother's and the baby's life¹. Technological advancement has made complicated conditions, including surgery for newborn babies, possible. In Ethiopia, statistical models were applied to analyze the survival rate of neonates and make interventions to increase this survival rate. In conclusion, the survival rate of neonates is low, with many babies not surviving the first four weeks after birth². The quality of technology within healthcare institutions was a major factor in determining the level of care provided to newborn babies. Additionally, where babies could breastfeed within the first hours of birth, there was increased survival². An increase in the number of NICU experts and physical facilities would have increased the survival rate of newborn babies. Also, as observed, motherly care is important for neonates since they require warmth and breast milk for faster development or recovery³. As such, kangaroo units cater to babies' needs and mothers' recovery, and their expansion is pertinent to the survival of neonates. Therefore, NICUs are essential in making life decisions and providing healthcare to neonates, necessitating the advancement of kangaroo units that facilitate mothers and babies.

When adjusted to optimal characteristics, Kangaroo units have been used to increase the survival rates of neonates. Raising neonates can distress parents since they are unsure of their babies' survival, which kangaroo units are supposed to correct. Between 1990 and 2015, the rate of neonatal deaths recorded fell from 37 in 1000 newborns to 19 due to technological advancement and increased kangaroo units². Through Kangaroo Care (KC), the essential needs of mothers and babies are met. It includes three stages in which optimal care and attention are given: baby-wearing, breastfeeding, and a critical perception shift³. In the first stage, the babies only wear diapers, changed based on the frequency of their use, and mothers have hats, which should assist in providing baby warmth, preventing the development of conditions such as hypothermia due to changes in environmental temperatures³. When babies are admitted to NICUs, and their mothers are expected to leave hospitals but consistently visit, it affects the maternal-infant connection, alters the frequency and ease of breastfeeding, and may affect mothers' emotional and mental wellbeing³. The kangaroo units' advancements create a personal space between the mothers and their children, reducing children's feeding difficulties and increasing the connection between babies and their mothers. Improving kangaroo mother care (KMC) may include increasing private rooms and extended durations between mothers and their infants⁴. Additionally, quality improvement factors have been observed to affect the effectiveness of KMC. Staff may consistently feel overworked, which affects the rate at which they provide care to mothers and infants; there is a stretch on facilities used. Mothers may consistently have insufficient breast milk and suffer sleep deprivation⁴. Having a general intensive care unit for neonates is unsafe for mothers and babies since there's varying light, noise, and touch that is sensitive to the development of infants⁴. Machines that may have alerting or operational noises affect infants' short- and long-term development of infants⁴. Different neonates require personal treatment plans, which is impossible where there's a general NICU for many babies and mothers. In addition, personal care from healthcare providers is essential. It can be adopted when mothers and infants have personal rooms, allowing medical care providers to regulate machinery settings while implementing individual development plans. As such, KMC programs manage the maternal neurologic results caused by the early separation of babies from their mothers for neonates. Therefore, kangaroo units are essential in reducing the rate of neonatal death and regulating common problems that kangaroo units may have, increasing the survival rate of neonates.

Description of Proposed InterventionThere are innumerable benefits to constructing a new kangaroo unit at Latifa Hospital, including benefits to the hospital, observing the safety and ethical requirements for medical institutions, and providing optimal healthcare to neonates and mothers. Organizational management will require financiers to sponsor the new block construction, but the eventual relevance of profits and customer loyalty will compensate for the financial requirement of constructing the new block. Latifa Hospital is a care hospital for mothers and children and has already set up plans for expansion to accommodate more patients and provide better healthcare to admitted patients. Constructing a new kangaroo unit wing will be relevant to meet the current organizational expansion plans. The goal will be to provide better healthcare without problems of understaffing, mother exhaustion, and proper infant development since the technology will facilitate these changes. The first objective involves the development of new treatment plans for maternal and neonates, which will enable healthcare providers to use a case-control approach to assess the improvement of service providers before and after adjusting treatment plans. Improved treatment plans involve personalization of treatment and allocating individual rooms to mothers and neonates for better facilitation of KMC. Results from the literature review have proved exponential growth in the number of recovered babies and the number of safe mothers since they can personally provide the basic needs of warmth and parental support and develop a maternal-infant connection pertinent to the short-term and long-term development of babies. Also, current statistics have necessitated a kangaroo unit since the maternal units in the hospital are consistently at full capacity. An expansion will be necessary for the hospital to continue observing the healthcare guidelines since the number of facilities will exceed the number of admitted mothers and neonates. The third objective includes staff motivation through training and increased staff members, which will increase the possibility of mothers and neonates receiving personal care from healthcare providers. Staff training and motivation will also reduce the rate at which mothers report exhaustion caused by sleep deprivation since, most times, mothers have to care for their neonates single-handedly. Since kangaroo units involve making moral decisions, as earlier discussed, staff and parents are involved in deciding treatment options for the infants, and with motivation, will be in a better place to advise parents and execute optimal treatment plans.

Evaluation, Design, and Research Design

A meta-analysis, a case-control study, and survival models can be used to identify neonatal survival factors and rates. Numerous studies have been done to evaluate the rates and causes of neonatal mortality. A meta-analysis can combine statistics from such studies and can be used to match the conclusions and results to provide a scientific basis for interventions suggested to Latifa Hospital. The case-control study will be relevant for comparing the neonatal mortality cases before and after KMC to determine the effectiveness of having more kangaroo care units. Also, the case-control study can be employed to analyze the medical improvement of patients continually and hospital staff after predetermined periods, say six months, to determine progress and suggest interventions that can improve operations of the new kangaroo unit. Lastly, the survival models include the cox-proportional hazard model, which will compute the neonatal survival rate after all factors contributing to neonatal development have been identified and implemented. Therefore, meta-analysis, case-control study, and the cox-proportional hazard model can be used to evaluate factors contributing to neonatal development and their survival rate.

Ethical Considerations

Ethical issues may arise during the execution of this project at Latifa Hospital that would determine its effectiveness. Healthcare ethical considerations have more weight in terms of consequences than other operational ethics since they involve the well-being and lives of human beings. During the construction of a kangaroo unit, ethical issues such as providing a basis for advising parents on whether or not to keep a child may arise. Particularly, measures that ensure the safe delivery of infants may be questioned, including healthcare provided by workers and machinery that could sustain a baby's life. How parents and healthcare providers decide to keep a baby may be a problem that the organization would consider during implementing proposed interventions. Additionally, practitioner-patient confidentiality is an essential ethical issue associated with NICU decisions. Regardless of the nature of the ethical decisions made by parents and doctors, the non-disclosure agreement policy cannot be ignored or violated. For healthcare providers, malpractice and negligence are essential ethical issues that workers cannot defy; healthcare providers should give optimal patient care without neglecting details in the process that could cause neonatal death. Therefore, important ethical considerations for the project's execution include the basis for making life-related decisions, confidentiality, malpractice, and negligence.

Conclusion

Latifa Hospital may need to expand its operations by including a kangaroo unit to cater to the increased number of admitted patients. Globally, there has been a reduction in neonatal mortality cases since medicine has evolved to use advanced technology that has increased the infant survival rate. Additionally, kangaroo units have reduced neonatal mortality since basic needs for mothers and neonates are catered for. Using the proposed interventions, Latifa Hospital can increase its operations by building a kangaroo unit, training its staff, and improving its technology within the newly constructed block. Statistical models, including meta-analysis, case-control, and the cox-proportional hazard model, can be used to estimate the effectiveness of the proposed interventions before and after execution. Additionally, considering relevant ethical issues, Latifa Hospital can execute proposed interventions for the project's success.

References

1. Mills, M. and Cortezzo, D.E., 2020. Moral distress in the neonatal intensive care unit: what is it, why it happens, and how we can address it. Frontiers in Pediatrics, 8, p.581. https://doi.org/10.3389/fped.2020.00581

2.    Orsido, T.T., Asseffa, N.A. and Berheto, T.M., 2019. Predictors of Neonatal mortality in Neonatal intensive care unit at referral Hospital in Southern Ethiopia: a retrospective cohort study. BMC pregnancy and childbirth, 19(1), pp.1-9. https://doi.org/10.1186/s12884-019-2227-5

3. Mu, P.F., Lee, M.Y., Chen, Y.C., Yang, H.C. and Yang, S.H., 2020. Experiences of parents providing kangaroo care to a premature infant: A systematic qualitative review. Nursing & Health Sciences, 22(2), pp.149-161. https://doi.org/10.1111/nhs.1263

4.Coutts, S., Woldring, A., Pederson, A., De Salaberry, J., Osiovich, H. and Brotto, L.A., 2021. What is stopping us? An implementation science study of kangaroo care in British Columbia’s neonatal intensive care units. BMC pregnancy and childbirth, 21(1), pp.1-15. https://doi.org/10.1186/s12884-020-03488-5