Inside the NICU

More words from winners!

We have presented the winning ways of our Kangaroo Challenge Champions earlier this week, but it is also absolutely true that everyone involved in this project is a champion, and we have learned so much from each and every unit that participated in this project.  We have tried to summarize some of this feedback here, but if you can think of other tips, tricks and questions, please feel free to add them in the comment section.


This amazing mural was done by the team at Northside Hospital Forsyth, Cumming, Georgia. Thanks for sharing!


What worked?

I think the education tips for staff and parents were amazing. It really got the conversation going for all of our staff – instead of just the ones who were already invested.  ~ Bonnie from Kelowna General, British Columbia

The Grandparent Challenge was super fun and spontaneous. Not sure you can buy that kind of enthusiasm.  ~ Luisa from Sunnybrook HSC, Ontario

I did a survey of grad parents and gathered some very powerful words that I shared with staff – this has been identified in our post-event survey as a very powerful motivator to get those babies onto their parents’ chests! ~ Joanna at Children’s Hospital at Dartmouth-Hitchcock, New Hampshire

We used a “I’m ready to Kangaroo!” laminated sign at each bedside. During rounds, eligibility for kangaroo care was discussed, thus making a VISIBLE team decision for each baby. ~ Tammy from Children’s Hospital at Dartmouth-Hitchcock, New Hampshire

Probably the most important outcome of our kangaroo-a-thon was the increased parent engagement on the unit. It was very rewarding to read the loving messages that many parents added to their infants’ kangaroos that they posted on the wall every time they did KC. Another highlight was the increased participation of dads on the unit and it was very rewarding to see them holding their infants in KC. It was also just what our unit needed to create the momentum that we needed to increase the use of our new wraps that had been acquired and introduced prior to the kangaroo-a-thon, but were not being used on a wide-scale yet.  ~ Stacy from Loma Linda University Children’s Hospital, Loma Linda, California.

We recently installed Roku boxes to the large tv screens in each pod, allowing us to personalize messages to parents and staff. They went live during the kangaroo a thon. I did notice that the hours of KC increased after this was up. We kept a running total of hours of KC and encouraged more of it. It worked!  ~  April from Woman’s Hospital, Baton Rouge, Louisiana

We had more parents in the unit and the families visited for longer periods of time. We saw infants in one weekend improve in their respiratory status going from HFOV to Conventional Ventilators, Ventilators to SiPap , one patient went from ventilator to HFNC all in one weekend. We saw weight gains on patients who had been maintaining, we had improved thermoregulations, we had happier parents and babies. ~ Kristin from Valley Children’s Healthcare NICU, Madera, California

The daily raffle draw for prizes (one for staff and one for parents) was a big motivator. We saw parents become more proactive and asking their nurse for KC time.  ~ Ashley from Erlanger Health  System NICU, Chattanooga, Tennessee

Our Neonatologist (and Medical Director) wore a kangaroo costume I bought for morning multidisciplinary rounds. What you can’t quite grasp is the fact that he is the LAST person anyone would think would wear a kangaroo costume. Everyone LOVED it and it was a great kick off to our Kangaroo-a-thon.  ~ Amy from Helen DeVos Children’s Hospital, Grand Rapids, Michigan.

I think the best part for me was when I went to collect the sheets at the end of the challenge and one dad said “Aw man, I can’t write on the sheet anymore? I wanted to get more hours than the whole sheet contained.” ~ Heather from Orillia Soldiers’ Memorial NICU, Orillia, Ontario. (Last year’s Level 2 winner! )


What could change?

Our neonatologist suggests that there be a category for “koala’ cuddling for volunteers. ~ Bonnie from Kelowna General, Kelowna, British Columbia.

We would love some funding! How did the rest of you go about getting any funding for your event?  Maybe we could have a running tally with all the hospitals on a website all together next year? And maybe a chat room where we could all be having a dialogue during the event? I think that would be really interesting.  ~ Amanda from Montreal Children’s, Quebec.

Level II specific education, We don’t have micro prems or long term vents so some of the education points, while interesting, were not as applicable. ~ The team from Peterborough, Ontario.

Find ways of communicating together during the challenge to cheer each other on! ~ multiple c enters

Find better ways of tallying hours.  ~ multiple centers

Start promoting earlier and bringing more team  members into the project.  This project really relies on an interdisciplinary approach ~ multiple centers

It’s hard to keep momentum going for two weeks. The first week is GREAT – how can we keep that going? ~ multiple centers

We also have a number of babies who have been in the NICU for over 1 month and many of 3 months, some over 6 and 12 months! So older babies can be challenging to do kangaroo care with, but we suggested to them to just do chest to chest holding. ~ Amanda from Montreal Children’s Hospital, Montreal, Quebec.


What next?

We are going to have a skills week set up for staff to practice transferring a baby on the jet, and also have staff practice having the parent pick the baby up out of the bed versus staff hand the baby to them. We are also going to be doing a year long incentive program with quarterly Rangers tickets, T-shirts, and other nurse staffing prizes (no float pass, no weekends for one schedule, etc.)  ~ Heather from Cook Children’s, Texas.

We plan on challenging some other Quebec hospitals next year. The response on our unit was amazing! ~ Amanda from Montreal Children’s Hospital, Montreal, Quebec.

I think it will be helpful to have extra kangaroo champions available periodically to encourage and support the bedside staff. ~ Debbie from Community Memorial Hospital, Venture, California.

Education of parents!! The nurses are all for KC but some of the parents haven’t bought into yet. ~ Dawn from Saint Mary’s Regional Medical Center, Reno, Nevada

If there was a way to find out how other units were doing or how they had done this might have helped with the competitive spirit of our group. We have some very competitive nurses on our unit. ~ Trisha from Women’s Hospital, Greenboro, North Carolina.

I think our docs and nnps could still be bigger zealots and explain to parents why KC is so important. Ask parents every day on rounds; remind them again about the importance…Parents want to do what’s best for their children and we need to teach them about this. ~ Howard from Salem Oregon (last year’s winner!)


What interesting things did you learn (and/or did we learn from you)?

It was surprising to observe how competitive the families were with this challenge, and how they were interested in recording their hours daily.  ~ Donna from North York General, Ontario

We consider ALL of our babies eligible for skin to skin holding. Vents, chest tubes, umbilical lines are no barrier. The only time we stop is if a baby isn’t tolerating it well.  ~ Sheryl from Memorial Children’s Hospital, Indiana.

The eye-opening moment was realizing that kangaroo care is not only for pre-term but for term babies. We are going to concentrate on supporting kangaroo care not only the first few days of life but ongoing during the entire hospital stay. ~ Sandra, Northside Forsyth Hospital, Georgia.

Our longest baby held was 17 hours in 24 hours. ~ Lynn from IU Health North NICU Riley, Carmel, Indiana.

One nurse came to me to tell me how a baby was grunty and after a few minutes of skin to skin with the father, the baby settled and the vital signs were normal. She stated that this episode might have made her a believer in skin to skin. If one nurse was able to see the benefits to skin to skin than to me, this challenge was a success. ~ Lindsay from Thunder Bay NICU, Thunder Bay, Ontario.

We encourage skin to skin in the Operating Room if baby is stable, and also with any blood draws we will do skin to skin. We are now starting to engage the lab in this process also. ~ Margaret from Guelph General Hospital, Guelph, Ontario.

This year we had our L&D and LDRP units participate at the same time as us. They kept their own log sheets and educated patients and visitors on the importance of Kangaroo Care. ~ Diane from St Boniface Hospital, Winnipeg, Manitoba.

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Thank you all so much for sharing these thoughts and experiences with us.  What a remarkable community this is!  The generosity and dedication of all the Kangaroo Challenge participants is inspiring.  We would love to hear from you if you have suggestions for how to make things better or how to address some of the issues mentioned above.  We will continue to post and share what we learn, and are eager to keep this conversation going.

If you are wondering where your hospital stood in the grand scheme of things, here’s a graph that shows all participants and their totals (de-identified).   PDF: KC2016 (1) 

Kangaroo Challenge participants

We know our American friends have big barriers to overcome regarding parental presence (i.e. different policies related to maternity and parental leave), so we are pretty impressed with their results.

Thanks again for being great sports, wonderful teams, and amazing people!

Happy holding!


About the author

Kate Robson