Kangaroo Care on HFJV in Micro Preemies: Feasibility, Physiology, and Unit Processes

The MDPI Children report on kangaroo care on high-frequency jet ventilation describes one NICU’s approach to skin-to-skin holding for extremely low birth weight infants supported on HFJV during the hold, with transfers performed using precautions intended to keep the ventilator circuit intact and avoid loss of baseline PEEP.

The authors pair a stepwise transfer workflow—focused on protecting the endotracheal tube and maintaining ventilator circuit integrity—with physiologic comparisons at three defined time points: pre-hold, during the hold (recorded at ~30 minutes after placement), and post-hold.

The authors characterize the work as a single-center, retrospective quality-improvement assessment in a Level IV NICU, drawing data from electronic medical records and protocolized bedside documentation. The cohort comprised 13 neonates contributing 96 HFJV kangaroo-care occurrences; baseline descriptors included a median gestational age of 24 1/7 weeks and a median birth weight of 670 g. Kangaroo care began a median of 16 days after birth, and the manuscript reports a median cumulative skin-to-skin exposure of 11 hours per neonate (interquartile range 6–15 hours). All sessions were performed while infants were on HFJV and were conducted within a multidisciplinary protocol framework, tying the feasibility question to a defined population and repeated, protocol-driven exposure.

Across the authors’ pre-, intra-, and post-session comparisons, mean heart rate was not statistically different across the three measurement points, and axillary temperature did not differ between pre- and post-session values (with during-session temperature data excluded due to limited documentation). Oxygenation metrics showed small, statistically significant post-session changes: mean SpO2 increased from 91.8% before kangaroo care to 92.8% after (p = 0.046), and a reduction in FiO2 was reported post–kangaroo care compared with the during-session value (p = 0.002), while other FiO2 comparisons were not statistically significant. Overall, the physiologic pattern is presented as stability with modest oxygenation-related shifts in the immediate post-session period.

Monitoring and documentation were described as continuous electronic cardiorespiratory and pulse oximetry monitoring using a Philips Intellivue (MX800) platform, supplemented by bedside nurse assessments every 30 minutes during the hold. For analysis, the authors used the first intra-session data point (recorded 30 minutes after the infant was placed on the parent’s chest) when multiple intra-session recordings existed. They also note that temperature during kangaroo care was not consistently documented and therefore intra-session temperature points were excluded from analysis. The protocol specified early-termination criteria of bradycardia below 80 beats/min or sustained desaturation requiring an FiO2 increase greater than 10% from baseline for more than 15 minutes, and the authors report these thresholds were not observed as triggers for stopping sessions; two inadvertent endotracheal tube dislodgements were reported during kangaroo care in this series.

Unit implementation details centered on a deliberately standardized, multidisciplinary HFJV-KC protocol described by the authors with defined eligibility examples, including age greater than 72 hours, HFJV mean airway pressure under 15 mmHg, FiO2 under 0.5, and absence of oxygen lability, with exclusions that included air leak and hemodynamic instability requiring vasopressors; participation required attending neonatologist approval. Transfers were performed by a four-person team (two nurses and two respiratory therapists) with equipment-handling priorities that included keeping the dual HFJV circuit intact, avoiding loss of baseline positive end-expiratory pressure, and preventing endotracheal tube dislodgement, supported by mannequin-based education and an instructional transfer-method video.

In a duration-focused secondary analysis, most sessions lasted more than one hour (69%), and the manuscript reports a mean duration of 2.3 hours in the prolonged group; comparisons between approximately 1-hour sessions and sessions longer than 1 hour showed no statistically significant differences in heart rate, SpO2, FiO2, or temperature, aligning the duration findings with the same structured workflow and monitoring cadence.

Key Takeaways:

• A single-center retrospective quality-improvement report describes repeated kangaroo-care sessions conducted while micro preterm infants remained on HFJV under a multidisciplinary protocol.
• Physiologic comparisons were reported as stable for heart rate and temperature, with small post-session changes in oxygenation metrics (SpO2 up and FiO2 down) described by the authors.
• The manuscript details staffing, continuous monitoring with defined termination thresholds, and a transfer method with training supports; a duration comparison reported no significant physiologic differences between shorter and longer sessions.