779 - Improving Kangaroo Care in a Level IV Neonatal Intensive Care Unit with a Focus on Families with Preferred Language Other than English

Publication Number: 1755.779

Henna Shaikh, University of Washington School of Medicine, Seattle, WA, United States; Stephanie Yeager, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Raisa Galbizo, University of Washington School of Medicine, Sammamish, WA, United States; Olivia Moretti, University of Washington School of Medicine, Seattle, WA, United States; Sarah Kolnik, University of Washington - Seattle Children's Hospital, Seattle, WA, United States

Background: Early and frequent skin-to-skin holding, known as kangaroo care (KC), has proven physiologic benefits and can empower parents of infants in the neonatal intensive care unit (NICU), which may serve to interrupt well-documented systemic inequities in the US healthcare system. Baseline analysis suggested that families with preferred language other than English (PLOE) in our level IV NICU experienced a greater delay in KC compared to families with preferred language of English (PLE) (median time to first hold of 131 vs 52 hours, p< 0.05).

Objective: To reduce the median time to first KC hold for newborns of families with PLOE in our NICU to less than 24 hours, in line with our goal for all families.

Design/Methods: A large multidisciplinary quality improvement (QI) initiative to improve overall KC has been ongoing in our unit from Sept. 2023-Oct. 2025. Six plan-do-study-act (PDSA) cycles have been completed, with the latter three focusing on KC disparities for families with PLOE. The primary outcome measure was median time to first hold. The key process measure was KC documentation. Balancing measures were unplanned extubations, bradycardia, desaturations, and hypothermia. Mann-Whitney and Fisher’s exact test were used to determine if differences existed in median time to first hold, demographics and balancing measures in infants with mothers PLOE and PLE. Control charts for median time to first hold were used to track changes over time for all infants, infants of families with POLE, and infants of families with PLE.

Results: Key drivers for KC were ascertained from stakeholder meetings and are shown in Fig 1. Awareness of KC and communication with families were highlighted as key drivers for families with PLOE. KC data was collected on 1139 infants (77% of all admitted infants). 1032 had PLE and 103 had PLOE. There were no differences in demographics or balancing measures between groups (Table 1). Median time to first hold decreased in all groups (Fig 2), however, a significant difference persisted between patients with PLOE compared to PLE (32 vs 19 hours, respectively (p < 0.05) (Table 1)). Nonetheless, data tracking indicated special-cause variation with a decrease in median time to KC for families with PLOE from 49 to 32 hours (Fig 2).

Conclusion(s): This QI initiative successfully shifted the median time to KC for families with PLOE, however, we have not yet achieved our goal of KC within 24 hours of birth for patients of families with PLOE. Continued PDSA cycles will aim to further improve KC provision and reduce KC disparities for families with PLOE.

Perinatal demographics and balancing measures for infants admitted to the neonatal intensive care unit during this quality improvement initiative
KC UW QI PAS 2026 Table 1.pdfThis table displays characteristics of all admitted infants in our neonatal intensive care unit during this quality improvement initiative along with balancing measures.

Figure 1. Key drivers for kangaroo care
KC UW QI PAS 2026 Figure 1.pdfKey drivers were identified through meetings with key stakeholders in the neonatal intensive care unit. Key drivers that impact equity for families with preferred language other than English have a red box around them.

Control charts of median time to first kangaroo care hold
KC UW QI PAS 2026 Figure 2.pdfControl charts of median time to first KC. QI study from Sept 2023 to Oct 2025. Process change occurred in January 2024 with a change of KC documentation. PDSA cycles: 1) improving KC documentation in the EMR, 2) updating KC guidelines, 3) integrating KC into a rounding checklist, 4) displaying equity-focused KC infographics in the NICU, 5) weekly equity-focused KC messaging in QI huddles, and 6) nursing education on disparities in KC. A) All admitted patients: Median time to first hold for all infants (n=1139) was 21 hours. Upper confidence limit (UCL) 31 hours and lower confidence limit (LCL) 10 hours. B) Patients of mothers with preferred language other than English (PLOE): Special cause variation identified with 8 data points under the median, therefore in Oct of 2025, the median time to first hold for infants of mothers with PLOE (n=103) significantly decreased from 49 to 32 hours. Upper confidence limit (UCL) 140 hours and lower confidence limit (LCL) 0 hours. C) Patients of mothers with preferred language English (PLE): Median time to first hold for infants of mothers with PLE (n=1032) was 19 hours. Upper confidence limit (UCL) 32 hours and lower confidence limit (LCL) 6 hours.