Does Changing Newborn Bath Procedure Alter Newborn Temperatures and Exclusive Breastfeeding?

Timing of first bath in term healthy newborns: A systematic review

Background

This systematic review of intervention trials and observational studies assessed the effect of delaying the first bath for at least 24 hours after birth, compared to conducting it within the first 24 hours, in term healthy newborns.

Methods

We searched MEDLINE via PubMed, Cochrane CENTRAL, Embase, CINAHL (updated till November 2021), and clinical trials databases and reference lists of retrieved articles. Key outcomes were neonatal mortality, systemic infections, hypothermia, hypoglycaemia, and exclusive breastfeeding (EBF) rates. Two authors separately evaluated the risk of bias, extracted data, and synthesized effect estimates using relative risk (RR) or odds ratio (OR). The GRADE approach was used to assess the certainty of evidence.

Results

We included 16 studies (two trials and 14 observational studies) involving 39 020 term or near-term healthy newborns. Delayed and early baths were defined variably in the studies, most commonly as >24 hours (six studies) and as ≤6 hours (12 studies), respectively. We performed a post-hoc analysis for studies that defined early bath as ≤6 hours. Low certainty evidence suggested that bathing the newborn 24 hours after birth might reduce the risk of infant mortality (OR = 0.46, 95% confidence interval (CI) = 0.28 to 0.77; one study, 789 participants) and neonatal hypothermia (OR = 0.50, 95% CI = 0.28-0.88; one study, 660 newborns), compared to bathing within first 24 hours. The evidence on the effect on EBF at discharge was very uncertain. Delayed bath beyond 6 hours (at or after nine, 12, or 24 hours) after birth compared to that within 6 hours might reduce the risk of hypothermia (OR = 0.47, 95% CI = 0.36-0.61; four studies, 2711 newborns) and hypoglycaemia (OR = 0.39, 95% CI = 0.23-0.66; three studies, 2775 newborns) and improve the incidence of EBF at discharge (OR = 1.12, 95% CI = 1.08-1.34; six studies, 6768 newborns); the evidence of the effect on neonatal mortality was very uncertain.

Conclusion

Delayed first bath for at least 24 hours may reduce infant mortality and hypothermia. Delayed bath for at least 6 hours may prevent hypothermia and hypoglycaemia and improve EBF rates at discharge. However, most of these conclusions are limited by low certainty evidence.

Registration

PROSPERO 2020 CRD42020177430.

Early Newborn Bath Practice and Its Associated Factors in Jimma, South West Ethiopia, 2021

Aims

The timing of the first bath is an important variable in newborn care despite variations from setting to setting. Early first bath can affect the newborn’s temperature, blood sugar levels, bonding with his/her mother, comfort, and security. Thus, timing affects several aspects of newborn care and is still a major concern. However, in Ethiopia, there is insufficient evidence regarding newborn bath timing. Therefore, this study aimed to assess early newborn bath practice and its associated factors in Jimma, Southwest Ethiopia, 2021.

Materials and Methods

An institutional-based cross-sectional study was conducted from July to August 2021 on 388 postpartum women who came for newborn immunization. Data were collected through face-to-face interviews using a structured questionnaire. Data were entered into Epi-data 4.4.2.1 and exported to Stata version 14 for cleaning and analysis. Logistic regression was used to determine the association between explanatory and response variables. The level of significance was declared at a p-value of less than 0.05 in multivariable logistic regression.

Results

This study revealed 126 (32.5%) of mothers were practicing early newborn bathing. Vaginal mode of delivery (AOR: 3.84 (95% CI: 1.96–7.52)), poor knowledge about danger signs (AOR: 6.78 (95% CI: 3.77–12.19), poor knowledge about hypothermia (AOR: 0.35 (95% CI: 0.20–0.58) and educational level of women (AOR: 0.33 (95% CI: 0.15–0.73) were variables significantly associated with early newborn bathing practice.

Conclusion

Early neonatal bathing practice in this study is high and needs priority as it results in neonatal hypothermia and its complications. Therefore, Education for women and their families on delayed bathing of their newborns could begin in antenatal care visit, on admission into the labor and delivery unit and again on the postpartum unit.

An Organization-Wide Initiative to Implement Parent-Performed, Delayed Immersion Bathing

OBJECTIVE

To implement an organization-wide evidence-based practice change to parent-performed, delayed immersion newborn bathing across nine facilities at a military health care system.

DESIGN

Organization-wide evidence-based practice initiative using preimplementation and postimplementation data.

SETTING

A military health system consisting of four medical centers and five community hospitals that averages 4,000 births each year.

PARTICIPANTS

Term newborns (≥37 weeks gestation) born within the nine facilities.

INTERVENTION/MEASUREMENTS

Champions were identified at each facility to change bathing practice. Baths for newborns were delayed until 24 hours of age, unless otherwise requested. Parents were instructed how to tub bathe their newborn and encouraged to complete the bath in less than 5 minutes. The team reviewed 100 records from each hospital and compared pre- and postimplementation temperature data.

RESULTS

The organization-wide practice change showed a statistically significant association between time point (i.e., before vs. after implementation) and postbathing hypothermia (χ² = 30.91, p < .001). In addition, data also showed fewer hypothermic temperature readings (i.e., <97.7 °F [<36.5 °C]) from the onset of birth until 8 hours of life with the new bathing process. Although this difference was not statistically significant (p = .11), it holds clinical significance if it can be replicated; newborn hypothermia requires provider notification and can lead to additional testing to rule out infection and other concerns.

CONCLUSION

Delaying newborns' first bath was associated with a significant decrease in the number of newborns who had hypothermic temperature readings immediately after the bath. The intervention involved minimal cost with multiple benefits. Delayed immersion bathing is a family-friendly process that can be implemented across an organization.

Newborn's first bath: any preferred timing? A pilot study from Lebanon

Objective

To try to find the most appropriate time for the newborn’s first bath. This prospective randomized study was conducted in one hospital (July–September 2017).

Results

A higher percentage of newborns who had a skin-to-skin contact with their mothers had their bath at 24 h vs 2 h after birth (65.2% vs 33.3%; p = 0.01). A higher percentage of mothers who helped in their baby’s bath had their baby’s bath at 24 h vs 2 h (65.2% vs 5.9%; p < 0.001) and vs 6 h (65.2% vs 15.7%; p < 0.001) respectively. A higher mean incubation time was seen between newborns who had their bath at 2 h (2.10 vs 1.78; p = 0.002) and 6 h (2.18 vs 1.78; p = 0.003) compared to those who had their bath at 24 h respectively. A higher percentage of newborns who took their first bath 24 h after birth were calm compared to crying vigorously (38.6% vs 9.1%; p = 0.04). Delaying newborn first bath until 24 h of life was associated with benefits (reducing hypothermia and vigorous crying, benefit from the vernix caseosa on the skin and adequate time of skin-to-skin contact and mother participation in her child’s bathing.

A Clinical Pathway for Hospitalized Pediatric Patients With Initial SARS-CoV-2 Infection

The novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread quickly across the globe, creating unique and pressing challenges for today's physicians. Although this virus disproportionately affects adults, initial SARS-CoV-2 infection can present a significant disease burden for the pediatric population. A review of the literature yields descriptive studies in pediatric patients; however, no evidence-based or evidence-informed guidelines for the diagnosis and treatment of the hospitalized pediatric patient have been published in peer-reviewed journals. The authors, working at a quaternary care children's hospital in the national epicenter of the SARS-CoV-2 pandemic, found an urgent need to create a unified, multidisciplinary, evidence-informed set of guidelines for the diagnosis and management of coronavirus disease 2019 in children. In this article, the authors describe our institutional practices for the hospitalized pediatric patient with confirmed or suspected initial SARS-CoV-2 infection. The authors anticipate that developing evidence-informed and institution-specific guidelines will lead to improvements in care quality, efficiency, and consistency; minimization of staff risk of exposure to SARS-CoV-2; and increased provider comfort in caring for pediatric patients with SARS-CoV-2 infection.

Effects of Delayed Newborn Bathing on Breastfeeding, Hypothermia, and Hypoglycemia

OBJECTIVE

To determine whether delaying the newborn bath by 24 hours increases the prevalence of breastfeeding initiation and exclusive breastfeeding at discharge in healthy full-term and late preterm newborns (34 0/7-36 6/7 weeks gestation) and to examine the effect of delayed newborn bathing on the incidences of hypothermia and hypoglycemia.

DESIGN

Pre-post implementation, retrospective, cohort study.

SETTING

Provincial children's hospital with an average of 2,500 births per year.

PARTICIPANTS

Healthy newborns (N = 1,225) born at 34 0/7 weeks or more gestation who were admitted to the mother-baby unit.

METHODS

We compared newborns who were bathed before 24 hours (n = 680, preimplementation group) to newborns who were bathed after 24 hours (n = 545, postimplementation group).

RESULTS

After adjustment for confounders, the odds of exclusive breastfeeding at discharge were 33% greater in the postimplementation group than in the preimplementation group (adjusted odds ratio = 1.334; 95% confidence interval [1.049,1.698]; p = .019). Delayed bathing was associated with decreased incidence of hypothermia and hypoglycemia (p = .007 and p = .003, respectively). We observed no difference in breastfeeding initiation between groups.

CONCLUSION

Delaying the newborn bath for 24 hours was associated with an increased likelihood of exclusive breastfeeding at discharge and a decreased incidence of hypothermia and hypoglycemia in healthy newborns. The implementation of a delayed bathing policy has the potential to improve breastfeeding rates and reduce the incidence of hypothermia and hypoglycemia.

Initiative to Improve Exclusive Breastfeeding by Delaying the Newborn Bath

OBJECTIVE

To examine whether delayed newborn bathing would increase rates of in-hospital exclusive breastfeeding and plans to use human milk at discharge.

DESIGN

A retrospective, two-group, pre- and postintervention design.

SETTING/LOCAL PROBLEM

At our facility, the initial bath was completed within 2 hours of birth, and the rate of in-hospital exclusive breastfeeding was low.

PARTICIPANTS

Couplets of mothers and healthy newborns (N = 996).

INTERVENTION/MEASUREMENTS

Newborn baths were delayed at least 12 hours after birth. Pre- and postintervention data were retrieved from the hospital's electronic medical record and administrative database. Univariate and multivariate analyses were completed.

RESULTS

Of 996 mother-newborn couplets, 448 were preintervention couplets and 548 were postintervention couplets. Of all mothers, 63.3% were White, 67.8% were married, and 67.1% gave birth vaginally. Of all newborns, 49.6% were female, and the mean (standard deviation) birth weight was 3.3 kg (0.50). We found no differences in maternal or newborn characteristics by group. Median (25th percentile, 75th percentile) times from birth to first bath before and after the intervention were 1.9 (1.6, 2.3) and 17.9 (11.9, 25.0) hours, respectively (p < .001). In-hospital exclusive breastfeeding increased from 59.8% before the intervention to 68.2% after the intervention (p = .006). In multivariate modeling, in-hospital exclusive breastfeeding increased for all couplets after the intervention (odds ratio = 1.49, 95% confidence interval [1.14, 1.96]; p = .004) and with vaginal versus cesarean birth (odds ratio = 1.60, 95% confidence interval [1.14, 2.25]; p = .006). In addition, the postintervention discharge feeding plan reflected an increase in use of human milk.

CONCLUSION

Delaying the newborn bath was associated with increased in-hospital exclusive breastfeeding rates and use of human milk as a part of the discharge feeding plan.