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

Health Professionals' Knowledge and Attitudes About Neonatal Bathing and Factors Affecting Them: A Cross-Sectional Study

In pediatrics, the knowledge and approach of health professionals in bathing, which are one of the first care of the newborn, are important in the initiation and continuation of care by transferring it to parents. The aim of the study was to determine the knowledge, attitudes, and influencing factors of health professionals about newborn bathing. This descriptive and cross-sectional study was conducted with 140 health professionals working in neonatology between March and June 2023. Data were collected and analyzed using the "Participant description form" and "Knowledge and Attitudes Form on Newborn Bathing." Since there is no equivalent measurement tool in the literature, the Knowledge and Attitude Form on Newborn Bathing was designed and submitted for expert assessment. A final version with 21 items questioning knowledge (15 items) and attitude (6 items) was completed. The cutoff point in the form was determined as the correct response of 16 items (12 items or more for the knowledge and 4 items or more for the attitude section). Descriptive and comparative analyses were performed on the data. Significance was evaluated at 95% confidence interval. A total of 140 health professionals with a mean age of 31.4 years participated in the study. The first bath of the newborn was reported to be a wipe/sponge bath with 80% and 68.6% reported that the first bath should be with water only. About 70% reported that there were clues indicating that the newborn was ready for bathing and the first clues were absorption of vernix caseosa (22.6%) and umbilical cord shedding (11.9%). According to the answers of the Knowledge and Attitudes Form on Newborn Bathing, 74.3% of the participants had sufficient knowledge about bathing. A statistically significant difference was found between gender, occupation, education, institution, clinic, working time, and knowledge adequacy (p < 0.05). Although bathing seems harmless, it is ill-advised when it comes to newborns. The study determined that health professionals possess sufficient knowledge about newborn bathing. We recommend studies be conducted on how health professionals transfer their knowledge to mothers with new babies and how mothers apply their instructions and advice.

Immediate Care for Common Conditions in Term and Preterm Neonates: The Evidence

BACKGROUND

Several interventions provided to newborns at birth or within 24 h after birth have been proven critical in improving neonatal survival and other birth outcomes. We aimed to provide an update on the effectiveness and safety of these interventions in low- and middle-income countries (LMICs).

SUMMARY

Following a comprehensive scoping of the literature, we updated or re-analyzed the LMIC-specific evidence for included topics. Ninety-four LMIC studies were identified. Delayed cord clamping with immediate neonatal care after cord clamping resulted in a lower risk of blood transfusion in newborns <32-34 gestational weeks and a lower occurrence of anemia in term newborns but did not have significant effect on neonatal mortality or other common morbidities both in preterm and term newborns. Immediate thermal care using plastic wrap/bag led to a 38% lower risk of hypothermia and a higher axillary temperature in preterm newborns without increasing the risk of hyperthermia. Kangaroo mother care initiated immediately (iKMC) or early after birth (eKMC, within 24 h) significantly reduced neonatal mortality and the occurrence of hypothermia in preterm or low-birth-weight neonates. For delayed first bath in newborns, no pooled estimate was generated due to high heterogeneity of included studies. Trials from high-income countries demonstrated anti-D's effectiveness in lowering the incidence of Rhesus D alloimmunization in subsequent pregnancy if given within 72 h postpartum.

KEY MESSAGES

We generated the most updated LMIC evidence for several immediate newborn care interventions. Despite their effectiveness and safety in improving some of the neonatal outcomes, further high-quality trials are necessary.

BACKGROUND

Several interventions provided to newborns at birth or within 24 h after birth have been proven critical in improving neonatal survival and other birth outcomes. We aimed to provide an update on the effectiveness and safety of these interventions in low- and middle-income countries (LMICs).

SUMMARY

Following a comprehensive scoping of the literature, we updated or re-analyzed the LMIC-specific evidence for included topics. Ninety-four LMIC studies were identified. Delayed cord clamping with immediate neonatal care after cord clamping resulted in a lower risk of blood transfusion in newborns <32-34 gestational weeks and a lower occurrence of anemia in term newborns but did not have significant effect on neonatal mortality or other common morbidities both in preterm and term newborns. Immediate thermal care using plastic wrap/bag led to a 38% lower risk of hypothermia and a higher axillary temperature in preterm newborns without increasing the risk of hyperthermia. Kangaroo mother care initiated immediately (iKMC) or early after birth (eKMC, within 24 h) significantly reduced neonatal mortality and the occurrence of hypothermia in preterm or low-birth-weight neonates. For delayed first bath in newborns, no pooled estimate was generated due to high heterogeneity of included studies. Trials from high-income countries demonstrated anti-D's effectiveness in lowering the incidence of Rhesus D alloimmunization in subsequent pregnancy if given within 72 h postpartum.

KEY MESSAGES

We generated the most updated LMIC evidence for several immediate newborn care interventions. Despite their effectiveness and safety in improving some of the neonatal outcomes, further high-quality trials are necessary.

Effectiveness of Delayed First Baths on Transepidermal Water Loss in Late Preterm Infants: A Randomized Controlled Trial

PURPOSE

This study evaluates whether delaying the first bath affects late preterm infants' skin barriers, body temperatures, and comfort.

BACKGROUND

Late preterm infants' skin is drier and has a limited water retention capacity compared to term infants and adults. It is important to determine timing of care for this population with limited competencies.

METHODS

A two-arm, three-center, and single- and evaluator-blind randomized controlled trial was conducted. The study is based on the CONSORT guidelines. The participants were recruited from September 2020 to September 2021. The first baths of participants in the intervention group were postponed until 48 hours after birth. Outcomes were measured before bathing and 1, 10, and 30 minutes after bathing.

RESULTS

There was a statistically significant interaction between the groups and times for transepidermal water loss, body temperature, and comfort. The intervention group had a lower transepidermal water loss value at follow-up than the control group in the forearm and sternum. The control group had lower mean body temperatures and comfort levels.

CONCLUSION

When the first bathing of a late preterm infant is postponed by a minimum of 48 hours, it reduces damage to the skin barrier, body temperature is maintained, and the experience is more comfortable. Therefore, the first bath should be delayed for at least 48 hours after birth.

IMPLICATIONS FOR PRACTICE AND RESEARCH

The study can guide nurses to eliminate the uncertainty of the first bath applied for late preterm infants with a fragile structure in the neonatal intensive care setting and to eliminate the differences between clinics.

Birth and household exposures are associated with changes to skin bacterial communities during infancy

Background and objectives

Microbial exposures during infancy shape the development of the microbiome, the collection of microbes living in and on the body, which in turn directs immune system training. Newborns acquire a substantial quantity of microbes during birth and throughout infancy via exposure to microbes in the physical and social environment. Alterations to early life microbial environments may give rise to mismatches, where environmental, cultural and behavioral changes that outpace the body's adaptive responses can lead to adverse health outcomes, particularly those related to microbiome development and immune system regulation.

Methods

This study explored the development of the skin microbiome among infants born in Chicago, USA. We collected skin swab microbiome samples from 22 mother-infant dyads during the first 48 h of life and again at 6 weeks postpartum. Mothers provided information about social environments and hygiene behaviors that may impact infants' microbial exposures.

Results

Analysis of amplicon bacterial gene sequencing data revealed correlations between infant skin bacterial abundances shortly after birth and factors such as antibiotic exposure and receiving a bath in the hospital. The composition of the infant microbiome at 6 weeks of age was associated with interactions with caregivers and infant feeding practices. We also found shifts in maternal skin microbiomes that may reflect increased hygiene practices in the hospital.

Conclusions and implications

Our data suggest that factors related to the birth and household environment can impact the development of infant skin microbiomes and point to practices that may produce mismatches for the infant microbiome and immune system.

Early newborn bathing practice and its determinants among postpartum women in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Early baby bathing has a major negative impact on the newborn's health. Even though early newborn bathing has numerous detrimental effects on neonatal health, evidence has provided little attention on the current level of practice. Furthermore, there is a dearth of data regarding the overall effects of early newborn bathing in Ethiopia, which would be helpful to program and policy designers. This meta-analysis aimed to ascertain the level of early bathing practice and its determinants among postpartum women in Ethiopia.

METHODS

All articles were searched from the Web of Sciences, CINAHL (EBOSCO), Science Direct, MEDLINE, PubMed, Google Scholar, and Google websites from inception to October 10, 2023. The meta-analysis was performed using Stata version 18. The summary estimates with 95% CI were estimated using the random effect model with the Der Simonian Liard method. Heterogeneity was explored using Galbraith plot, Cochrane Q statistics, I2 statistics, and test of theta. To deal with the observed heterogeneity, subgroup analysis, sensitivity analysis, and meta-regression were done.

RESULTS

This meta-analysis included a total of 2787 postpartum women. The pooled level of early newborn bathing practice among postpartum women in Ethiopia was 55% [95% CI: 38-71]. Based on subgroup analysis by region, the highest level of early newborn bathing practice was among studies conducted in the Afar region which was 73% (95% CI: 69-77). There is a significant association between maternal level of education and early newborn bathing practice among postpartum women in Ethiopia (AOR = 0.51, 95% CI: 0.24, 0.78).

CONCLUSIONS

In this meta-analysis, the overall estimate illustrates that more than half of postpartum women practice early newborn bathing in Ethiopia. Maternal level of education was significantly associated with early newborn bathing practice. Thus, both the government and all the concerned stakeholders should take coordinated action to boost information dissemination and awareness creation among postpartum women thereby reducing the practice of early newborn bathing and alleviating consequences of early newborn bathing.

Gap identification for improvement in maternal and early infant health care practices among tribal pregnant women in an aspirational tribal district Sirohi, Rajasthan

Background

Sirohi is one of the aspirational districts of Rajasthan which is also tribal-dominated. The maternal and early infant health indicators are worrisome compared to regional or national statistics. First-trimester registration of pregnant women is 54% in district Sirohi, which is much less as compared to registration in the state of Rajasthan (63%) and India (59%). Four antenatal care (ANC) visits of pregnant women are 32% in district Sirohi, which is also much less as compared to ANC visits in the state of Rajasthan (39%) and India (51%). However, there was no tribal-specific data regarding maternal and early infant health.

Objective

The study aims to identify gaps for improvement in maternal and early infant health care practices among tribal pregnant women in an aspirational tribal district of Sirohi, Rajasthan.

Materials and Methods

It was a cross-sectional study conducted among 560 tribal pregnant women to assess the existing maternal, and early infant health care knowledge and practices through a pre-validated questionnaire in the tribal population of district Sirohi Rajasthan.

Result

Nineteen per cent (19.5%, n = 109) of tribal pregnant women got married between the age of 10 and 17 (less than the legal age of marriage of 18 years). There is a significant relationship between early age at marriage and low educational status P < 0.001, r = 0.241 among participants. Measurement of weight, blood pressure and urine examination was done in 32.5% (n = 181), 19.5% (n = 109) and 7.1% (n = 39), respectively, among tribal pregnant women. The majority (94.6%) of the pregnant tribal women (385/407) were anaemic. Approximately 60% (n = 337) of mothers were unaware of thermal protection (skin-to-skin care). Sixty per cent (n = 334) of tribal pregnant women preferred to seek consultation regarding antenatal and infant health care from doctors, while 40.1% (n = 224) were more comfortable seeking advice from traditional birth attendants (TBAs).

Conclusion

The study finds inadequate knowledge and practice towards maternal and early infant care among tribal pregnant women. As TBAs influence tribal pregnant women, systematic training and involvement of TBAs in maternal and child health are indispensable.

Neonatal Burn Injuries Managed in a Neonatal Intensive Care Unit of a Tertiary Hospital in North-Central Nigeria

Introduction

Neonatal burn injuries are rare in clinical practice. This explains the many case reports of such injuries. This is a report of our experience in the management of neonatal burn injuries in our centre.

Materials and Methods

This is a retrospective study of neonatal burn injuries that were managed over an eight year period (2014-2022). The information that was retrieved from the case notes included the socio-demographic data, birth weight, weight at admission, type of injury, total burn surface area (TBSA), depth of burn injury, type of treatment, length of hospital stay and outcome of care. The data were then entered into the SPSS version 25 (IBM Corp., United States) software and analysed.

Results

We managed 11 neonates, five males and six females with a male: female (M: F) ratio of 1:1.2. Their age ranged from zero to 25 days with a median (IQR) of 2 (1 -15) days. Eight (72.7%) of them were one to two days old and eight (72.7%) were admitted as out born. Majority (81.8%) of the mothers were primiparous women. Nine (81.8%) of the injuries were as a result of hot water bath. Most (66.6%) of these baths were done by the grandmothers or mothers of the babies. The total burn surface area (TBSA) ranged from 1% to 62%, with a median (IQR) of 11 (7.5 - 19.0). None of the babies had skin grafting. The length of stay (LOS) ranged from six days to 25 days with a median (IQR) of 11.0 (7.0 - 16.0) days. Only one baby died giving a hospital mortality rate of 9.1%.

Conclusions

The commonest cause of neonatal burn injury in this series is scald injuries from hot water bath. Providing education about safe bathing to caregivers should be included in routine antenatal and postnatal instructions in order to prevent burns.