Effect of Timing of the First Bath on a Healthy Newborn's Temperature

Maternal and child factors associated with late neonatal bathing practices in Nigeria: evidence from a national survey

BACKGROUND

Twohundred and seventy out of every thousand live births died in Nigeria in 2019. These deaths were attributable to infections, complications of preterm birth, and intrapartum-related conditions. The World Health Organization recommends withholding bathing of neonates until 24 h after birth or until their vital signs become stable to prevent hypothermia. Despite the link between neonatal bathing and thermal control, the subject is understudied in Nigeria. This study aimed at investigating the factors associated with late neonatal bathing practices in Nigeria.

METHODS

The study adopted a cross-sectional design and extracted data from the women's file of the 2018 Nigerian Demographic and Health Survey. The unit of analysis was limited to 12,972 women who had complete data for the study. We applied chi-square test of independence to ascertain the association between the outcome variable and explanatory variables. At 95% confidence interval, two logistic regression models were built with Model I consisting of only maternal factors whilst Model II contained both maternal and child factors, and results were presented in adjusted odds ratio.

RESULTS

Descriptively, 12% (CI = 0.122-0.134) of the women bathed their neonates after 24 h of delivery. Inferentially, women with secondary/higher education [AOR = 1.30, CI = 1.05-1.61], the rich [AOR = 1.24, CI = 1.03-1.50], those with access to mass media [AOR = 131, CI = 1.15-1.50], women that professed other religions [AOR = 9.28, CI = 4.24-17.56], those who delivered in a health facility [AOR = 1.93, CI = 1.66-2.25], whose child was small in size at birth [AOR = 1.46, CI = 1.21-1.77] and delivered by caesarean section [AOR = 2.50, CI = 1.97-3.18] had higher odds of bathing their neonates 24 h after birth.

CONCLUSIONS

The proportion of women who practised late neonatal bathing was generally low. To improve the practice of late neonatal bathing, much-concerted effort should be directed to women's education and approaches to increasing receptivity of late neonatal bathing among pregnant women through the media. The Nigerian Ministry of Health should incorporate routine counselling on the risks of bathing newborns prematurely into antenatal and postnatal care services.

Evidence-Based Consensus Recommendations for Skin Care in Healthy, Full-Term Neonates in India

Purpose

Neonatal skin care practices guided by personal experience and preferences might be substantially different across different hospital settings. The aim of this consensus recommendation is to provide clinical practice guidance to healthcare practitioners on evidence-based neonatal skin care practices from delivery-to-discharge, in hospital settings.

Patients and Methods

A Scientific Advisory Board meeting on "Evidence-based Neonatal Skin Care Practices and Protocols" was held in December 2020 with an expert panel comprising neonatologists, pediatricians, obstetricians and gynecologists and pediatric dermatologist. Comprehensive literature search was performed up to 23 March 2021 using PubMed and Google Scholar to retrieve relevant evidence.

Results

Recommendations were developed on critical aspects of skin care in healthy full-term neonates including cleansing at birth, skin-to-skin care, cord care, diaper area care, initial and routine bathing, cleansers and emollients use, and criteria to choose appropriate skin care products. Recommendations include inclusion of skin assessment in routine neonatal care, first bath timing after cardio-respiratory and thermal stabilization, 6-24 hours after birth; bathing with water alone or adding a mild liquid cleanser could be considered appropriate as it does not impact the developing skin barrier; use of emollients is recommended for neonates with higher risk of development of eczema to maintain and enhance skin barrier function and integrity; and inclusion of skin care advice in neonatal discharge checklist. Importance of rigorous quality control, high-quality clinical trials for assessment of baby products, usage of products that are formulated appropriately for newborns, and full label transparency for baby products were highlighted. The panel identified gaps in literature and discussed the scope for future research.

Conclusion

These recommendations may help to standardize evidence-based skin care for healthy full-term neonates in Indian hospital settings to improve the quality of care that neonates receive in hospital and facilitate improvement in overall neonatal health outcomes.

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.

Variation in Newborn Skincare Policies Across United States Maternity Hospitals

OBJECTIVE

Newborn skincare influences levels of beneficial factors from vernix and vaginal secretions but also the emergence of potential skin pathogens. However, evidence-based national guidelines for newborn skincare do not exist, and actual hospital practices for newborn skincare have not been described. In this study, we test the hypothesis that US maternity hospitals follow differing policies with regard to newborn skincare.

METHODS

A 16-question survey querying skin care practices was distributed to nursery medical directors at the 109 US hospital members of the Better Outcomes through Research for Newborns network. Data from free text responses were coded by 2 study personnel. Survey responses were analyzed by using descriptive statistics and compared by region of the United States.

RESULTS

Delaying the first newborn bath by at least 6 hours is a practice followed by 87% of US hospitals surveyed. Discharging newborns without a bath was reported in 10% of hospitals and was more common for newborns born in nonacademic centers and on the West Coast. Procedures and products used for newborn skincare varied significantly. Parental education on tub immersion and soap use was also inconsistent and potentially contradictory between providers. Evidence cited by hospitals in forming their policies is scant.

CONCLUSION

In this study, we identify similar and strikingly different newborn skincare policies across a national network of US maternity hospitals. Research is needed to identify effects of differing skincare routines on skin integrity, infection rates, and childhood health outcomes to improve the evidence base for the care of newborn skin.

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.

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.

Effects of Skin-to-Skin Care During Cesareans: A Quasiexperimental Feasibility/Pilot Study

Introduction: Our aim was to describe feasibility and outcomes of skin-to-skin care (SSC) that began during cesarean surgery and continued, uninterrupted, for about 5 hours. We described maternal/newborn measures of physiologic stability and stress; maternal measures of comfort; maternal satisfaction with surgery and SSC; and exclusive breast milk feeding at discharge. Materials and Methods: We used a quasiexperimental, time-interrupted design and randomly assigned women to receive SSC that began during surgery (Group 1, intervention; n = 20) or after surgery, before transfer to recovery (Group 2, standard care; n = 20). We analyzed differences across time and for five observations: before transfer to the operating room (OR); in the OR, about 20 minutes after birth; in the recovery room, about 1 hour after admission; in the New Family Center (NFC), about 1 hour after admission; and in the NFC, about 2 hours after admission. Results: Group 1 began SSC an average of 0.89 minutes after birth and continued an average of 300 minutes and Group 2 began an average of 46 minutes after birth and continued an average of 126 minutes. Women who began SSC during surgery were more satisfied with the experience (p = 0.015) and had lower levels of salivary cortisol across time (p = 0.003). We found no negative effects on maternal or newborn measures of physiologic stability and no difference in exclusive breast milk feeding rates at discharge. Conclusion: Immediate and uninterrupted SSC during medically uncomplicated cesarean surgery is a feasible, low-cost intervention that can safely begin during surgery and continue, uninterrupted, for extended durations.