Swaddled bathing in the Newborn Intensive Care Unit

Physiological responses and behavioural organization of very low birth weight infants during swaddled versus traditional weighing

AIM

Despite the consequences of neonatal distress and agitation, preterm infants undergo stress owing to weighing procedures. The objective of this study was to enable very low birth weight infants to maintain adequate self-regulation during weighing.

DESIGN

This prospective crossover study utilizes a within-subjects design, where intervention days were compared to control days.

METHOD

Infants were exposed to both swaddled and unswaddled weighing in an intensive care nursery setting. Nineteen very low birth weight infants were weighed on two consecutive days. Variables of heart rate, respiratory rate and ALPS-Neo score were recorded.

RESULTS

Stress score decreased significantly from 1.65 (pre-weight) to 0.23 (weight measurement) in swaddled-intervention periods; conversely, it increased significantly from 1.26 (pre-weight) to 4.97 (weight measurement) in control periods. During weight measurement, heart and respiratory rate were significantly lower for swaddled-intervention days when compared to control days. Given the significant impact of swaddled weighing in reducing stress, this method can be used as an appropriate weighing procedure in intensive care. This research has no patient or public contribution.

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.

Effect of newborn bathing training with the swaddled and tub bathing methods given to primiparous pregnant women on the mother's experience, satisfaction and newborn's stress during the first bathing of the newborn at home: A mixed method study

AIM

The aim of this study is to compare the effect of two different bathing methods training given during pregnancy on the mother's experience, satisfaction and newborn's physiological and behavioral parameters during the first bathing of the newborn at home.

METHODS

A mixed methods research was used in this study. The groups were determined as swaddled bathing (SB) (n = 31) and tub bathing (TB) (n = 31). After training given to the groups, the first bath of the newborn in both groups was built by the mothers. The body temperature, heart rate, oxygen saturation, respiration rate, crying times, stress parameters of the newborns and mother satisfaction in both groups were evaluated. The open-ended questions were used to determine mothers' experiences.

RESULTS

There was a statistically significant difference between the groups in terms of oxygen saturation, respiration rate, crying time, face/forehead grimacing, unrest and maternal satisfaction. Four categories and 14 subcategories made up the qualitative part of the study which includes the experiences of the mother about two different bathing methods. "The feelings and worries of the mothers about first bathing" refers to the participants in both groups how they feel during the first bathing; "Positive aspects of this method compared to other bath method" and "Negative aspects of this method compared to other bath method" refers to positive and negative aspects of different bathing methods applied to groups; "Difference between the applied bathing method and other methods" refers to differences they observed when compared to other bathing methods. The mothers in the SB group had less fear of drowning hazard and injuring the newborn, and the fear of uneasiness and the newborn slipping down from hands were more frequent in the TB group.

CONCLUSION

It was determined that both bath methods reduced body temperature, the SB method decreased the stress of newborns and had a positive effect on mother satisfaction and experience.

Biobehavioral Responses of Preterm Infants to Conventional and Swaddled Tub Baths: A Randomized Crossover Trial

Bathing is a routine care procedure that exposes preterm infants to prolonged handling, which could cause stress and potentially disrupt infants' biobehavioral responses. The aim of this double-blind randomized crossover trial was to compare the preterm infant's body temperature, heart rate (HR), peripheral capillary oxygen saturation (SpO2), salivary cortisol levels, and sleep-wake states during and after swaddled and conventional tub baths. Forty-three infants born at 32 to 36 weeks postmenstrual age, weighing 2225 g or less, were enrolled in the study. Infants were videotaped before and after each type of baths. The time interval between baths ranged from 24 to 72 hours to allow a washout period. Physiological, hormonal, and behavioral responses were collected at baseline and during recovery from baths. No significant differences in the mean body temperature, HR, SpO2, salivary cortisol levels, and sleep-wake states between the bath types were observed in the baseline or recovery responses during the first 20 minutes after bath. Regardless of bath type, salivary cortisol levels showed a nonstatistical significant increase.

Effects of swaddled and traditional tub bathing methods on crying and physiological responses of newborns

PURPOSE

The purpose of this study was to examine the effects of two bathing methods on crying duration and physiological measurements of newborns.

DESIGN AND METHODS

A randomized trial design was used in this study. The sample consisted of newborns (n = 80) who were admitted to neonatal intensive care unit of a university hospital located in a large city. The groups were determined as swaddled bathing (SB) (n = 40) and traditional tub bathing (TTB) (n = 40) by using random number table. All newborns were bathed 24 hours after the birth. Environmental variables were organised identically in both experimental and control groups. Duration of bathing was determined as maximum 5 min in both groups. Body temperature, heart rate (HR), and O₂ saturation values were evaluated before bath, just after the bath and at 10 min after the bath. The groups were compared in terms of all vital symptoms and duration of crying during bath. Pre-bath and post-bath stress levels between newborns in both groups were compared by using the Newborn Infant Pain Scale (NIPS).

RESULTS

When the newborns were compared based on groups, it was observed that there was no statistically significant difference between SB and TTB groups in terms of the gestational week, APGAR score, postnatal age, and body weight. Body temperatures of the newborns in SB group just after the bath and 10 minutes after the bath were significantly higher than those in TTB group. HR was higher in TTB group in the post-bath period. NIPS scores of the newborns in SB group after bath decreased at a statistically significant level, but the scores of the newborns in TTB group increased. The results of the study indicated that SB was effective in maintaining body temperature, SpO₂ level, and HR of newborns within normal limits and may decrease stress experienced during the bath.

PRACTICE IMPLICATIONS

Swaddled bathing decreases behavioural stress symptoms such as crying, agitation, and pulling arms and legs back unintentionally and thus the infants feel relaxed. Swaddled bathing can be recommended because swaddled bathing method decreases behavioural stress symptoms in infants.

Bathing and Beyond: Current Bathing Controversies for Newborn Infants

BACKGROUND

Bathing the newborn infant is controversial, ranging from how and when to give the newborn their first bath, whether to bathe newborns at all in the initial days of life, and how to approach bathing the hospitalized premature and full-term infant in the neonatal intensive care unit (NICU).

PURPOSE

To review relevant literature about bathing newborn infants, as well as examine the controversies about bathing NICU patients including the use of daily chlorhexidine gluconate (CHG) baths.

FINDINGS

Despite studies showing that temperature can be maintained when the first bath was at 1 hour after delivery, there are benefits from delaying the bath including improved breastfeeding. Tub or immersion bathing improves temperature, and is less stressful. It is not necessary to bathe infants every day, and premature infants can be bathed as little as every 4 days without an increase in skin colonization. No differences have been reported in skin parameters such as pH, transepidermal water loss, and stratum corneum hydration whether the first and subsequent baths are given using water alone or water and a mild baby cleanser. Concerns about systemic absorption suggests caution about widespread practice of daily CHG bathing in the NICU until it is known whether CHG crosses the blood-brain barrier, particularly in premature infants.

IMPLICATIONS FOR PRACTICE AND RESEARCH

Research regarding bathing practices for NICU patients should be evidence-based whenever possible, such as the benefits of immersion bathing. More evidence about the risks and benefits of daily CHG bathing is needed before this practice is widely disseminated.

Endotracheal suctioning in preterm infants using four-handed versus routine care

OBJECTIVE

To evaluate the effect of four-handed care on preterm infants' physiologic and behavioral responses to and recovery from endotracheal suctioning versus routine endotracheal (ETT) suctioning.

DESIGN

Randomized crossover design with infants as their own controls.

SETTING

Single-family-room newborn intensive care unit in an academic health center.

PARTICIPANTS

Ten intubated infants on conventional ventilation with inline suctioning who were fewer than 37 weeks gestation at birth, and less than one week of age.

METHODS

Each infant was observed twice on a single day. One observation involved routine ETT suctioning and one involved four-handed care. Physiologic and behavioral response data were collected.

RESULTS

No differences were noted when comparing baseline heart rate (HR) or oxygen saturation (SpO(2)) data to those obtained during and after suctioning while in the routine care condition. In the four-handed care condition, mean SpO(2) increased from preobservation 95.49 to during observation saturation 97.75 (p = .001). Salivary cortisol levels did not differ between groups at baseline or postsuctioning. No significant difference in behavior state was observed between the two conditions. More stress and defense behaviors occurred postsuctioning when infants received routine care as opposed to four-handed care (p = .001) and more self-regulatory behaviors were exhibited by infants during (p = .019) and after suctioning (p = .016) when receiving four-handed care. No statistical difference was found in the number of monitor call-backs postsuctioning.

CONCLUSIONS

Four-handed care during suctioning was associated with a decrease in stress and defense behaviors and an increase in self-regulatory behaviors.