Delayed Newborn Bathing: Why It is Being Encouraged and Practiced in Hospitals

Introduction

Newborn bathing in the past has always been done immediately after a mother gives birth to her child and the reason being is mostly for hygienic purposes. However in recent studies, it has been discovered that delaying newborn bathing is very beneficial to the newborn infant, whether it be via normal delivery or cesarian section.

In hospital births, immediate bathing of infants was a standard practice soon after being born. The baby is taken from mother by the newborn care team, thoroughly bathed before being brought back to the mother for rooming-in. This way, the pediatric team will have an ample time to do post birth assessment care and for the OB team to wrap up the post-delivery care.

Sometime in the year 2013, the usual practice of bathing newborns started to change and pediatric experts studied as to when newborn bathing should be done. According to the World Health Organization, they have released a statement stating that newborn bathing should be done at least 24 hours after birth. Although for some cultural beliefs that do not allow this, bathing is done at least 6 hours after birth. It is also highly recommended for the infant to wear appropriate clothing to control body temperature.

Rooming-in with the mother 24 hours a day/7 days a week is also encouraged and mother-infant should not be separated as this is one of the most important parts of bonding. A campaign regarding delaying the bathing of a newborn for 8 hours was also announced by the Association of Women’s Obstetric, Health, and Neonatal Nurses to reduce the instability associated with stress relating to cold. In this paper, the effects and benefits of delaying new born bathing will be discussed based on studies made by experts in the pediatric society.

Interview with the RN

At the time of my clinical rotation at Kaiser Permanente Foundation Hospital Riverside Medical Center, I had the pleasure of observing my assigned nurse on how to perform proper newborn bathing. As my nurse bathed the infant, I took the liberty of asking her questions pertaining to delaying newborn bathing, such as to when is the proper time to bathe a newborn.

As per the RN, the bathing is usually done 12 hours after the infant was born. Some of the reasons include (but not limited to): reducing the risk of infection, to stabilize the infant’s blood sugar, to prevent newborn hypothermia, to create maternal-infant bond, and to improve breastfeeding.

As I observed, my nurse wiped the newborn’s body with pre-moistened disposable baby wash cloth and then proceeded to wipe the infant’s head. I then asked her how she learned how to properly bathe a newborn infant, if there is a correct way to do it, and what to avoid in bathing the infant. The nurse said she learned how to bathe newborns simply by observing preceptors. She also provides crucial bathing techniques to first time mothers to make sure these mothers are well informed once they are home and have to do the bathing of their babies without the supervision of a nurse or midwife.

Also mentioned by the nurse, there are other acceptable methods in bathing a newborn for the first time. Usually 12 to 24 hours post-delivery, given that there are no complications involved.

Locating the Evidence

A policy has been established at Kaiser Permanente Foundation Hospital Riverside Medical Center regarding delayed newborn bathing; Section Perinatal Services, Policy No. 2090, titled Bathing the Newborn/Umbilical Cord Care. This policy was effective in September 1989, recently reviewed on April 2002, and revised on June 2017. As stated in the policy, “bath will be done only after the infant’s temperature has been stable (at least 36.5C) and baby is a least 12 hours old”. The purpose stated in the policy is “to cleanse the infant as needed while promoting bonding and neuro-development in the initial hours of life.”

Also stated in Policy No. 2090, “a neutral thermal environment will be provided for bathing”, to prevent hypothermia in the newborn. My nurse was able to give the newborn bath and followed the hospital’s policy accordingly and made sure that the room was not too cold before she provided the bath. I observed as my nurse performed the procedure for the infant, and I was able to listen close as she provided teaching to the first-time parents.

Research

I came across multiple studies done in relation to delayed bathing of newborns. The research that I used were printed from 2013-2017, and still continue to be updated. I found it quite challenging to locate quality, relevant, and timely evidence due to the fact that most articles that discuss newborn bathing were published in the early 2000's.

Comparison of Research and Protocol

The research I conducted along with the Policy from KPFHRMC show that there are many benefits in delaying newborn bathing. According to Brogan & Rapkin (2017), “an analysis of newborn temperature data showed that newborns who received delayed immersion baths were less likely to be hypothermic than those who received a sponge bath shortly after birth.”

A research done by Peer et al. (2013), states that “a retrospective chart review comparing in-hospital breastfeeding rates during the 6 months before and the 6 months after the bath was delayed was done and the results: Of the infants, 702 met inclusion criteria. Before the bath was delayed, infants were bathed at an average of 2.4 hours of life. Afterward, infants were bathed at an average of 13.5 hours of life. In-hospital exclusive breastfeeding rates increased from 32.7% to 40.2% (p<0.05) after the bath was delayed.

Multivariate logistic regression analysis showed that infants born after implementation of delayed bathing had odds of exclusive breastfeeding 39% greater than infants born prior to the intervention (adjusted odds ratio [AOR]=1.39; 95% confidence interval [CI] 1.02, 1.91) and 59% greater odds of near-exclusive breastfeeding (AOR=1.59; 95% CI 1.18, 2.15). The odds of breastfeeding initiation were 166% greater for infants born after the intervention than for infants born before the intervention (AOR=2.66; 95% CI 1.29, 5.46). It was concluded that a delayed newborn bath was associated with increased likelihood of breastfeeding initiation and with increased in-hospital breastfeeding rates.”

Per Lund (2016), “early bathing after delivery is in conflict with the WHO and AWHONN skin care guidelines, which recommend leaving residual vernix caseosa intact and allowing it to wear off with normal care and handling.Vernix caseosa, a protective fetal film, acts as a chemical and mechanical barrier in utero, with the thickest coating accumulating between 36 and 38 weeks of gestation.

In the past, bathing was often initiated early to remove this substance, but the retention of vernix has been shown to have benefits in the immediate postbirth phase. Benefits include protection from infection, improved skin barrier function, skin cleansing and moisturizing, development of the acid mantle, and protection from the activity of host defense proteins important in innate immunity.”

Comparison of Research and Clinical Practice

Kaiser Permanente Foundation Hospital Riverside Medical Center's policy on delayed newborn bathing correlates with the research conducted, as all agree that there are many benefits that occur with delaying a newborn's bath. KPFHRMC's institution performs evidence-based practice which is supported by the research by Brogan & Rapkin, 2017, “there has been a recent trend toward delaying newborn baths because of mounting evidence that delayed bathing promotes breastfeeding, decreases hypothermia, and allows for more parental involvement with newborn care.”

The clinical practice that was done by my assigned nurse follows the KPFHRMC's policy on delaying newborn baths by 12 hours, as well as other evidence-based research that have been published. It has shown evidence that delaying bath has been proven to promote thermo-regulation and regulate glycemic levels due to minimal metabolic expenditure.

Plan of Improvement

Although teachings have been provided to parents regarding newborn bathing, it would be beneficial for nurses to explain the benefits of delayed newborn bathing, why it is being done, and provide the education that is beneficial to the parents whether it be visual or auditory, as each of us have a different way of learning. Auditory learning would be done through classes that mother's attend, especially those who are first-time moms; while visual learning would be done by providing pamphlets on information regarding delayed bathing.

Reflection

This evidence-based research paper has allowed me to expand my knowledge regarding newborn bathing. I always believed that a newborn should be bathed immediately, as it was taught to us during our college years in the Philippines. I have learned the many benefits that delayed newborn bathing can provide to an infant, and it was interesting to see my assigned nurse perform such intervention while following the hospital's protocol.

As a nurse, I believe that it is important for us to provide the necessary teaching and understanding as to why we do evidence-based procedures. The experience in writing this paper has allowed me to share my newfound knowledge in delaying newborn baths if I end up as a nurse in the obstetrics unit.

Conclusion

Delaying a newborn bath is found to be beneficial in many ways. There are plenty of research that support this finding and many hospitals are following this type of procedure due to the association of increased breastfeeding initiation, as well as increased in-hospital breastfeeding rates, to say the least. Delayed newborn bathing is a family-friendly process that can be implemented in any type of medical facility. Not only is it cost-effective, the newborns have decreased cold stress, increased skin protection and increased parent satisfaction which foster optimal newborn outcomes.