Delaying the Newborn’s First Bath to Enhance Neonatal Stability Ogechi Anyanwu, BS; Risa Hoffman, BS; Lorin Meynard, BS

University of Houston Second Degree BSN Program 2019

PICOT Question Background Decision to Change

In newborns, how does delaying the first A newborn’s inability to self regulate their temperature places them at risk of many Policy: bath to after the first 24 hours of life complications, including hypothermia, hypoglycemia and infection, therefore proper initiation ●No baths given on labor and delivery unit compared to bathing within 6 hours after of newborn interventions are vital to ensuring early stabilization after birth. The current ●Temperature checks before and after bath delivery influence optimal neonatal stability standard of practice is bathing newborns as early as 6 hours after birth, however WHO ●First bath delayed for 1st 24 hours of thermoregulation, glucose control, and recommends delaying bathing to after the 24 hours of life can be very beneficial in the ●Skin to skin contact immediately after birth ? transition to extrauterine life. Delaying the infant’s first bath also shown to support early Education: initiation of breastfeeding by providing uninterrupted skin-to- skin and bonding time. Since ●Educate on reason for delayed P •Newborn infant bathing directly impacts thermoregulation, establishing evidence-based practice on the bathing during antepartum, intrapartum and best time to give the first bath is critical in promoting optimal neonatal health. postpartum periods ●Nurses will be provided a script to promote •Delayed Bathing After the I First 24 Hours of Life delayed bathing to parents Thermoregulation Infection Control •Versus Bathing Within the Newborn Temperature Results C First 6 Hours After Delivery Delayed •Enhanced Neonatal Stability O Bathing

Figure 1. PICOT question. Early Initiation of Glucose Stability Review of Literature Breastfeeding

Databases used: Figure 2. Benefits of delayed bathing. ● PubMed ● AWHONN Synthesis of Findings ● Google Scholar Figure 3. Newbrn Temperature Results. Note:The z score is 2.0101, and p = .044 ● Science Direct ● Interventions to reduce infection-related newborn mortality include drying, skin-to-skin Keywords searched: contact, breastfeeding initiation and delayed bathing1,4,6 ● neonatal thermoregulation References ● delayed infant bathing ● Vernix caseosa should remain on the newborn for as long as possible because it has many Brogan, J., & Rapkin, G. (2017). Implementing evidence-based neonatal skin care with ● essential newborn care beneficial properties, such as acting as a temperature regulator, antioxidant and safe -performed, delayed immersion baths. Nursing for Womens Health,21(6), 442- 450. doi:10.1016/j.nwh.2017.10.009 ● newborn hypoglycemia antimicrobial for the baby1,2,3,4,5,6 Chamberlain, J., Mccarty, S., Sorce, J., Leesman, B., Schmidt, S., Meyrick, E., . . . Coultas, L. (2019). Impact on delayed newborn bathing on exclusive breastfeeding rates, ● exclusive breastfeeding glucose and temperature stability, and weight loss. Journal of Neonatal Nursing, ● Components of the amniotic fluid have been found to act as a sensory cue for breastfeeding 25(2), 74-77. ● evidence-based newborn care 3 Dicioccio, H. L., & Ady, C. M. (2019). Delaying the initial newborn bath to improve exclusive initiation by guiding the newborn to the breast breastfeeding. Journal of Obstetric, Gynecologic & Neonatal Nursing, 48(3). Article selection criteria: Mcinerney, C. M., & Gupta, A. (2015). Delaying the first bath decreases the incidence of ● Delaying a newborn’s first bath at least 13.5 hours increased the odds of exclusive neonatal hypoglycemia. Journal of Obstetric, Gynecologic & Neonatal Nursing,44. ● peer reviewed articles Salasibew, M. M., Dinsa, G., Berhanu, D., Filteau, S., & Marchant, T. (2015). Measurement of ● 2,3 delayed bathing and early initiation of breastfeeding: A cross-sectional survey published within last 5 years (2014-2019) breastfeeding by 39% compared with those newborns who were bathed at 2.4 hours exploring experiences of data collectors in Ethiopia. BMC ,15(1). Turney, J., Lowther, A., Pyka, J., Mollon, D., & Fields, W.(2019). Delayed newborn first bath ● Delaying newborn bathing to after 24 hours of birth showed a statistically significant decrease and exclusive breastfeeding rates. Nursing for Womens Health,23(1), 31-37. in blood sugar checks below 45 mg/dL compared to no delay in the first bath2,3 doi:10.1016/j.nwh.2018.12.003 ● It is believed that delaying the bath reduced the amount of cold stress events; When newborns are cold-stressed, an increased metabolic rate is required to generate warmth, thus Acknowledgements 1,2,3,4 decreasing their glucose stores causing hypoglycemia We would like to thank Dr. Lenora McWilliams, PhD, MS, RN and Dr. Cheryl Brohard, PhD, RN, CNS- ONC, AOCN®, CHPCA® for their mentorship on this poster. We would also like to thank the George and Vivian L. Smith Foundations for providing academic scholarships