Delayed Newborn Bathing
This study used a retrospective cohort design to compare the incidence of breastfeeding initiation and exclusivity upon discharge, hypoglycemia, and hypothermia for low-risk, low-incidence of comorbidity late-preterm (34 0/7-36 6/7) and term (37 weeks and older) newborns born before and after the hospital implemented a delayed bathing protocol (Warren et al., 2020). Participants were drawn from one hospital in Canada and included 680 newborns bathed before 24 hours of life and 545 newborns bathed after 24 hours of life. The procedure prior to the delayed bathing intervention included bathing occurring at an average of 3.5 hours after birth, nurse’s transport from the mother to the nursery, bathing in a tub and then wrapping the baby in warmed blankets or placing under a radiant warmer before returning them to their mothers(Warren et al., 2020). Post-intervention included waiting for an average of 30 hours after birth, bathing occurring in the mother’s room, and performed by the parent(s) under the supervision of a nurse. The mother was then encouraged to place the baby skin-to-skin, or the baby was wrapped in a blanket and given to the mother (Warren et al., 2020). Breastfeeding initiation was defined as “any action of placing the newborn to the mother’s breast during the hospital stay,” and exclusive breastfeeding at discharge was defined as “the newborn received no formula, water, glucose, or any substance other than breastmilk during the hospital stay,” (Warren et al., 2020, p. 183). Hypoglycemia was set at less than 47 mg/dl, and hypothermia was defined as a temperature less than 36.5oC.
The Results, Significance & Discussion
There was no statistically significant difference in breastfeeding initiation between groups. For the other measured outcomes, it is important to look at the two subgroups separately. The post-intervention odds of exclusive breastfeeding at discharge for the average-risk subgroup was 43% greater than the pre-intervention group, and delayed bathing was associated with decreased incidence of hypothermia in the average-risk subgroup and group as a whole. There was not a significant difference in the incidence of hypoglycemia. There was a decreased incidence of hypoglycemia in the total sample and in the high-risk (late pre-term) subgroup (Warren et al., 2020). There was not a statistically significant change in hypothermia or breastfeeding exclusivity for the higher-risk newborns (Warren et al., 2020). The authors state that the World Health Organization (WHO) recommends delaying newborn bathing until 24 hours after birth for all babies, and the authors’ overall findings were consistent with four other studies suggesting that delaying the first newborn bath may positively affect breastfeeding and five studies suggesting a relationship in decreased incidence of hypothermia and hypoglycemia (Warren et al., 2020). The authors state that there is limited research relating bath time to these outcomes, and more research is necessary in order to support the WHO’s recommendations. Significantly, this study showed no correlation between delayed bathing time and breastfeeding initiation and exclusivity or for reduced incidence of hypothermia for higher-risk babies (Warren et al., 2020). This may be due to the definition of “breastfeeding initiation” and the fact that higher-risk babies may require additional nutrition and nursing care.
Curiously, the authors state that there was one change in their bathing policy – the timing of the bath. However, that was not the only part of the intervention that changed. In addition to delaying the bathing time to an average of 30 hours, the intervention also changed where the bath was performed (in the mother’s room), and who performed the bath (usually the parent, under the supervision of a nurse). These changes seem significant and possible confounding factors. A future area of study may include looking at if the bath environment and the mother providing the bath improve breastfeeding exclusivity outcomes.
References
Warren, S., Midodzi, W., Allwood Newhook, L.-A., Murphy, P., & Twells, L. (2020). Effects of delayed newborn bathing. Journal of Obstetric, Gynecologic & Neonatal Nursing, 49(2), 181–189. https://doi.org/10.1016/j.jogn.2019.12.00
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Question 
Please read the journal, formulate a PICO question, and answer the questionnaire attached. Also, answer the two questions at the end of the paper:
Delayed Newborn Bathing
Is the study purpose an important clinical issue? Why or why not?
What does this research mean for clinical practice in your unit?