Delaying the First Newborn Bath and Exclusive Breastfeeding

Abstract

Purpose: The purpose of this study was to determine if changing the timing of the initial newborn bath would have an impact on exclusive breastfeeding during hospitalization. The first newborn bath had been routinely done within 2 hours of age; practice was changed to the first bath being delayed until at least 12 hours of age. A secondary purpose was to examine the nurses' perceived benefits and challenges to such a change. Study Design and Methods: Through a retrospective design, exclusive breastfeeding rates among mother–infant couplets prepractice change (cohort A) were compared with two postchange cohorts (B and C). Cohorts B and C were from the first 5 months and second 5 months, respectively after the practice change. Demographic information, birth type, bath timing, and feeding data were collected. Comparative statistics were applied to the three cohorts to examine differences in exclusive breastfeeding rates. Postpartum nurses were asked two open-ended questions on concerns and benefits of this change via an anonymous survey. Content analysis was completed on responses. Results: There were 1,463 mother–infant couplets included in three cohorts (A: n = 564; B: n = 468; C: n = 431). There were no significant increases in the exclusive breastfeeding rates (baseline 74.1%) in both the first postimplementation delayed bath cohort (70.1%, p = .207) and the second “sustainability” cohort (79.4%, p = .060). Fifteen of the 60 postpartum nurses completed the survey, for a response rate of 25%. Themes generated from survey responses included concerns (infection control, work distribution), as well as benefits (perceived breastfeeding success, decreased workload) with delaying the first newborn bath. Clinical Implications: Delaying the first newborn bath may be one factor that can influence exclusive breastfeeding rates during postpartum hospitalization. Results have been mixed based on recent literature. In our study, the exclusive breastfeeding rate was already above average, as would be expected in a Baby-Friendly designated hospital and may be a reason we did not see a significant change in the rate among mother–infant couplets in our study. Randomized trials are needed for a rigorous evaluation of timing of the newborn bath and possible link to exclusive breastfeeding in the hospital and beyond.

Outcomes of Neonates Born to Mothers With Severe Acute Respiratory Syndrome Coronavirus 2 Infection at a Large Medical Center in New York City

“…In addition, maternal vaginal secretions and skin-to-skin contact are involved in development of infant immunogenic responses . Delayed bathing has significant benefits, including potential to increase rates of exclusive breastfeeding, and early bathing has significant risks, including hypothermia and hypoglycemia …”

A review of newborn outcomes during the COVID-19 pandemic

“…75 Delaying the first bath has been shown to decrease rates of hypothermia and hypoglycemia in newborns, 27 , 76 while improving exclusive breastfeeding. 27 , 77 , 78 , 79 Retaining the vernix and amniotic fluid by delaying bathing aids in temperature regulation, and the scent of amniotic fluid helps to guide newborns during breastfeeding. 80 Importantly, delayed bathing allows sustained postnatal contact with maternal microbes from vaginal secretions, as well as amniotic fluid and fetal membranes, which has been shown to contribute to the development of the newborn's microbiome.…”

Nivel de glucemia y temperatura al alta, de los recién nacidos de término, del Instituto Nacional Materno Perinatal, 2019

“…Luego, Warren et al 24 y Chamberlain et al 25 señalan que bañar al RN después de 24 horas incrementa la prevalencia de LME en el momento del alta y disminuye la incidencia de hipotermia e hipoglucemia. Sin embargo, Long et al 26 en un estudio de cohorte, comparativo de 1403 niños no encontraron aumentos significativos en las tasas de LME, cuando los recién nacidos fueron bañados antes de las dos horas, como con aquellos que fueron bañados después de 12 horas de vida, debido a que, en el hospital designado para niños, la tasa promedio de LME ya estaba por encima del promedio. En el presente estudio todos los RN fueron bañados en presencia o con la ayuda de la madre, después de 24 h de vida.…”