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Background: Current research suggests that routine daily bathing for preterm infants can render many adverse effects on physiological responses and comfort distress of the infant. Repeated stress on premature babies can have destructive longterm effects on brain development. Objectives: To identify the best current evidence regarding bathing method for preterm infants in enhancing neuro developmental care by using atraumaticcareapproach. Methods:Acomprehensiveliteraturesearchwasperformed in PubMed, ScienceDirect, Wiley Online Library, EbscoHost, Proquest from year of 2008 – May 2019 with the search strategy keywords: bathing, behavioral responses, physiological parameters, premature babies, preterm infants. Inclusion criteria for this study were an original research or systematic review about preterm/premature infants with gestational age is 30 – 37 weeks. PRISMA guideline was applied as a search strategy tool, compared to the used of another conceptualizing tool. Results: A total of 883 of records were identified. After removal of duplicates and initial screening, nine articles met the inclusion criteria of bathing methods for preterm infants. There are several bathing methods were identified: sponge bath, conventional/immersion tub bath, and swaddle bath which is related to physiological responses and behavioral distress during and after bathing intervention. This systematic review showed that swaddle bath had a positive effect on physiological measurement and behavioral responses to preterm infants compared to conventional tub bath and sponge bath which can increase physiological and behavioral discomfort to the preterm infants. Conclusion: This study showed that some of the processes actually reduce negative effects of bathing on the health of the preterm infants. Swaddle bath has proven to be the best and safest type of bathing method for preterm infants during hospitalization that produces fewer changes regarding physiological and behavioral distress to the preterm infants. It is recommended that swaddle bath should be used for preterm infants during they are hospitalized and to be considered as a standard operating procedure in the perinatology unit and neonatal intensive care unit or pediatric intensive care unit.
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         

 
Conference Paper
Bathing Method for Preterm Infants:
A Systematic Review
Dior Manta Tambunan1and Henny Suzana Mediani2
         
          
Abstract
Background:          
           
           
   Objectives       
           
   Methods      
          
           
         
          
              
          Results  
            
            
        
            
          
          
           
          
Conclusion:           
               
            
          
            
            
           
  
Keywords:      
  
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 
  

   
   
   
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   
   
    
    
  
   
   
    

   
    
  
 
1. Intorduction
             
           
           
           
           
    
             
              
          
             
           
        
              
          
          
           
           
             
            
         
            
              
           
              
             
           
            
           
            
           

   
 
2. Methods
            
          
         
               
          
         
      
          
              
           
             
               
   
Database Records: PubMed,
ScienceDirect, Wiley Online
Library, EbscoHost,
Proquest (n = 883)
Records after
removing irrelevant
articles (n = 155)
Records screened
and full-text articles
assessed for
eligibility (n = 14)
Articles included in
synthesizing(n = 9)
Full-text articles
excluded with
reason, not in
English (n =5)
Removing
irrelevant records
(n = 728)
Records excluded
by removing
duplicate articles
(n = 133)
Figure      
   
 
3. Results
              
              
       
3.1. Charasteristic of Studies
           
            
            
           
              
             
          
             
            
            
              
    
      
   
   
    
       
      
    

      
      
     
       
        
     
    
     
    
     
       <
     
      
     
      
     
     
 <
   
 
   
    
   
    
    
    
      
  
     
      
     
     
    < 
     
     
        
     < 
   
    
    
      
   
      
    
<  
<    
    <
     
       
      
     
    
    
    
     
       
     
   
      
       
      
     
    >
    
    
     
     
   
    
   
    
      
     
        
      > 
     
      
    
   
     
      
    
    
   
    
     
     
   <    
       
       
      
    <
    
     
      
    
      
  
     
    
     
      
     
   
   
    
   
  
   
   
   
   
     
     
   
      
      
      
      
     
      
    
 
   
 
   
    
      
  
    
    
   
   
  
     
    
    
 
      
    
   
      
     
        
     
      
     
       
       
     
4. Discusion
            
          
            
              
     
              
               
             
             
          >    
               
              
                
          
            
          
             
              
              
              
           
          
       <       
           
   
 
           
   <    
           
            
           
  <         
             
     <        
            
            
      <  
<         <
             
            
    
          
             
              
              
          
           
             
            
    > 
             
            
            
            > 
                
           
             
      >       
      
           
            
   
 
              
             
            
          
         
             
<               
             
  <
              
             
              
          
             
             
           
         
         
               
              
           
       
            
          
          
          
            
             
             
           
            
          
           
          
           
             
   
 
            
         
5. Conclusions and Suggestions
             
               
             
          
             
             
           
Conflict of Interest
        
References
    Pediatric Nursing        
  
    Recommendation on Newborn Health Guidelines
Approved by Review Committee   

       Wong’s Essential of Pediatric Nursing 
     
    Bayi Prematur: Perspektif Keperawatan    
            
          
  American Journal of Nursing Science  
              
        
      Journal of Perinatal and Neonatal Nursing
 
             
         
   
 
 Journal of child health care: for professionals working with children
in the hospital and community  
             
    Pediatric Research  
              
           Annals
of Neurology  
           
         Early Human
Development,  
              
     Journal of Obstetric, Gynecologic & Neonatal
Nursing  
                
   International Journal of Caring Sciences   
    Transformative nursing in the NICU traumainformed age-
appropriate care      
             
           
         Journal of Caring
Sciences  
             
          
 Iranian Journal of Neonatology  
             
           
           
     Journal Of Nursing Research (ICCR-
JNR),  
             
         
 The Journal of Perinatal & Neonatal Nursing  
             
           
 Worldviews on Evidence-Based Nursing  
   
 
              
         
  Texto Contexto Enferm  
           
 Advances in Neonatal Care  
    Asuhan Kebidanan Neonatus: Bayi, Balita dan Anak Pra
Sekolah     
        Newborn and Infant Nursing
Reviews,  
            
     Journal of Pediatric Nursing  
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              
         
   Revista Da Escola de Enfermagem Da USP 
  
              
          JOGNN
- Journal of Obstetric, Gynecologic, and Neonatal Nursing  
             
          
     Pediatric Dermatology  
            
              
       Journal of the European
Academy of Dermatology and Venereology  
   
Article
The purpose of the present study was to compare the effect two bathing methods, bathing in a tub with and without swaddle, on the behavioral responses to stress in premature infants who were hospitalized in the NICU. In this study of clinical trial, the mean behavioral stress score for infants who were given a bath in the tub without swaddle (56.84 ± 21.79) was significantly more than the one for the infants who received a swaddle bath (17.12 ± 7.67) (P < 0.001). The infants’ crying time in the group without swaddle (15.57 s) was longer than the group with swaddle (5 s) (P < 0.001). The mean score for sudden twitches was 0.90 in infants bathed without swaddle and 0.18 in infants bathed with swaddle (P < 0.001). In this study, swaddle bathing caused fewer behavioral responses to stress in premature infants. Therefore, applying this method can improve the quality of care delivered to these infants in the NICU.
Article
Full-text available
There is a dearth of research in Indonesia regarding pain management in children. Previous studies have identified that although a variety of research and clinical studies on all aspects of pain have been conducted in many countries, children continue to experience moderate to severe pain during hospitalization. Greater research efforts are needed to identify and explore the factors that impede effective pain management in children. To address this gap, the researchers conducted an exploratory descriptive qualitative study to capture Indonesian nurses’ perceptions of barriers to paediatric pain management in two hospitals. Using purposive sampling, data were collected from 37 nurses through semi-structured, in-depth interviews. Findings indicated that nurses working in Indonesian paediatric wards felt that they were not able to provide effective pain care to hospitalized children. Nurses identified several organizational structural and cultural factors that were thought to hinder their provision of effective pain care to paediatric patients. These factors are embedded in nurses’ clinical practice. The study findings can assist to inform relevant initiatives and strategies to improve clinical nurses’ performance and competency in providing effective pain care to paediatric patients.
Article
Full-text available
Preterm infants are exposed to serious health problems that require advanced highly specialized nursing skills in order to sustain their life. Developmental positioning is one of an essential skill for neonatal intensive care unit nurses. This study aimed to investigate the effectiveness of developmentally supportive positioning on preterm infants' pain responses at NICU. A Quasi experimental design was used to conduct the study at neonatal intensive care unit on a sample of (56)preterm infants who admitted through nine months and were equally divided randomly into the study and control group after fulfilling the inclusion criteria using demographic characteristics of Preterm infants. Infant Position Assessment Tool (IPAT) and Preterm Infant Pain Profile (PIPP) Tool. The results indicated that all the preterm infants (100%) had an unacceptable positioning in both groups, and none of preterm infants in both groups had no- or- minimal pain at baseline assessment. While after one week of intervention about two third (64.3%) of the infants were placed in an acceptable position in the study group and only less than one quarter (21.4%) of the preterm infants in the control group were placed in an acceptable position. Regarding pain response at day seven of intervention five minutes after morning routine care, about half (53.6%) of infants in the study group had no-or-minimal pain while none of infants in the control group had no-or-minimal pain and about one third (32.1%) of infants in the control group had severe pain and none of the infants in the study group had severe pain. The present study concluded that preterm infants who were placed in developmentally supportive positioning had acceptable position and exhibited less pain scores. It is recommended to replicate the present study on a larger sample.
Article
Full-text available
Background: The newborn’s first bath, performed in Neonatal Intensive Care Units (NICU), is believed to be a stressful situation, especially for the premature infants. As a developmental care approach, swaddle bathing is a low-stress bathing method for vulnerable preterm neonates. Given the limited number of the studies examining this bathing method, the present study was conducted with the aim of comparing the effects of swaddle and conventional bathing methods on some behavioral responses in premature infants. Methods: This study was a randomized clinical trial conducted on 50 premature neonates admitted to NICU. The neonates, who met the inclusion criteria, were randomly assigned into experimental and control groups. The infants in the experimental group received swaddle bathing and those in the control group were given conventional bathing. To record the behavioral responses, the infants' faces were filmed in close-up during the bathing. The data were analyzed, using Chi-squared test, independent samples t-test, and Mann-Whitney U test. Results: The results demonstrated that the occurrence rates of such behaviors as facial grimace (P<0.001), mouthing/yawing movements (P<0.001), tongue extension (P=0.017), eyes open (P=0.027), and fussing/crying (P<0.001) were significantly lower in the experimental group than those in the control group. In addition, the percentage of eyes closed was higher in the experimental group, compared to the control group (P=0.006). Conclusion: According to the findings of this study, swaddle bathing can reduce the neonatal stress during bathing. Consequently, this
Article
Full-text available
Objective To verify the effect of bathing on the body temperature of preterm infants (PTI). Method Systematic review conducted in the following bibliographic electronic sources: Biblioteca Virtual em Saúde/Lilacs (BVS), Cumulated Index of Nursing and Allied Health Literature (CINAHL), Cochrane Library, Google Scholar, PubMed, SCOPUS and Web of Science, using a combination of search terms, keywords and free terms. The review question was adjusted to the PICO acronym (Patient/population, Intervention, Control/comparative intervention, Outcome). The selected publications were evaluated according to levels of evidence and grades of recommendation for efficacy/effectiveness studies, as established by the Joanna Briggs Institute. Results Eight hundred and twenty four (824) publications were identified and four studies met the inclusion criteria, of which three analyzed the effect of sponge baths and the effect of immersion baths. Conclusion Sponge baths showed a statistically significant drop in body temperature, while in immersion baths the body temperature remained stable, although they studied late preterm infants.
Article
Full-text available
Introduction: Maintaining body temperature and reducing stress are important challenges in bathing preterm infants. Swaddle bathing, which includes in itself the principles of developmental care, can be used as a low-stress and appropriate bathing method for premature infants. Given the limitations of the researches carried out on this bathing method, the present study was conducted with the aim of comparing the effects of swaddled and conventional bathing methods on body temperature and crying duration in premature infants. Methods: In this randomized clinical trial study, 50 premature infants hospitalized in Neonatal Intensive Care Unit (NICU) who were eligible for the study were divided by random allocation into two experimental and control groups. The infants in the experimental group were bathed using the swaddle bathing method and the infants in the control group were bathed using the conventional bathing method. Body temperature was measured 10 minutes before and 10 minutes after the bath. To record the crying, the infants' faces were filmed during the bath. The data were analyzed using chi-squared test, independent t-test, paired t-test and Mann-Whitney U test. Results: The mean temperature loss was significantly less in the swaddle-bathed newborns compared to the conventionally-bathed newborns. Furthermore, crying time was significantly less in the experimental group than in the control group. Conclusion: Given the positive effect of swaddled bathing in maintaining body temperature and reducing stress, it can be used as an appropriate bathing method in NICU.
Article
Aims: To determine the effects of sponge baths and swaddled bathing on premature infants' vital signs, oxygen saturation levels, crying times, pain, and stress levels. Methods: This study was a clinical trial with a crossover design. Data were conducted in the neonatal intensive care unit of a public hospital in Denizli, Turkey. A total of 35 premature infants, who were born at 33-37 weeks gestation with a birth weight <1,500 g, were enrolled in the study. Two bathing methods were applied at 3-day intervals. Vital signs and oxygen saturation levels were measured before and at minutes 1, 5, 15, 30 after bathing. Infants' bathing was video recorded to assess pain and stress behaviors. The pain and stress behaviors of infants were evaluated by independent observers. A significance level of .05 was used for all statistical analyses. Results: There were statistically significant differences between bathing methods on vital signs, oxygen saturation levels, and crying times. Levels of stress and pain according to bathing type were significantly higher in the sponge bath condition (p < .05). Linking evidence to action: Swaddled bathing has a positive effect on the infant's vital signs, oxygen saturation levels, crying time, and level of stress and pain compared to the sponge bath condition. Swaddled bathing is a harmless and safe nursing practice.
Article
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.
Article
The skin, along with other organ systems, makes rapid changes as the newborn moves from an intrauterine aquatic environment to an extrauterine atmospheric environment. Some of these changes include the development of an acid mantle and an increase in skin hydration.While skin care and bathing practices have traditionally been based on the patient's culture, regional customs and anecdotal experience, recent evidence-based recommendations have been made and will be presented in this article (AWHONN, 2013). Hopefully, with further research and the incorporation of evidence-based recommendations into skin care of the infant, we will see improved skin health and a decrease in skin disease in infancy and childhood.
Book
Description This innovative text for Neonatal Nurses and NICU clinicians introduces new, evidence-based care protocols proven to mitigate or reduce the profound morbidities and subsequent developmental challenges that afflict newborns in the NICU. The book reframes the concept of developmentally supportive care to trauma-informed, age-appropriate care of the hospitalized premature infant. Aimed at transforming NICU practice, the book links developmental care to quality standards and Joint Commission requirements. The text is also unique in its provision of engaging online learning activities that facilitate the translation of content into clinical practice, whereby the user can also earn CEUs. The text highlights the ways in which Nightingale's tenets of nursing and Watson's theory of human caring science resonate with the its subject matter and are applied in the NICU. It includes examples of favorable outcomes associated with the protocols described in this book from practitioners in the U.S. and overseas. Additionally, the text aligns with NANN guidelines for Age Appropriate Care of the Premature and Hospitalized Infant. This book will provide the neonatal nurse/APN with best available, evidence-based caring strategies to consistently and reliably manage the trauma associated with the NICU experience and mitigate both short-term and long-term complications associated with this developmental trauma. Key Features: Introduces cutting-edge, evidence-based care protocols proven to reduce the profound morbidities and developmental challenges of premature infants Reframes the concept of developmentally supportive care to trauma-informed, age-appropriate care Meets Joint Commission requirements for age-appropriate staff education Includes examples from researchers and practitioners worldwide Presents innovative online learning activities to facilitate translation of content to clinical practice