Best Practive for bathing neonates?

[BABY--RN]

I have ben asked to look into the best practice for bathing our infants in the nicu.. Right now we are using tap water and a name brand baby soap and lotion. Our yougest babes get a sponge bath, but some of our older ones do get to take a tub bath. What do you do in your units? The suggestion has been made by our ID department for us to use the adult comfort baths (wet wipes that do not require rinsing). ID doesn't like the idea of using tap water. I have not gotten hold of these kits yet and was just checking to see what everyone else was using.

Thanks for all your input,

Kim

level III NICU

North Carolina

[t2000JC]

Well, they just used the soft side, not the bristles side. I think using the spongy part is okay, but I was wondering if the soap was too harsh (which it probably is, since we use it to scrub in).t.

[Gompers, BSN, RN]

MY opinion is that is a very bad thing to do. Not sure what you mean by gunky, but vernix is not all bad. I don't think it's important to get it out of every crevice.

Right, I wish people would stop trying to scrub vernix off! It's so good for their skin to just let it absorb, which it will do over a few hours. I don't even bathe my micropreemies on admission. For the bigger ones, I just use plain warm water on washcloths and do a quick spone bath, but I don't scrub hard enough to remove all the vernix. I do occassionally use the side of the scrub brush that has the soft short bristles to comb vernix out of babies' hair, but I don't scrub them with it. We have the dry brushes - not pre-soaped.

Well, they just used the soft side, not the bristles side. I think using the spongy part is okay, but I was wondering if the soap was too harsh (which it probably is, since we use it to scrub in).t.

Oh my goodness, not only did they use the scrub brushes on the babies' skin, but they also used the ones with that harsh surgical soap on it? That is very rough on our skin, and a newborn baby shouldn't be exposed to those kinds of chemicals. I hope they've updated their practice!

We used to use name brand baby soaps on our unit but no more. I am part of our developmental and skin care committee, and we got the manager to stop stocking the baby soap. In the first two weeks of life, baby soap shouldn't really be used on any baby - until their skin keratinizes and they have a stronger top layer of skin. Baby soap changes the acid mantle of the skin, leaving babies at greater risk for skin infections. We use plain water on our preemies for at least 2 weeks, and we recommend no soap until they're 1 kilo. For bigger kids, we don't use soap for the first week. We also changed to Cetaphil - this is because we know that people will still sneak in soap despite what we have recommended - old habits are hard to break, you know the drill. So by using Cetaphil, which doesn't change the acid mantle of the skin, we can ensure that if babies are getting soaped up before their skin is mature, at least it's a safer type of soap.

Once babies are bigger, like feeder-growers and otherwise, we allow the parents to bring in baby soap for bathtime. We just don't stock it is all, to prevent temptation...

[prmenrs, RN]

I did a couple of quick tests w/our nurse manager once upon a time. We had Dial soap, and we had J&J baby shampoo. We used pH paper. Dial was alkaline-REALLY alkaline; J&J was fairly neutral. So we got rid of the Dial.

I like the idea of Cetaphil--how does it work as shampoo? We get all newborns for transition, and the hair is always got blood and other stuff in it.

I'm not sure I can sell the Cetophil in our place. The nurse who does our ordering was actually busted one day cutting cotton balls in 1/2. Can we say CHEAP?

[sofiam]

hi! he j&j that you´ve been refering is shampoo?

[iceNICUnurse]

We don´t use any soap at all on any newborns. Just plain tap water (Our tap water is wery clean). We teach the parents to wait as long as possible to start using soap b/c it makes the skin dry.

The only ones who get soap in the NICU are the old cronic BPD kinds, they get a drop of Infant Care soap.

[Gompers, BSN, RN]

I like the idea of Cetaphil--how does it work as shampoo? We get all newborns for transition, and the hair is always got blood and other stuff in it.

I'm not sure I can sell the Cetophil in our place. The nurse who does our ordering was actually busted one day cutting cotton balls in 1/2. Can we say CHEAP?

LOL!!!

Gotta say, the Cetaphil doesn't work very well as a shampoo. It doesn't lather at all! It's great for the skin because it is so neutral and it's not actually a soap at all (which is why it doesn't lather in the first place)...but for the hair it sucks! For the older kids who actually are post-term (mostly chronic BPD and GI babies) we have their parents bring in the real baby soap and shampoo - but this is fine because their skin is mature. But for an older preemie or a full-term new admission whose hair is really coated in blood, vernix, and/or meconium...we usually will sneak a little baby wash in there, but just for the hair, not the skin. We just need something that lathers for that first wash. We'll try to get out as much as we can with just plain water, Cetaphil, and many many washcloths first, though.

[twinkletoes53]

We do not have a L & D in our hospital; all our babies are transported in; some from surrounding states. We have a new policy in our unit, where all stable babies, regardless of weight, get some type of bath within 24 hours of admission. If infant is medically unstable, the bath is deffered.We use warm sterile water on babies

[preemieRNkate, RN]

Johnson's Head-to-Toe Baby Wash and tap water for us! We use the disposable wash basins as tubs, and only older babies that are in open cribs actually go in the tub. Babies still in isolettes get sponge baths inside their isolette. Also, babies who still have a cord get sponge baths (regardless of whether they are in a crib or isolette). The relatively new LBW babies or really sick babies who cannot handle a sponge bath just get spot-cleaned with sterile water prn.

We use the scrub brush (rinsed of chlorohexidine brush side) only to "style" the babies hair, not to actually scrub their heads.

I love washing kids with a lot of hair, it's the best when it's all clean, soft and fuzzy! :)

[twinkletoes53]

Extubated babies with no lines will get a "swaddle bath" twice a week, on specified days. We use J&J baby wash for them. Our chronic, stable babies with no lines get a tub bath twice a week. If they have lines , they will get a sponge bath. We try to bathe intubated babies on days and nonintubated babies at night. We also try to schedule the bath for when parents are here, so they can participate.

I forgot to add that we do have warming lights that we place over the scales or wherever the tub baths are placed, so that the babies don't get cold. Our policy also states that we take a temp. before and 30 minutes after a bath. If the baby's temp is

[KatrinaPM]

We don't give baths on new admits until at least 6 hours after they arrive, and are stablized, whichever comes first. The vernix has a antimicrobial property, so best to let it protect that new skin like it is designed to do.

Micropremies get baths with h2o only. Older kids with J&J and tap water.

I personally think that as soon as the kid loses his cord and or ivs, and is stable throw them in the tub bath. I find kids that have a swaddled tub bath that is quick maintain their temperature much better than a sponge bath where you basically are systematically cooling each body part off as you're cleaning it.

Where I used to work, babies got bathes every other day, but here we only do twice a week or (if they're older or chronic) when they are stinky.

We also do not use alcohol anywhere on an infant's body except the cord. We only use cholorhexadine (for anyone over 27 weeks, otherwise cholorhexadine can slough skin and it's horrible!) because of skin sensitivity.