timing of newborn bath

Specialties Ob/Gyn

Published

THE MBU I WORK ON IS HAVING A DILEMMA ABOUT THE IDEAL TIME THE NEWBORN BATH SHOULD BE GIVEN. WE HAVE BEEN GIVING THE BATH SOON AFTER THE DELIVERY DURING THE MOM'S RECOVERY PERIOD. OUR NICU SEEMS TO THINK WE ARE COLD STRESSING THE BABIES. MOST NURSES DO THE BATH UNDER THE WARMER. ALSO IF BABY'S TEMP IS LOW THE BATH IS POSTPONED TILL STABLE. WOULD LIKE TO HEAR OTHER HOSPITAL POLICIES OR ROUTINES ON THIS SUBJECT.

Why do you do B/'s on a well newborn? Get rid of thoswe old school nursery nurses! they screw more up for new parents than most people do. We still have a couple of die hard nursery people but like ther est of us, theyhave had to crosstrain andit's a good thing. All our old school nursery people either left or retired! Thank goodness!

Specializes in Maternal - Child Health.

Mira,

You are correct that in theory, the healthy, full-term fetus lays down glucose reserves which should carry it thru the transitional period whether or not it is fed. But in actual practice, things don't always work that way. Numerous factors, including gestational age, maternal health and nutrition, and drug (illicit and Rx) use can affect the amount of glucose stores a baby has.

Glucose stores can be depleted by a long labor during which the mother typically eats very little. IV fluids are a poor substitute for food in terms of the amount of glucose they provide.

Mild cold stress, mild respiratory distress, high Hct, and other factors can rapidly deplete the baby's glucose stores, causing hypoglycemia that may not present with obvious symptoms.

Since no-one wants to go around pricking the heels of every newborn, some units suggest feeding all infants prior to the first bath to lessen the risk of hypoglycemia in asymptommatic infants.

Most breastfeeding moms want to nurse their babies ASAP after delivery, so this is rarely an issue with them. Bottle-fed babies need just a small amount of glucose water or formula (preferably). No one wants to stuff a newborn like a turkey and then feed it! But the first bath, especially if the baby is submerged in water, is usually fairly gentle and calming, so vomiting or choking should not be an issue.

Specializes in Maternal - Child Health.

OOps! I meant no-one wants to stuff a newborn like a turkey and then bathe it!

We usually wait at least 4 hours before the 1st bath. Not only that, but the bath is done with the parents in the parents room so a lot of the timming is due to when the parents are both there. Of course if it is not possible for them to be there together we do the bath with mom. This is generally speaking for a healthy baby who is rooming in with mom.

The circumstances of the bath change if baby is in the nursery or if there have been any complications.

Why rush the bath when mom and baby (and dad too) can bond. The bath can wait.

Specializes in cardiac, diabetes, OB/GYN.

On the night shift people want to get some sleep so we combine teaching and bathtime in a more timely manner to get those people to sleep. Unless there was a cold stress problem, I do it as soon as I can for everyone....Takes a second....

Specializes in cardiac, diabetes, OB/GYN.

Anyone who can should attend or check into the STABLE program, which was developed by nurses.....THEN one would see why temp and blood sugars and certainly important and NOT old school...Not in all cases, either BUT they do have their place....Check out the S.T.A.B.L.E. website.....

Specializes in PERI OPERATIVE.

Ok, I decided to revive this old thread upon reading it. We have all LRDP nurses who do everything (mom, baby, couplets). We usually do the bath when we are doing the assessment, at least an hour after birth. And only if the babe is stable. We do blood sugars on all babies, one at birth and one at one hour of age. Actually, this has helped us find a lot of babies with hypoglycemia (less than 45) that should be fed. We also do pulse oxymetery on all of our newborns shortly after birth. Does anyone else do this?

As for staffing, we usually have two nurses in the delivery, one for mom and one for babe. I find its hard if you have a mom and babe that both need your attention at the same time. But this doesn't seem to be a prob at all at our place. Most of our nurses are relatively new, and very welcome to change. I would LOVE to have warmers in all of our rooms, but its just not possible on our budget. But after reading these posts, I think that I will try to do all my assesssments, bath, Dubowitz, in the room so parents can see it.

The AAP does NOT recommend blood sugars on all babies. You guys are way behind the times. You are doing a huge number of completely unnecessary heel sticks. Pulse oximetry is NOT recommended, either. I doubt you could find any rationale that would support the pulse ox use on a perfectly healthy baby.

We also are an LDRP. As the labor nurse, I would have a second nurse come in and help at the delivery, but then the care of mother and infant is up to me. I would do Mom's recovery and while that's happening, baby goes to breast, mom gets to eat, I do the Ballard, assessment on baby q 30 minutes x4 (if baby is at breast I wait until baby is done, of course) and do baby's bath. It's a great system. It's also very easy to do after you get the hand of it. There is no reaqson to separate a healthy mom and baby. Also, remember that you can STOP doing all those blood sugars. The AAP position statement will support that. The only babies that need the d-stick protocol are infnts of any ind of diabetic mother, any baby over 4000 or under 2500 grams, and any babgy that may have had some kind of traumatic deliovery or looks jittery. You are having trouble getting lots done because you are doing things that are unnecessary and outmoded. Good luck with changes. You'll like the less work!

We don't do baths until baby is at least 3 hours old with a stable temp. We also do it at the bedside in the warmer and encourage Mom/Dad participation.

We never bathe our babes until they are at least four hours old and then only if their temp is stable and all baths are done under the radiant warmer. Usually, we don't expect parents to help with the initial bath unless they want to...we talk them through a bath sometime before discharge. We recognize the importance of bonding, but we also try to let the mom rest if she needs to...having a baby is hard work. When I had my first, all I wanted to do was sleep after she was about 3-4 hours old...

First of all, let me post this disclaimer: This reply is being written by a NICU nurse, and so may be biased.

While you all have given excellent suggestions on maintaining baby's temp during bathing, I am not in favor of doing the newborn bath too soon. I would prefer to have the initial assessment done, and a second set of stable vitals at least 1 hour later before bathing baby. Cold stress is not the only problem made apparent by bathing. If a baby is having mild respiratory distress, a bath will put him over the edge. Same with unstable blood sugars. I would prefer to utilize the first hour of life for breastfeeding, if mom is able, since many babies are very alert and eager to nurse at this point.

I agree that the bath should be done at mom's bedside for mom and dad to observe and participate. But it can be done at any time. With the exception of hepatitis-exposed infants, there is just no rationale to hurry it along. I have never admitted a baby to NICU for stress related to being grimy, but I've admitted plenty for cold stress, mild respiratory distress and hypoglycemia.

We are an LDRP and we recover Mom and baby together (as long as all is well). Our focus is getting the baby to breast, getting Mom some food and watching her vitals and fundus. We do baby vitals q 1/2 hour times 4, which of course is 2 hours. We also do the initial first physical assessment and the Ballard on baby During that time, we also give the baby bath under the warmer if baby's temp is above about 99.6.We use that as a teaching demonstration. If It's close to that I give it because I want to get it done and leave the family together. If there is any respiratory distress, unstable augars or something else, we do not bathe the baby. It's pretty straightforward.

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