timing of newborn bath

NurseMegA · Nov 20, 2003

We also do our newborn baths during Mom's recovery period. We only do the bath though if the baby's temp is 98.0 or higher. We will postpone the bath and keep the infant under the radiant until the temp is stable.

mother/babyRN, RN · Nov 20, 2003

We do it during the recovery phase as long as the temp is above or at 98.....This gives the family a chance to observe and learn. I will make sure the water is warm and put the infant foot in first, then slowly introduce the rest of the body..we do our baths in the sink or on the warmer..If in the sink, a heated bath blanket is put down first and continues to be warm. First bath can be a tub bath as the cord is still moist...Most babies don't even cry...I wrap them immediately in another warmed bath blanket, dry them off under the radiant warmer, then use three warmed baby blankets and one warmed bath blanket as well as two warmed hats and undershirt and leggings...I never have cold stressed babies. Babies tend to warm the environment they are in, so it is all about keeping them warm from the get go....Leave them fully wrapped like that, check the axillary temp in one half an hour....

Have never had a problem with the temp/

Jolie, BSN · Nov 20, 2003

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.

L&D_RN_OH · Nov 20, 2003

I'm not sure what our exact policy is, since I don't work in the NSY, but most baths are done within the first 3-4 hours. I don't even take my babes to the NSY until they are over an hour old, unless there is a problem. I know the full assessment, VS, treatments, etc. are done under the radiant warmer before the bath is started. And if the temp isn't stable, it is postponed.

dawngloves, BSN, RN · Nov 20, 2003

I work NBN about twice a year. We bath after assesment and if baby's temp is above 98. It is done in the nursery because right after, the baby is put back in the isolette and temp is taken again before they are put in a crib (temp again >98)

And although Jolie makes a good arguement, most babies here aren't even brough to the nursery until they are about an hour old and have bonded with mom. I think we (NICU) get very few admissions after a bath has been done , believe me!:chuckle

SmilingBluEyes · Nov 20, 2003

What on earth's the rush everyone??????

Even w/healthy babies, I will WAIT usually.

I let mom/baby bonding take place a GOOD hour or two before considering a BATH ---UNLESS requested otherwise by the parents......

I consider initiating breastfeeding and family bonding (in that critical first hour of quiet-alert baby state and maternal euphoria) MUCH more important than hospital "routine" ..........oh and yes, I DO raise the "ire" of some "efficient" coworkers with my ways. Shame on me......

YES meds are give on time, (eye prophylaxis is sometimes held off for 30 min so mom and baby can look at each other clearly)..... but bathing waits til Mom and Dad are ready. IF that is several hours, so be it. I have not a problem with it. Takes five minutes and I think bonding lasts a lifetime.

And I agree, temps, breathing and sugars MUST be stable before ever considering stressing out a newborn with bath. The first hour tells us a lot about how a baby will transition and what to do next.

And NO babies go to our "nursery" unless they are SICK, period.

L&D_RN_OH · Nov 20, 2003

Originally posted by SmilingBluEyes
I let mom/baby bonding take place a GOOD hour or two before considering a BATH

And NO babies go to our "nursery" unless they are SICK, period.

Unless I'm reading it wrong, I think that's what most people are saying, right? That they wait an hour or so, but it's still done during Mom's recovery. I usually don't take the babies into the NSY until close to 2 hours old, only because our policy states the newborn assessment must be done within the first 2 hours.

And unfortunately, staffing doesn't allow for bedside transition very often. And even then, only if the parents request.

SmilingBluEyes · Nov 20, 2003

How does staffing NOT allow it? I take care of couplets here.....like many, meaning both mom/baby. Letting them bond and breastfeed for several hours has NO bearing on staffing or vice-versa. It's MY couplet and it takes FIVE minutes to give a bath, maybe 10 if baby is really cheesy. Either way, it's 10 min here or 10 there, it will get done in good time. And baby will have bonded with mom and family and HOPEFULLY breastfeeding off to a good start. That should be our priority.

I work with a LOT of old-school RNs who were used to a "nursery routine/schedule" who insisted this or that be done "on schedule", including a bath within 15 minutes or so of birth. I can't disagree with this belief more. Really, I find it takes no more time out of my busy schedule to let Mom and Dad decide when it's time for baby's first bath. It's relaxed and easy....they can film it and usually, by then visitors and family are gone and everything is low-key. I do tell them if they wait, and call and IF I am busy helping someone else, it may be a few minutes. But I leave this up to them. And they appreciate it.:)

SmilingBluEyes · Nov 20, 2003

I do my newborn assessments on mom's chest or in the warmer, right after birth. I DO FIND the assessments to be a great opportunity to teach new parents about NORMAL newborn appearance and reflexes. It's a great time for them to learn and appreciate the amazing characteristics of their new baby....things they would not have known otherwise. :)

L&D_RN_OH · Nov 20, 2003

Originally posted by SmilingBluEyes
How does staffing NOT allow it? I take care of couplets here.....like many, meaning both mom/baby. Letting them bond and breastfeed for several hours has NO bearing on staffing or vice-versa. It's MY couplet and it takes FIVE minutes to give a bath

Because the Nsy nurses do the transition here. Not the L&D nurses.

The RT's do the intitial assessment and Apgars. The L&D nurses do a set of vitals at 30 min, allow parents and baby to bond for an hour or two, assist with breastfeeding, etc. But the full assessment, Ballard scale, Vit K, erythromycin ointment, and bath are done in the NSY, unless nursery staffing allows for a NSY nurse to transition at the bedside. Our policy states the newborn assessment must be done within 2 hours of birth. I keep them with Mom as long a I can, but if I wait much longer than 2 hours, the NSY will hunt me down.

After Mom's recovery, she is turned over to the Mom/Baby nurse by L&D and report is given to her on the baby from the NSY nurse. Make sense?

fergus51 · Nov 20, 2003

I have only worked at one hospital that had the NSY do transition instead of L&D, and this is exactly why I didn't like it. It was just awkward timing-wise and I found parents enjoyed seeing a newborn assessment and being taught about it at the bedside. I am a hog and want my patients all to myself:)

Our hospital requires 2 stable temperatures, 2 hours apart before a bath. I always liked to wait until mom or dad could do the bath with my help, rather than me demonstrating a bath for them. Most parents loved it that way, although I admit, the babies would get a better scrubbing if I was doing it!