Newborn Bathing

Bath time is an opportunity for the nurse to accomplish much more than
general hygiene. It is an excellent time for observations of infant’s behavior,
state or arousal, alertness, and muscular activity. Bathing is usually
performed after the vital signs have stabilized, especially the temperature.

With the possibility of transmission of viruses such as HBV and HIV via
maternal blood and blood-stained amniotic fluid, the traditional timing of the
newborn’s bath has been questioned. The newborn must be considered a
potential contamination source until proved otherwise. As part of standard
precautions, nurses should wear gloves when handling the newborn until
blood and amniotic fluid are removed by bathing.

In a study of 97 healthy full-term newborns bathed at age 1 hour

(experimental group) and 4 hours (control group), there were no significant
differences in rectal temperatures at 1 and 2 hours after the bath among the
two groups. the researcher concluded that healthy full-term newborns with
rectal temperature greater than 36.5 º C can be bathed after the initial
assessment to decrease the chance of contamination (penny-McGillivray,
1996. this study has been recently replicated by another group of nurse
researchers who also found that the timing of the initial bath in the term
newborn does not negatively affect temperature stability. Newborns bathed
within 1 hour of birth did not experience thermoregulation difficulties as a
result of the timing of the bath (Behring, Vezeau, and Fink, 2003). Nurses are
cautioned, however, to avoid instituting routine newborn bathing according
to rigid schedule; nursing interventions such as bathing should be based on
individualized assessment and family interaction needs rather than schedule.

The bath time provides an opportunity for the nurse in involve the parents in
the care of their child, to teach correct hygiene procedures, and to learn
about their infant’s individual characteristics. The appropriate types of
bathing supplies and need for safety in terms of water temperature and
supervision of the infant at all times during the bath are stressed. For
example, if sponges are used, they need to dry thoroughly between each use
to prevent growth of organisms.

Parents are encouraged to examine their infant closely during bathing.

Frequently, normal variations such as Epstein pearls, Mongolian spots, or
“stork bites” cause parents much worry because they are unaware of the
significance of such findings. Minor birth injuries may appear as major
defects to them. Explaining how these occurred and when they will disappear
reassures parents of their infant’s normalcy.

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One of the most considerations in skin cleansing is preservation of the skin’s
“acid mantle” which is formed from the uppermost horny layer of the
epidermis, sweat, superficial fat, metabolic products, and external
substances such as amniotic fluid, microorganisms, and chemicals. The
infant’s skin surface has a PH of about 5 soon after birth and the
bacteriostatic effect of this PH are significant. Consequently, only plain warm
water should be used for the bath. Alkaline soaps, oils, powder, and lotions
are not used because they alter the acid mantle, thus providing a medium of
bacterial growth, Talcum powder has the added risk of aspiration if it is a
cornstarch-based powder.

Parents should be involved in a discussion regarding the newborn’s bath at

home. It is recommended that for the first 2 weeks the infant be bathed no
more than two or three times per week with a plain warm sponge bath. This
practice will help maintain the integrity of the newborn’s skin and allow time
for the umbilical cord to completely dry. Routine daily soap bathing for
newborns is no longer recommended ( AWHONN,2001; Darmstadt and
Dinulos, 2000).

Cleansing proceeds in the cephalocodal ( head to toe) direction. The eyes are
carefully wiped from the inner to the outer aspect of the lid. The face is
cleansed next. The scalp is usually wiped, although it is sometimes
necessary to shampoo the hair. Shampooing is best accomplished by
positioning the infant’s head over a small basin, lathering the scalp with a
mild soap, and rinsing by pouring water from a small vessel over the head
into the basin. The rest of the body is kept covered during this procedure.
The head is dried quickly to prevent heat loss from evaporation. The ears are
cleansed with the twisted end of a washcloth, not with a cotton-tipped swab,
which, if inserted into the canal, can damage the ear.

The rest of the body is washed in a similar manner. Although the infant’s skin
requires little rubbing for adequate cleansing, certain areas( eg. folds of the
neck, axillae, creases at joints) need special attention. The genitalia of both
sexes require careful cleansing. Cleansing of the vulva is done in a front-to-
back direction. The bath is a perfect opportunity to stress this part of hygiene
to the mother, for both the infant’s and her protection against urinary tract
infection.

Cleansing the male genitalia involves washing the penis and scrotum.
Sometimes smegma needs to be removed by wiping around the glans. The
foreskin is not retracted, because it is normally tight in newborns. It remains
adhered to the glans for approximately 3 to 14 years.

Parents are also instructed to be aware of the signs of urinary tract

infections, which may be more common in uncircumcised infant males.

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Symptoms include irritability of fussiness on urination (from discomfort),
voiding in small amounts and frequently, and unusual voiding urgency.

The buttocks and anal area are thoroughly cleansed of any fecal material. As
with the rest of the body, the area is dried to prevent a warm, moist
environment that fosters growth of bacteria.

A diaper is applied after the bath. It should fit snugly around the thighs and
abdomen to prevent urine from leaking. Disposable diapers with absorbent
gelling material have benefits related to preserving healthy skin, preventing
diaper dermatitis, especially beyond the neonatal period, and controlling
contamination of the environment because of their better containment of
urine and feces.