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Abstract
After delivery, newborns go through a series of physiologic changes in an effort to adapt to extrauterine life, with preterm newborns more likely to experience medical problems following this transition. Neonatal hypothermia, defined as a temperature ,36.5°C, is a major contributor to neonatal mortality and morbidity.1 Early bathing may be a contributing factor to hypothermia and interfere with the premature neonate's ability to safely adapt to an extrauterine environment.2 Skin physiology, the physiologic changes that result from bathing, the importance of maintaining vernix for temperature stability, and how policy change and education-based programs for developmentally supportive care will be discussed in an attempt to improve patient care outcomes for neonates in the NICU.
Keywords: hypothermia; vernix; respiratory distress; stratum corneum
After the delivery of a newborn, it is common for nurses to bathe the infant in an attempt to remove debris and potentially infectious or harmful pathogens. However, the seemingly benign act of bathing can contribute to hypothermia, hypoglycemia, respiratory distress, and a change in vital signs.3 This is especially true in late preterm infants (34-37 weeks). Traditionally, bathing is performed to decontaminate newborn skin that may have been exposed to potentially infected maternal blood, vaginal secretions, or other birthing f luids, but there are no studies that support the hypothesis that bathing will reduce infection transmission rates.4 The American Academy of Pediatrics5 and the Centers for Disease Control and Prevention6 do, however, recognize the necessity to bathe in order to decrease the risk of exposure of health care workers to blood-borne pathogens and infectious diseases such as HIV and hepatitis B and C.7,8 When bathing is necessary, every effort should be made to accomplish thermal stability. Precautions to take to avoid hypothermia from bathing may include warm water (40 6 1°C), bathing time limited to one to two minutes, bathing on a radiant warmer platform, and thoroughly drying with a prewarmed towelette.
Early bathing may not be appropriate for the late preterm neonate who is physiologically less mature than a full-term newborn. A wellknown term popular in emergency medicine is the golden hour.9 This terminology refers to the fragile time frame when decisions about care activities and treatments are evaluated to determine the course of care. The golden hour can be applied...