The Effect of Tub vs Sponge Bathing on the Comfort of Premature Infants
Condition: Preterm Infant; Premature Birth
MeSH terms: Premature Birth
Study type: Interventional

Summary: 
      The integumentary system protects the underlying body from the external environment, such as
      shocks, temperature, ultraviolet radiation, chemicals, and other threats. There is a
      considerable body of clinical evidence highlighting the importance of the stratum corneum and
      its barrier functions, which are especially beneficial for newborns. Given the dramatic
      transition from the aqueous womb to the dry terrestrial environment at birth, studies
      describing adaptations made by the skin barrier within the first month of life assume greater
      importance. The skin of the baby is morphologically and functionally different from the skin
      of adults. Neonatal skin is thinner, more fragile, and drier than adult skin; it is difficult
      to maintain fluid-electrolyte balance and temperature regulation. Notwithstanding, structure
      and function of skin continues to improve during the first months and even years of life.
      Special care procedures are nonetheless necessary to ensure healthy development, to protect
      the skin from irritation and reddening, and to help the newborn feel well. Therefore, this
      study, taking the form of a randomized controlled trial, aims to examine the effectiveness of
      tub bathing and sponge bathing on the physiological parameters (heart rate, respiration rate,
      oxygen saturation, body temperature) and comfort of late preterm infants. Increasing comfort
      and physiological stabilization in premature infants during neonatal care improves their
      neurophysiological development. Bathing procedures that support this development and will not
      expose the newborn to stress should be preferred.
    

Detailed description: 
      Increasing comfort and physiological stabilization in premature infants during neonatal care
      improves their neurophysiological development. Bathing procedures that support this improves
      and will not expose the newborn to stress should be preferred.This study aimed to examine the
      eﬀectiveness of tub bathing and sponge bathing methods on the comfort and physiological
      parameters of late preterm infants. The study was conducted in the Neonatal Intensive Care
      Unit of a university hospital in Turkey, between November 2015 and November 2016. Skin care
      is routinely performed between 08.00 and 09.00 in the form of sponge bathing. This research
      study sampled 120 stable, late preterm infants being cared for in the NICU. This sample was
      deemed adequate based on a sample size calculation conducted in PS Power and Sample Size
      Calculations (Version 3.0). Information concerning allocation was available only to the
      principal investigator. Participants were assigned a sequential number that was placed in an
      opaque, sealed envelope by the researcher who received the signed parental informed consent.
      When the participant was scheduled to be bathing, the envelope was opened by the researcher
      who then performed the test. The nurses could not be blinded to the allocation because of the
      nature of the intervention. However, the outcome assessment of the participants was blinded.
      Participats were randomly assigned to either sponge bathing or tub bathing groups. Bathing
      was performed anywhere from 6 to 48 hours post-birth, based on individual participant needs.
      Participants were subsequently placed in a preheated incubator, which varied according to the
      participant's weight and age. In order to compensate for such differences, the heads of all
      participants were placed at a height of 30 degrees in a right lateral position after bathing
      and they were monitored. The participants were not dressed during the observation period.
      After bathing, participants were left without intervention or contact for approximately 10
      minutes or until settled before being assessed. The data collection instrument, the Preterm
      Infant Bathing Study Record, was designed specifically for this study. The instrument
      incorporates a number of scales for the measurement of outcome variables, physiological
      parameters, and demographic information (age, gender, type of delivery, gestational age,
      birth weight, body weight at study time, etc.). Outcome measures include neonatal comfort
      behavior and physiological parameters (body temperature, heart rate, oxygen saturation,
      respiratory rate). Those responsible for data collection were blinded as to the allocation of
      participants they were assessing. The ComfortNeo scale was used to measure newborns' comfort
      and pain intensity. Comfort was inferred based on infant behavior, which was evaluated on two
      separate occasions, 10 minutes before bathing and 10 minutes after bathing. Measurement took
      approximately 1-2 minutes. Internal consistency was measured by way of Cronbach's alpha
      coefficient, which was 0.94 before bathing, 0.93 after bathing for the second researcher, and
      0.92 after bathing for the nurse. Kappa coefficients were approximately 0.84 for each
      sub-item. Thus, there was harmony between the two observers. Infant physiological parameters
      (heart rate, respiratory rate, oxygen saturation, and body temperature) were evaluated on
      three separate occasions (10 minutes before bathing, 15 minutes and 30 minutes after
      bathing).Statistical analysis was performed using SPSS 20.0 and SAS (ver.9.3), with
      statistical signiﬁcance set at p<0.05.

      Data was presented as means and standard deviations for continuous variables, and frequencies
      for categorical variables. For participant characteristics, such as the type of delivery and
      sex, a Chi-square test was applied to determine whether there were signiﬁcant between-group
      differences. participant characteristics, such as birth weight and body weight at the time of
      the study, were evaluated for signiﬁcant between-group diﬀerences using a one way ANOVA test.
      For a comparison of the diﬀerent phases, measurement parameters (comfort score, heart rate,
      oxygen saturation, respiratory rate, body temperature) through the baths were averaged
      separately. Repeated measurement analysis of variance was performed to analyze both between
      and within-group diﬀerences, followed by the Bonferroni post-hoc test.
    

Intervention name(s): Tub Bathing; Sponge Bathing
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The infant's face was washed and dried while still wrapped before being immersed. The water level in the tub was set at approximately 9-12 cm or deep enough to cover the baby's shoulders. A folded cloth towel was placed into the tub before bathing. The temperature of the bath water was controlled using a special water thermometer and adjusted to 37-38°C. The infant was held securely; the head and neck were supported on the researcher's forearm, and the shoulder was grasped using the researcher's thumb and finger. Cleaning was performed using a soft cloth and baby skin cleaner. The front and back areas were cleaned without turning the infant. The newborn was safely removed from the water and wrapped in a clean towel.; Sponge bathing is routine care of the clinic
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: A randomized controlled two-group pre-test and repeated post-test study design were adopted. Preterm infants were randomly allocated before bathing by the researcher using a random computer-generated table to one of two groups: sponge bathing (routine care) or tub bathing. The bathing procedures were performed by the researcher. Nurses and a second researcher were blinded to the study hypotheses.
Masking: Single (Outcomes Assessor)
Primary purpose: Supportive Care
Keywords: Bathing; Comfort; Neonatal intensive care unit; Nursing care; Premature infant; Skin care