1. Long Term Benefits of EBP
 Reduced hypothermia R/T
physiological disorders
 Improved neonatal outcomes
 Increased patient satisfaction rates
 Decreased nursing interventions
 Reduced NICU admissions
 Reduced hospital re-admissions /
hospital stays
 Decreased hospital expense
The World Health Organization
(WHO, 2012)
WHO recommends delaying the initial neonate
bath for 24 hours to decrease development of
hypothermia.
Exceptions:
 Cultural implications: delay bath
minimum of 6 hours
 Neonate born with communicable
disease: bathed early to prevent
disease transmission between the
neonate and the healthcare provider
UC San Diego Medical Center
Model (UCSDMC, 2006)
UCSDMC adapted a successful policy to delay
neonate bath for a minimum 24 hours.
 Decreased cold stress and energy
expenditure
 Decreased thermoregulation rates
 Improved parental bonding and
breastfeeding
Ugandan Hospital Study (Smith, 2014)
Showed increased hypothermia rates were
experienced when neonate baths were performed
shortly after birth.
PICO(T) Question:
For neonates (P) does delaying the
initial bath twenty four hours
postpartum (I) reduce the future risk
of hypothermia (O) compared to
providing the initial bath one to two
hours after birth (C)?
Image retrieved from http://parentingpatch.com/week-19-pregnancy-week-
week-pregnancy-calendar/
Reducing
the Incidence
of Hypothermia
in Neonates
Presented by:
Stephanie Holman, SN/ASU
Phone: (602) 214-5071
Email: stephanieholman26@gmail.com
Presented by:
Stephanie Holman, SN/ASU
References
Loring, C., Gregory, K., Gargan, B., LeBlanc, V.,
Lundgren, D., Reilly, J., . . . Zaya, C. (2012).
Tub bathing improves thermoregulation of
the late preterm infant. Journal of Obstetric,
Gynecologic & Neonatal Nursing
(JOGNN), 41(2), 171-179,
doi:10.1111/j.1552-6909.2011.01332.x
Smith, J. (2014). Thermoregulation and
temperature taking in the developing
world: A brief encounter. Journal of
Neonatal Nursing, 20(5), 218-229.
doi:10.1016/j.jnn.2014.03.002
Sobel, H. L., Silvestre, M. A., Mantaring III, J. V.,
Oliveros, Y. E., & Nyunt-U, S. (2011).
Immediate newborn care practices delay
thermoregulation and breastfeeding
initiation. Acta Paediatrica, 100(8), 1127-
1133. doi:10.1111/j.1651-
2227.2011.02215.x
UC San Diego Health System. (2006). Bathing a
healthy newborn. Retrieved from
http://health.ucsd.edu/Pages/SearchResul
ts.
aspx?q=Bathing%20a%20Healthy%20Ne
wborn
World Health Organization. (2012).
Recommendation on newborn health.
Retrieved from
http://apps.who.int/iris/bitstream/10665
/97603/1/9789241506649_eng.pdf
Image retrieved from:
http://parentingpatch.com/week-19-pregnancy-
week-week-pregnancy-calendar/
http://www.childhealth-
explanation.com/newborn-nursing.html

2. Current Practice
Many hospitals nationwide provide the initial neonate
bath within 1-2 hours after birth.
Clinical Issue
(Sobel, Silvestre, Mantaring III et al., 2011; Smith 2014)
Exposure to a cold environment can lead to several
physiological processes which can lead to increased
oxygen consumption and energy demands as heat is
generated through non shivering thermo genesis, which
can lead to mortality.
The most critical time to maintain thermoregulation is
within 24 hours of birth. Decreased thermoregulation can
lead to shock or death.
Bathing the neonate 1-2 hours postpartum increases the
infant’s vulnerability to temperature instability through
environmental temperature variations which exposes
neonates to hypothermia related to (R/T):
 Removal of vernix caseosa which provides highly
moisturizing maternal bacteria which contains
anti-infective agents and helps maintain body
temperature.
 Early bathing can result in vernix being removed
too early, resulting in a disrupted skin barrier
which can lead to transepidermal water loss
through cooling in the neonates bare skin.
 Preterm infants at great risk to develop cold
stress within first 24 hours of birth as they
transition into extrauterine life.
 Early bathing linked to: sepsis, infant stress, and
thermoregulation.
 Neonates at risk of heat loss R/T: radiation,
convection, conduction, and evaporation.
Late preterm infants have (Loring et al., 2012):
 Decreased muscle tone & proportion of brown
adipose tissue
 Thinner skin
 Increased surface area to body mass
 Immature nervous system
These conditions can lead to cold stress resulting in
physiological changes which can lead to (Loring et. al., 2012):
 Hypoglycemia
 Hyperbilirubinemia
 Dehydration
 Failure to thrive
 Respiratory compromise
 Hypoxia
Potential Complications (Sobel, Silvestre, Mantaring
III, Oliveros, Nyunt-U, 2012; Smith, 2014):
Exposure to a cold environment can lead to hypothermia,
oxygen consumption, or death.
Hypothermia has been linked to:
 Brain or pulmonary hemorrhage
 Acidosis
 Hyaline membrane disease
 Fetal-to-newborn circulatory adjustment
 Difficult resuscitation
 Coagulation defects
 Lowered systemic arterial pressure
 Increased peripheral resistance
 Decreased cardiac output
 Increased oxygen requirements
 Necrotizing entercolitis
 Increased incidence of disseminated
intravascular coagulation (DIC)
 Infections leading to increased morality
Surfactant production decreased when < 35° C temp
(Smith, 2014)
 Neonate becomes cold, increasing exposure to
hypothermia
 Surface tension lowering agent becomes
impaired
 Core temperature is decreased resulting in rapid
heat loss, which can lead to cold stress
 Can lead to atelectasis
Retrieved from http://www.childhealth-explanation.com/newborn-nursing.html
EBP Recommendations
(Loring et al., 2012; Smith, 2014)
The initial neonate bath should not be performed until the
neonate’s vernix has been absorbed by the infant’s body
and temperature stability has been maintained. It is
recommended that the initial neonate bath be performed
24 hours postpartum, thus promoting:
 Decreased energy expenditure
 Increase oral nutrition
 Prevention of: heat loss, cold stress, &
hypothermia
 Reduce significant clinical complications
 Critical to prevent thermoregulation
 Prevention of deaths