Study finds vast variations in newborn skincare

The hours immediately after delivery are critical in the bonding process for mother and baby,¹ but a lot else is happening in this period, too. There are assessments to be done and measurements to take. One practice that is now being debated is whether to include an infant’s first bath on the postnatal to-do list and how to do it.

A new study reveals that there isn’t really a standard in newborn bathing practices across the United States, with a wide variety of timing and methods.²

The survey polled directors at more than 100 birthing centers across 35 states. It revealed that most hospitals wait to bathe newborns for at least several hours after delivery, and some skip baths altogether.

Most hospitals—63%—delayed newborn bathing for 6 to 24 hours after delivery, with the exception of initially drying the infant. Another 15% wait until 24 hours after birth, and just 8% bathed infants within 6 hours of delivery.

Newborns were discharged to home with no bath at all in 10% of the birthing centers polled—mostly on the West Coast. The majority (71%) of birthing centers who discharged newborns without baths as a policy claimed the practice was evidence-based, but the research team notes that studies cited by these facilities were small in scope and generally inconsistent.

Numerous studies have investigated the importance of preserving temperature and preventing transepidermal water loss (TEWL) in newborns.³ There is also evidence that the vernix caseosa has vast benefits for infant skin, including⁴:

• Increased hydration
• Antimicrobial effects
• Cleansing properties
• Skin barrier and protectant
• Improved wound healing

This kind of research has informed the World Health Organization’s recommendation to delay bathing for at least 6 hours after birth,⁴ yet there is still no nationwide best practice or protocol that has been widely adopted in the United States, the study notes.

In addition to timing of baths, the study also investigated how baths were done when they were given.

Sponge baths were the most common method, used at 85% of the facilities that provided baths to newborns. Immersion baths were done in 11% of birthing centers and swaddle baths in just 3%, despite research that these types of baths can reduce heat loss and stress in newborns.⁵

Other bathing techniques that were reported included:

1. Use of liquid soap in 96% of facilities
2. Use of skin cleaner wipes alone or followed by a liquid soap bath at 2 facilities
3. Use of water alone in 3% of facilities

The study also investigated cleaning practices and skin care during diaper changes. Unscented wipes were used in the diaper area at 70% of birthing centers, and water alone was used in 23%. Skin moisturizers were used in just 8% of facilities, with another 5% reporting that parents applied moisturizer on their own.

Finally, regarding education, 87% of hospitals reported teaching parents to avoid immersion bath until “after the umbilical cord falls off,” whereas 6% instructed parents that immersion baths could happen right away. There was also a lot of variation in education about what types of soaps to use and where, how often to moisturize infant skin, as well as how to launder infants clothing and bedding. Only 1 out of 19 facilities that provided education on laundering recommended using fragrance-free detergents, the report notes.

The research team says that the study is the first to take the pulse of nationwide newborn bathing practices and suggests there is a need for more research and the development of evidence-based guidelines in the United States.

Ann Kellams, MD, a pediatrician at the University of Virginia in Charlottesville and co-author of the study said the goal of the report was to highlight the inconsistencies among hospitals on infant bathing practices, as well as to highlight new research that supports avoidance of soaps and detergents on infants. Kellams said there is a push toward more oil-based cleaners and emollient use on newborns, but it’s clear that more organized research is needed.

“Our goal was to survey the landscape of newborn skincare practices across the United States to get a sense of what we are currently doing, and call attention to the variability and the fact that much of what we do is more along the lines of ‘what we have always done’ and less based on evidence,” Kellams stated. “Our hope is that by calling attention to the wide variety of practices, we will encourage more research and investigation into best practices in order to craft guidelines and clinical protocols that will protect babies’ skin integrity to foster and nurture the development of strong immune systems and potentially help prevent the development of allergies and eczema.”

References

1. Wisniewski J, Phillipi C, Goyal N, et al. Variation in newborn skincare policies across united states maternity hospitals. Hosp Pediatr. 2021;11(9):1010-1019. doi:10.1542/hpeds.2021-005948

2. Crenshaw JT. Healthy birth practice #6: keep mother and baby together-it's best for mother, baby, and breastfeeding. J Perinat Educ. 2014;23(4):211-217. doi:10.1891/1058-1243.23.4.211

3. Brogan J, Rapkin G. Implementing evidence-based neonatal skin care with parent-performed, delayed immersion baths. Nurs Womens Health. 2017;21(6):442-450. doi:10.1016/j.nwh.2017.10.009

4. Visscher M, Narendran V. Vernix caseosa: formations and functions.Newborn and Infant Nursing Reviews. 2014;14(4):142-146. doi: 10.1053/j.nainr.2014.10.005

5. Lund, C. Bathing and beyond.Advances in Neonatal Care. 2016;16(5S):S13-S20. doi:10.1097/anc.0000000000000336