Study reveals confusing mishmash of newborn bathing practices at US hospitals
IMAGE: "THE VARIATION IN WHAT HOSPITALS ARE DOING FOR NEWBORN SKINCARE IS A DIRECT RESULT OF PREVIOUSLY NOT HAVING A GOOD UNDERSTANDING OF WHAT REALLY IS THE BEST WAY TO CARE FOR A BABY'S SKIN," SAID RESEARCHER ANN L. KELLAMS, MD, OF UVA CHILDREN'S. "THE HOPE NOW IS THAT THIS WORK WILL CHALLENGE US ALL TO TAKE A LOOK AT THE EVIDENCE AND INCORPORATE PRACTICES THAT PROTECT BABIES THE MOST." view more
CREDIT: DAN ADDISON | UVA COMMUNICATIONS
A nationwide survey of hospitals has revealed a wide variety of approaches to newborn skincare – including the timing of the first bath – that could ultimately have lasting effects on a baby’s health and wellbeing.
Believed to be the first of its kind, the survey sought to document newborn skincare practices at hospitals around the country. Doctors have increasingly come to appreciate the importance of infant exposure to natural skin microbes, but there are no clear evidence-based guidelines for hospitals to follow.
The result, the researchers found, is a mishmash of practices that sometimes break down along regional lines.
“The variation in what hospitals are doing for newborn skincare is a direct result of previously not having a good understanding of what really is the best way to care for a baby’s skin,” said researcher Ann L. Kellams, MD, of UVA Children’s. “The hope now is that this work will challenge us all to take a look at the evidence and incorporate practices that protect babies the most.”
Newborn Skincare: What’s Best for Baby?
The skincare babies receive in the hours and days after birth has long-term effects, shaping breastfeeding outcomes, infant skin health and even infection rates. For example, children who are birthed vaginally are known to have decreased rates of childhood allergies compared with those born by caesarian section.
That said, there is little hard evidence on health outcomes associated with delayed bathing and other newborn skin practices, such as the use of specific soaps and cleansers. That often leaves doctors with conflicting opinions, often built on anecdote and personal experience.
To get a sense of the practices in place around the country, the researchers sent 16 questions to nursery medical directors at 109 hospitals that are members of the Better Outcomes through Research for Newborns (BORN) network. The questions asked about bathing practices, the products used and the advice given to parents, among other topics.
The responses indicated:
- 87% of hospitals delay the first bath by at least six hours.
- 10% send babies home without a bath, a practice more common in non-academic centers and on the West Coast.
- There is a huge variety of products and procedures used, though almost all include a “baby” soap containing detergents known to compromise the newborn’s skin integrity.
- Bathing advice for parents, such as whether they should use soap when washing the baby, is “inconsistent and potentially contradictory” among healthcare providers. This can leave parents confused and uncertain what to do.
The evidence underpinning most hospitals’ skincare practices is “scant,” the researchers report in a new scientific paper outlining their findings. They are urging the formulation of more consistent guidelines built on hard evidence.
“Given the potential widespread clinical impact of newborn skincare and the paucity of data to support or refute widespread adoption of specific practices, further research is needed to improve and standardize care in U.S. nurseries and mother-baby units,” they state.
COVID-19 guidelines may also be needed, they note. “Based on one large case series of maternal hospitals in New York City showing no increased morbidity to newborns, authors recommend that early skin-to-skin contact and delayed bathing can be practiced even in newborns born to mothers infected with COVID-19,” the researchers write.
Developing better, evidence-based guidelines in general would benefit all parents and infants, Kellams says. “In the future, we may be seeing a decreased emphasis on soap, an increased emphasis on oil-based cleansing and an increased emphasis on the application of emollients,” she said. “Better skin integrity would offer more protection to the babies against infection, development of allergies, etcetera.”
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Findings Published
The researchers have published their findings in the scientific journal Hospital Pediatrics. The research team consisted of Julia A. Wisniewski, Carrie A. Phillipi, Neera Goyal, Anna Smith, Alice E.W. Hoyt, Elizabeth King, Dennis West, W. Christopher Golden and Kellams. The authors thank the members of the BORN network for their participation in the study.
To keep up with the latest medical research news from UVA, subscribe to the Making of Medicine blog at https://makingofmedicine.virginia.edu.
JOURNAL
Hospital Pediatrics
DOI
Infants with history of reported maltreatment at greater risk of death from medical causes, study shows
A new USC study published in the journal Pediatrics finds a heightened risk of death from medical causes for infants with histories of reported maltreatment, suggesting a need for ongoing care coordination between the child protection system and pediatric health providers.
“Newborns in families involved with the child protection system reflect a highly vulnerable group and it is not surprising that their rates of death are elevated relative to infants never reported,” said study author Janet Schneiderman, a research associate professor emerita and former chair of the Department of Nursing at the USC Suzanne Dworak-Peck School of Social Work.
“Families with children who are reported to the child protection system often have risk factors that make providing adequate care for their children or meeting their children’s health care needs more difficult, especially during infancy.”
Researchers used a dataset for analysis comprised of birth and death records for all children born in California between 2010 and 2016 obtained from the California Department of Public Health, and administrative child protection system and foster care placement records made available through a data-sharing agreement between USC, the California Department of Social Services and the Children’s Data Network.
After adjusting for baseline risk factors, the researchers found that the risk of death from medical causes among infants reported for maltreatment was two to three times greater than observed for infants never reported. Among infants reported for maltreatment, the study found that periods of foster care placement reduced the risk of infant death due to medical causes by roughly half.
“Foster care placement was found to be protective against infant death from medical causes, highlighting the preventable nature of many of these deaths and raising questions of missed opportunities to ensure health and other preventive services for infants who remain at home,” Schneiderman said.
“Only one quarter of infants reported for maltreatment spent any time in foster care, and infant death is a rare event. The emergence of statistically significant differences in risk of preventable death is provocative and suggests that more intensive case management and health care supports are needed for infants remaining at home following allegations of abuse or neglect,” said co-author Emily Putnam-Hornstein, a distinguished scholar at USC, the John A. Tate Distinguished Professor for Children in Need at the University of North Carolina School of Social Work and co-director of the Children’s Data Network.
In addition to Schneiderman and Putnam-Hornstein, the study was authored by John Prindle, research assistant professor for the Children’s Data Network at the USC Suzanne Dworak-Peck School of Social Work.
The study was supported by The Conrad N. Hilton Foundation and the Heising-Simons Foundation, and data infrastructure support from First 5 LA for the Children’s Data Network.
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JOURNAL
PEDIATRICS
METHOD OF RESEARCH
Data/statistical analysis
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Open Access Infant Deaths From Medical Causes After a Maltreatment Report
ARTICLE PUBLICATION DATE
1-Aug-2021
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