Biobehavioral Responses of Preterm Infants to Conventional and Swaddled Tub Baths: A Randomized Crossover Trial

Area of Science:

• Neonatal care and developmental pediatrics.
• Infant physiology and stress response.
• Evidence-based nursing practices.

Background:

• Routine bathing of preterm infants can induce stress and alter biobehavioral responses due to prolonged handling.
• Understanding the impact of different bathing methods is crucial for optimizing neonatal intensive care unit (NICU) environments.
• Swaddled bathing is a potential alternative to conventional tub baths, aiming to minimize infant stress.

Purpose of the Study:

• To compare the effects of swaddled baths versus conventional tub baths on preterm infants' physiological and behavioral responses.
• To assess differences in body temperature, heart rate (HR), peripheral capillary oxygen saturation (SpO2), salivary cortisol, and sleep-wake states.
• To evaluate the impact of bathing methods on stress markers and recovery in vulnerable preterm infants.

Main Methods:

• A double-blind randomized crossover trial involving 43 preterm infants (32-36 weeks postmenstrual age, weight ≤2225 g).
• Infants received both swaddled and conventional tub baths, with a 24-72 hour washout period between interventions.
• Physiological (temperature, HR, SpO2), hormonal (salivary cortisol), and behavioral (sleep-wake states) data were collected pre-bath and during recovery.

Main Results:

• No significant differences were found in mean body temperature, HR, SpO2, or salivary cortisol levels between swaddled and conventional tub baths.
• Sleep-wake states also showed no significant variations between the two bathing methods during baseline or the first 20 minutes post-bath.
• Salivary cortisol levels exhibited a non-statistically significant increase irrespective of the bath type, suggesting a minimal stress response.

Conclusions:

• Both swaddled and conventional tub baths appear to be equally safe and well-tolerated regarding immediate physiological and hormonal stress markers in preterm infants.
• The findings suggest that current bathing practices, whether swaddled or conventional, do not elicit significant acute stress responses in this preterm infant population.
• Further research may explore longer-term developmental outcomes or subtle behavioral differences not captured in the immediate post-bath recovery period.