Purpose and Goal: CEARP #1092

  • Describe the detrimental effects of stress in the NICU.
  • Identify an alternative strategy for decreasing stress related to routine bathing.

None of the planners, faculty or content specialists has any conflict of interest or will be presenting any off-label product use. This presentation has no commercial support or sponsorship, nor is it co-sponsored.

Requirements for Successful Completion

  • Successfully complete the post-test.
  • Complete the evaluation form.


  • November 2013 - November 2015

Learning Objectives

  • Describe the detrimental effects of stress in the NICU.
  • Identify at least two alternative strategies to decrease stress during routine bathing in the NICU.

The NICU Environment

  • The NICU is drastically different from the womb environment.
  • The NICU exposes the infant to excessive light and noise.
  • Routine NICU care can be painful and stressful.
  • Daily care can be stressful and interrupt normal development.
    • Position changes
    • Diaper changes
    • Feeding
    • Bathing
  • Stress can have detrimental effects.
    • Interrupted sleep
    • Altered brain development
    • Altered outcomes

Developmentally Supportive Care

  • Reduces environmental and infant stress
  • Creates an environment for growth
    • Supports physical growth
    • Supports psychological growth
    • Supports emotional growth
  • Provides developmentally appropriate experiences
  • Promotes parent-infant bonding and interaction
  • Minimizes potential complications and poor outcomes

AWHONN and NANN Skin Care Guidelines

  • Routing bathing is important.
  • Bathing removes contaminants from the skin.
    • Waste material
    • Creams and emollients
    • Reduces microbial colonization
  • Immersion bathing is recommended.
  • Sponge baths have been shown to be stressful.
  • Adverse physiological responses
    • Bradycardia
    • Oxygen desaturation
  • Adverse behavioral responses
    • Crying
    • Startle responses
    • Agitation

Swaddled Bathing

  • Uses immersion bathing
    • Removes creams and emollients
    • Sloughs dead skin cells
    • Rehydrates skin surface
  • Reduces infant stress and agitation
  • Uses blanket swaddling to provide comfort
  • Promotes flexion and containment
  • Provides developmentally supportive care

Swaddled Bathing Procedure

  • Take infant's temperature.
  • Disconnect leads and pulse oximeter.
  • Remove leads and pulse oximeter probe.
    • Leads may be removed in the bath.
  • Remove clothing and diaper.
  • Wrap infant in a warm blanket.
    • Hands to face
    • Arms and legs flexed
  • Clean infant's face using warm water only.
    • Clean eyes wiping from nose to ears.
    • Clean around entire face.
  • Place infant in tub of warm water.
    • Ideal temperature is 100°-101° F.
    • Immerse to shoulders.
  • Support infant's shoulders and head at all times.
  • Gently unwrap one arm and wash with soap.
  • Rinse and reswaddle the arm.
  • Unswaddle, wash and reswaddle the other arm.
  • Unswaddle, wash, and reswaddle each leg, one at a time.
  • Wash the infant's neck, chest, stomach, back and diaper area.
  • Reswaddle the infant and end the bath with hair washing.
  • Gently rinse hair with irrigation bottle, avoiding infant's eyes.
  • When the bath is complete, unswaddle the infant.
    • Remove infant from tub and place on a warm dry blanket.
    • Leave wet swaddling blanket in the tub.
  • Dry the infant and dress in diaper and hat.
  • Place new leads and pulse oximeter probe, and attach to monitor.
  • Prepare for feeding or skin-to-skin care.

Post-Bath Care

  • Swaddled bathing can be used to promote parent-infant interaction.
    • Promotes parent participation in infant care
    • Promotes parent-infant attachment and bonding
    • Promotes parent confidence with infant handling
  • Swaddled bathing has been shown to increase infant alertness.
    • Improved infant participation in feeding
    • Improved parent-infant interactions
    • Decreased infant and parent stress
  • Swaddled bathing can be used prior to skin-to-skin care.
    • Place the infant on parent's chest upon removal from tub.
    • Dry and dress infant in diaper and hat while on parent's chest.
    • Promotes quiet and alert parent-infant interaction


  1. Quraishy, K., Bowles, S.M. and Moore, J. A Protocol for Swaddled Bathing in the NICU. 2013. Newborn and Infant Nursing Reviews, 13, p. 48-50.
  2. Neonatal Skin Care - Evidence-Based Clinical Practice Guideline. 3rd Edition. 2013. Association of Women's Health, Obstetric, and Neonatal Nurses.
  3. Lund, C., Kuller, J., Lane, A., Lott, J.W., & Raines D.A. 1999. Neonatal Skin Care: The Scientific Basis for Practice. Neonatal Network, 18 (4), p. 15-26.
  4. Lund, C., Kuller, J., Lane, A., Lott, J.W., & Raines, D.A. 1999. Neonatal Skin Care: The Scientific Basis for Practice. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 28 (3), p. 241-254.
  5. Lund, C. H., Osborne, J. W., Kuller, J., Lane, A. T., Lott, J. W., & Raines, D.A. 2001. Neonatal Skin Care: Clinical Outcomes of the AWHONN/NANN Evidence-Based Clinical Practice Guideline. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 30 (3), p. 41-51.

Test and Evaluation