Maternal Child Flight article published in journal Published Dec. 28, 2017 By Merrie Schilter-Lowe 60th Air Mobility Wing Public Affairs TRAVIS AIR FORCE BASE, Calif. -- The David Grant USAF Medical Center’s Maternal Child Flight at Travis Air Force Base, California has one more reason to celebrate December. An article outlining how the labor and delivery unit implemented a delayed immersion bathing process for newborns that decreases heat loss and teaches parents how to care for their newborn’s skin is featured in the December issue of Nursing for Women’s Health. The peer reviewed clinical practice journal publishes the most recent health care information on women’s health, newborn care and professional nursing issues. The article is the result of an evidence based practice change that the labor and delivery unit initiated in November 2015 to improve infant skin care, said Maj. Jeannette Brogan, 60th Medical Group Maternal Child Flight commander and prenatal clinical nurse specialist. “An evidence based practice is taking research that has already been done and translating it into practice,” said Brogan, who co-authored the journal article with Capt. Gloria Rapkin who is now assigned as a clinical nurse at the San Antonio Military Medical Center, Fort Sam Houston, Texas. EBP is used in a variety of fields including medicine and psychology. Although previous studies have not identified an optimal time for a newborn’s first bath, the Association of Women’s Health, Obstetric and Neonatal Nurses recommended delayed bathing in 2013 to allow the vernix caseosa to absorb into the infant’s skin. The vernix – the waxy cheese-like substance that coats newborn skin – is believed to cleanse and moisturize the skin, regulate temperature, develop appropriate pH levels, help with wound healing and protect the infant from infection. However, as with most military treatment facilities, the labor and delivery staff at Travis sponged bathed healthy term newborns when they were about 2 to 4 hours old. After comparing the data from this study, the staff now instructs parents how to bathe their child in a newborn tub in their delivery room when the infant is 24 hours old and to do it in five minutes to prevent heat loss. “We are thrilled that the results we have seen in decreasing newborn hypothermia can be shared with the rest of the obstetrics community and particularly our Air Force and Department of Defense counterparts who are interested in implementing this process at their facilities,” said Brogan. Although there is mounting evidence that delaying newborn baths promotes breastfeeding, decreases hypothermia and allows for more parental involvement, Brogan said the practice is not routine. “Our hope is that this project will encourage other facilities to change their method of bathing,” she said. In fact, Brogan is already working with multiple Air Force military treatment facilities to implement delayed immersion bathing. “They will be collecting data pre- and post-implementation and sending that information back to DGMC so we can compile it and have organizational level results,” said Brogan. The EBP team, which included Maj. (Dr.) Laura White, 60th MDG inpatient pediatric medical director, won an award for their delayed immersion bathing project in May and will use the grant money to purchase newborn tubs for the participating MTFs. “Immersion bathing encourages hospitals to practice rooming-in, which allows mothers and newborns to stay together, and is a great opportunity to teach parents how to properly care for their newborn’s skin,” the authors stated in journal article. To evaluate the effectiveness of the practice change, the team reviewed electronic health records to compare newborn temperature data for all infants born from Nov. 1, 2014 to Oct. 31, 2015 who were sponge bathed with data collected on infants born from Nov. 1, 2015 to Oct. 31, 2016 who were bathed by their parents. Additionally, the team collaborated with several mothers who had previously given birth at DGMC to develop a survey to determine parents’ beliefs about the importance of delayed bathing, parent participation and the bath experience as a whole. Parents of newborns who received a tub bath in December 2016 and January 2017 completed the survey before leaving the hospital. Of the 36 respondents, 44 percent said they had never bathed a newborn, 77 percent said they preferred to have staff assists with baths and 89 percent said they wanted to bathe their newborn and believed that this was an important part of the birth experience. The survey also showed that 72 percent of parents were not sure if delaying the first bath was that important for their baby’s skin. “This highlighted the opportunity for education about the benefits of delaying the first bath,” the authors stated in the article. The article concluded that, overall, parents were satisfied with the new process. The cost is minimal, and the benefits of decreased cold stress, increased skin protection, and increased parent satisfaction are overwhelming and foster optimal newborn outcomes,” the authors wrote. With the delayed immersion bathing becoming routine at DGMC, the labor and delivery unit is now recruiting participants for a study to evaluate the impact of allowing women to eat during labor. “Once this study is completed, we plan to write up the results and disseminate to an appropriate scholarly journal for publication,” said Brogan. Volunteers for the study should contact their primary care provider at DGMC.