| Abstract | BACKGROUND: Routine procedures are a large component of the caretaking day for preterm infants.
Such procedures can have profound adverse effects on an infant's condition, to the point of disrupting normal
growth and development. Despite this evidence, routine procedures are perpetuated in the neonatal ICU.
OBJECTIVE: To determine the physiological and behavioral effects of a supposedly beneficial procedure, a
sponge bath, on premature infants. METHODS: The study sample consisted of 14 preterm neonates with no
neurological abnormalities at two tertiary neonatal ICUs. The ages of the subjects were 28.1 to 31.8 weeks
postconception and 4 to 25 days after birth. The study was a prospective, quasi-experimental,
repeated-measures design in which each infant acted as his or her own control. Oxygen delivery, heart rate,
oxygen saturation, and behavioral responses were continuously recorded by computer or real-time videotape.
Physiological and behavioral parameters were compared across three phases: 10 minutes before a bath
(baseline), during a standardized bath, and 10 minutes after the bath. RESULTS: Physiological and
behavioral disruptions occurred throughout the bath phase and in many cases beyond that phase. These
disruptions included significant increases in heart rate, cardiac oxygen demand, and frequency of behavioral
motoric cues. Significant decreases in oxygen saturation also accompanied the bath. Nine infants required
increased concentrations of ambient oxygen. A significant association was found between physiological
components and the frequency and timing of behavioral motoric cues. CONCLUSIONS: The results provide
further evidence that routine care is not innocuous to neonates. Routine sponge bathing is not recommended
for care of ill premature infants. |