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Biobehavioral Responses of Preterm Infants to Conventional and Swaddled Tub Baths

A Randomized Crossover Trial

de Freitas, Patrícia, PhD, RN; Bueno, Mariana, PhD, RN; Holditch-Davis, Diane, PhD, RN, FAAN; Santos, Hudson Pires, PhD, RN; Kimura, Amélia Fumiko, PhD, RN

The Journal of Perinatal & Neonatal Nursing: October/December 2018 - Volume 32 - Issue 4 - p 358–365
doi: 10.1097/JPN.0000000000000336
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Bathing is a routine care procedure that exposes preterm infants to prolonged handling, which could cause stress and potentially disrupt infants' biobehavioral responses. The aim of this double-blind randomized crossover trial was to compare the preterm infant's body temperature, heart rate (HR), peripheral capillary oxygen saturation (SpO2), salivary cortisol levels, and sleep-wake states during and after swaddled and conventional tub baths. Forty-three infants born at 32 to 36 weeks postmenstrual age, weighing 2225 g or less, were enrolled in the study. Infants were videotaped before and after each type of baths. The time interval between baths ranged from 24 to 72 hours to allow a washout period. Physiological, hormonal, and behavioral responses were collected at baseline and during recovery from baths. No significant differences in the mean body temperature, HR, SpO2, salivary cortisol levels, and sleep-wake states between the bath types were observed in the baseline or recovery responses during the first 20 minutes after bath. Regardless of bath type, salivary cortisol levels showed a nonstatistical significant increase.

School of Nursing, University of Sao Paulo, Sao Paulo, Brazil (Drs Freitas, Bueno, and Kimura); Duke University School of Nursing, Durham, North Carolina (Dr Holditch-Davis); and University of North Carolina at Chapel Hill School of Nursing (Dr Santos).

Corresponding Author: Patrícia de Freitas, PhD, RN, School of Nursing, University of Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 419, Sao Paulo, SP, Brazil, 05403-000 (

This research was funded by the Sao Paulo Research Foundation (grant # 2013/23884-1, PIs: Drs Freitas and Kimura). The authors thank the parents who agreed to let their babies participate in this study.

Clinical Trial Registry: This trial was registered at the Brazilian Registry of Clinical Trials (UTN # U1111-1151-5469).

Disclosure: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Each author has indicated that he or she has met the journal's requirements for Authorship.

Submitted for publication July 31, 2017; accepted for publication December 7, 2017.

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