The effect of bath applied in two different sequences on stress level and physiological parameters in term babies.

BACKGROUND

The sequence of neonatal bathing may significantly influence an infant's ability to maintain homeostasis. Traditional methods begin with the head, but deferring head washing to the final stage may reduce thermal loss and procedural distress.

PURPOSE: This study compared the effects of two swaddle bathing sequences head-first versus body-first on the stress levels and physiological parameters of term newborns.

DESIGN AND

METHODS

This randomized controlled trial (RCT) included 104 term infants born in a Training and Research Hospital in Istanbul between July 18 and September 20, 2023. Infants were randomly assigned to Group 1 (head washed first, then body; n = 52) or Group 2 (body washed first, then head; n = 52). Stress levels, calming durations, and physiological parameters (body temperature, oxygen saturation, heart rate) were systematically analyzed.

FINDINGS: Baseline measurements were similar between groups (p > 0.05). During and after the procedure, Group 1 exhibited significantly higher stress levels (p < 0.001) and longer calming times (p < 0.001) than Group 2. Post-procedure body temperature and O2 saturation were significantly lower (p < 0.001), while heart rate was significantly higher (p = 0.001) in Group 1.

CONCLUSION

Washing the body before the head minimizes neonatal stress, accelerates recovery, and preserves physiological stability. Deferring head washing is recommended to enhance neonatal care (RCT ID: NCT06166485).

IMPLICATIONS FOR PRACTICE: These findings provide evidence-based guidance for neonatal nurses. Implementing a body-first sequence optimizes thermoregulation and minimizes procedural stress in term infants.