Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
Department of Neonatology, St. Johns Medical College Hospital, Bangalore, Karnataka, India.
J Glob Health. 2022 Aug 17;12:12004. doi: 10.7189/jogh.12.12004.
This systematic review of intervention trials and observational studies assessed the effect of delaying the first bath for at least 24 hours after birth, compared to conducting it within the first 24 hours, in term healthy newborns.
We searched MEDLINE via PubMed, Cochrane CENTRAL, Embase, CINAHL (updated till November 2021), and clinical trials databases and reference lists of retrieved articles. Key outcomes were neonatal mortality, systemic infections, hypothermia, hypoglycaemia, and exclusive breastfeeding (EBF) rates. Two authors separately evaluated the risk of bias, extracted data, and synthesized effect estimates using relative risk (RR) or odds ratio (OR). The GRADE approach was used to assess the certainty of evidence.
We included 16 studies (two trials and 14 observational studies) involving 39 020 term or near-term healthy newborns. Delayed and early baths were defined variably in the studies, most commonly as >24 hours (six studies) and as ≤6 hours (12 studies), respectively. We performed a post-hoc analysis for studies that defined early bath as ≤6 hours. Low certainty evidence suggested that bathing the newborn 24 hours after birth might reduce the risk of infant mortality (OR = 0.46, 95% confidence interval (CI) = 0.28 to 0.77; one study, 789 participants) and neonatal hypothermia (OR = 0.50, 95% CI = 0.28-0.88; one study, 660 newborns), compared to bathing within first 24 hours. The evidence on the effect on EBF at discharge was very uncertain. Delayed bath beyond 6 hours (at or after nine, 12, or 24 hours) after birth compared to that within 6 hours might reduce the risk of hypothermia (OR = 0.47, 95% CI = 0.36-0.61; four studies, 2711 newborns) and hypoglycaemia (OR = 0.39, 95% CI = 0.23-0.66; three studies, 2775 newborns) and improve the incidence of EBF at discharge (OR = 1.12, 95% CI = 1.08-1.34; six studies, 6768 newborns); the evidence of the effect on neonatal mortality was very uncertain.
Delayed first bath for at least 24 hours may reduce infant mortality and hypothermia. Delayed bath for at least 6 hours may prevent hypothermia and hypoglycaemia and improve EBF rates at discharge. However, most of these conclusions are limited by low certainty evidence.
PROSPERO 2020 CRD42020177430.
本系统评价纳入了干预试验和观察性研究，评估了与出生后 24 小时内首次沐浴相比，至少 24 小时后首次沐浴对足月健康新生儿的影响。
我们通过 MEDLINE（通过 PubMed）、Cochrane 中心对照试验数据库、Embase、CINAHL（更新至 2021 年 11 月）和临床试验数据库以及检索到的文章的参考文献列表进行检索。主要结局指标为新生儿死亡率、全身感染、低体温、低血糖和纯母乳喂养（EBF）率。两位作者分别评估了偏倚风险、提取数据，并使用相对风险（RR）或比值比（OR）来综合效应估计值。使用 GRADE 方法评估证据的确定性。
我们纳入了 16 项研究（两项试验和 14 项观察性研究），涉及 39020 名足月或近足月健康新生儿。研究中对延迟和早期沐浴的定义各不相同，最常见的是＞24 小时（6 项研究）和≤6 小时（12 项研究）。我们对将早期沐浴定义为≤6 小时的研究进行了事后分析。低确定性证据表明，与出生后 24 小时内沐浴相比，出生 24 小时后沐浴可能降低婴儿死亡率（OR=0.46，95%置信区间（CI）=0.28-0.77；一项研究，789 名参与者）和新生儿低体温（OR=0.50，95%CI=0.28-0.88；一项研究，660 名新生儿）。关于出生后出院时 EBF 的效果的证据非常不确定。与出生后 6 小时内沐浴相比，出生后 6 小时后（9、12 或 24 小时后）延迟沐浴可能降低低体温（OR=0.47，95%CI=0.36-0.61；四项研究，2711 名新生儿）和低血糖（OR=0.39，95%CI=0.23-0.66；三项研究，2775 名新生儿）的风险，并改善出院时 EBF 的发生率（OR=1.12，95%CI=1.08-1.34；六项研究，6768 名新生儿）；关于新生儿死亡率影响的证据非常不确定。
至少 24 小时的首次延迟沐浴可能降低婴儿死亡率和低体温。至少 6 小时的延迟沐浴可预防低体温和低血糖，并提高出院时 EBF 的比例。然而，这些结论大多受到低确定性证据的限制。
PROSPERO 2020 CRD42020177430。
