Effects of tub bathing procedures on preterm infants' behavior.

Although medical advances have increased the survival rate of preterm infants, morbidity in terms of neurodevelopmental impairment has not decreased for this population. This results in caregivers having to reconsider how neonatal intensive care unit (NICU) caregiving impacts on preterm infants. The purpose of this study was to examine the effects of different phases of a routine tub bath on preterm infants' distress and state behavior in the NICU. The study used an exploratory repeated measures design that focused on preterm infants' distress and state behavior, and evaluated the effects of three phases of a routine tub bath, which were performed according to standard unit practice in the NICU. Thirteen nurses repeatedly bathed 12 infants on different days, and 64 baths were videotaped for the purpose of assessing the variety of distress behavior. The procedures of one bath could be categorized into three phases designated to Phases I, II, and III. The variables were measured by a preterm infant behavioral coding scheme developed for this research. The inter-rater reliability of the instrument ranged from .82 to .99. Mixed effects analysis of variance was used to analyze the differences among the bath phases in the occurrences of distress and state behavior. The results showed significant statistical difference among most distress behaviors during the three phases (e.g. "startle, jerk, tremor" F ratio = 25.62, p < .001; "finger splay, grasping, fisting" F ratio = 49.99, p < .001; "grimace" F ratio = 36.55, p < .001; "fussing or crying" F ratio = 25.27, p < .001), with the exception of "extension, arching and squirming". In particular, the occurrence of distress and state behavior increased significantly in phase II. Routine tub bathing not only disrupts preterm infants' sleep but also causes an increase in distress behavior. Preterm infants' stress increases with the intrusiveness of nursing procedures. NICU caregivers should consider the effects of routine nursing activities that influence the infants, and modify handling to promote techniques to promote preterm infants' recovery, growth and development.