The NeoBath Study: Nursing babies in Neonatal Care

Research question Does the frequency of bathing babies on a neonatal unit impact upon pathogenic skin colonisation and parent preparedness for infant discharge?

Background Currently in the UK neonatal sepsis is estimated to effect around 49/1000 neonatal admissions and contributes significantly to neonatal mortality and morbidity.

Baby baths are an important part of infection control measures which can potentially support the prevention of harmful skin colonisation and subsequent neonatal infections, however optimal bathing frequency of neonates is unknown.

Encouraging parents to become primary caregivers in baby baths can also enhance parent-infant bonding and facilitate parenting skills in preparation for infant discharge.

Aims and Objectives To test the feasibility of a neonatal swaddle bathing intervention, identifying primary outcome measures, usability, and acceptability.

This will inform a future trial exploring the impact of neonatal bathing upon skin colonisation and parent-infant bonding. Study objectives will: Determine whether the bathing intervention is feasible.

Determine primary outcomes for a larger pilot study Develop processes for collecting outcome data on skin colonisation following introduction of the bathing intervention.

Develop processes for collecting outcome data on parent-preparedness for discharge following introduction of the bathing intervention. Determine the sample size and unit of randomisation for a larger randomised neonatal trial.

Identify confounding factors Determine user acceptability of the trial from parents and neonatal staff Methods A feasibility randomised control trial will compare the effects of bathing babies in one neonatal unit once every 4 days (n=25) to once every 7 days (n=25), over a 5-week period. The main outcome is to determine the feasibility of conducting a larger, powered study.

Outcomes assessed will be physiological variables and axilla skin swabs taken pre-post bath to determine impact upon the infant and detect changes to the bacterial load (colony forming units).

Qualitative interviews with participating parent(s) and neonatal healthcare professionals will explore study acceptability and parents preparedness for discharge. Timelines for delivery The study will be conducted over an 18-month period, starting in September 2024. We will aim for 50% target by June 2025, with 100% recruitment achieved by August 2025.

All infant data collection and qualitative interviews of the embedded qualitative study will be complete by October 2025.

Data analysis will be finalised by December 2025, with results ready for publication and dissemination by February 2026. If successful, preparation for the larger trial proposal will begin January 2026.

Anticipated Impact and Dissemination We hope to develop an intervention which can be piloted in future research in a multicentre trial.

The aim of the intervention will be to determine the impact of a bathing intervention upon rates of neonatal sepsis and parent-prepardness for discharge.

This could potentially reduce the impact of neonatal sepsis, reduce length of stay and associated prolonged family separation, and reduce financial implications for families and the NHS.

Findings will be disseminated online (webpage), through social media of relevant professional and parent organisations, academic publications and conference presentations, and a workshop with neonatal nurses to discuss, if successful, potential involvement of other units in further pilot studies.