# Situation: A nurse at a lying-in clinic prepares mothers and their healthy term newborns for discharge and follows them up by telephone and home visits during the first weeks after birth. A healthy term girl was born at 3:00 a.m. At 8:00 a.m., her mother asks whether she may bathe the baby now. The baby's axillary temperature is 36.8 °C, and her cord stump is still attached. According to World Health Organization (WHO) postnatal care recommendations, what should the nurse advise?

> source: MyMerci (mymerci.kr)  
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> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: A nurse at a lying-in clinic prepares mothers and their healthy term newborns for discharge and follows them up by telephone and home visits during the first weeks after birth.

A healthy term girl was born at 3:00 a.m. At 8:00 a.m., her mother asks whether she may bathe the baby now. The baby's axillary temperature is 36.8 °C, and her cord stump is still attached. According to World Health Organization (WHO) postnatal care recommendations, what should the nurse advise?

## 보기

1. Wait until she is 1 day old, then sponge-bathe her in warm water **✔ 정답**
2. Give her a bath now, since her temperature is already stable
3. Wait until she is 7 days old, then sponge-bathe her in warm water
4. Avoid giving her any bath at all until the cord stump falls off

**정답: 1**

## 해설

WHO recommends delaying the first bath until at least 24 hours after birth, or at least 6 hours when a full day is not possible, and giving it only when the temperature is stable. This baby is only 5 hours old, below both the WHO 24-hour recommendation and the 6-hour minimum. The cord is kept clean and dry with nothing applied to it.

## 심화 해설

Scenario Analysis

The newborn is only 5 hours old at the time of the mother's request. Although the axillary temperature of 36.8 °C is within the normal range, WHO guidance prioritizes delaying the first bath until at least 24 hours after birth, with a minimum acceptable window of 6 hours only when a full day is not feasible. The cord stump is still attached, which further supports keeping the area dry and avoiding immersion.

Why Delaying the Bath Matters

The immediate postnatal period is a time of significant physiological transition. Bathing too early can disrupt the newborn's adaptation to extrauterine life in several ways. Thermoregulation is especially fragile because newborns have a high surface-area-to-body-mass ratio, limited subcutaneous fat, and immature mechanisms for heat production. Exposure to water and air during a bath accelerates evaporative and convective heat loss, which can lead to hypothermia even when the pre-bath temperature appears stable.

Beyond temperature, early bathing may interfere with pulmonary and gastrointestinal circulatory adaptation. The transition from fetal to neonatal circulation depends on pressure changes in the lungs and systemic vasculature. Cold stress triggers peripheral vasoconstriction and can increase pulmonary vascular resistance, potentially compromising oxygenation. Similarly, blood flow to the gut may be reduced, delaying feeding tolerance and increasing the risk of necrotizing enterocolitis in vulnerable infants [1].

Applying the WHO 24-Hour Rule to This Case

The WHO practical guide for thermal protection of newborns explicitly recommends withholding the first bath for at least 24 hours after delivery [2][3]. This recommendation exists to prevent neonatal hypothermia, reduce infection risk, and support overall morbidity and mortality reduction [2][4]. The 6-hour minimum is a fallback position for settings where cultural or logistical constraints make a full 24-hour delay impossible. In this scenario, the baby is only 5 hours old, which falls below even that minimum threshold.

| Time Since Birth | WHO Recommendation Status | Nursing Action |
| --- | --- | --- |
| Less than 6 hours | Below minimum acceptable delay | Do not bathe; keep warm and dry |
| 6 to 23 hours | Acceptable only if 24 hours not possible | May sponge-bathe if temperature stable and no cultural barrier to waiting |
| 24 hours or more | Meets WHO standard | Bath may be given when vital signs are stable |

Watch out! A normal axillary temperature at one moment does not guarantee thermal stability during a bath. The risk of hypothermia is highest in the first hours after birth, so the timing of the bath—not just the current temperature—drives the decision.

Cord Stump Care in the Same Window

The attached cord stump reinforces the need for conservative care. WHO recommends keeping the cord clean and dry, with nothing applied to it. Bathing, especially immersion, can introduce moisture and delay cord separation. Sponge-bathing after the recommended delay is safer than tub bathing while the stump remains attached. In this case, the nurse should advise the mother to wait until the baby is at least 1 day old and then use a warm-water sponge bath, ensuring the cord area stays dry.

Key point! The correct nursing advice is to delay the first bath until the newborn is at least 24 hours old, then sponge-bathe in warm water. This aligns with WHO thermal protection guidance and protects both thermoregulation and cord stump integrity [1][2][3][4].References (research sources)

- [1]Early newborn bathing practices, perceptions, and associated factors among women in public hospitals of South Wollo Zone, northeast Ethiopia: mixed methods study.Research articleAyele ZT, Assefaw M, Gashaw W, Wondifraw EB, Abebaw N, Liyew AD, Dilnessa T, Chanyalew L, Worku A, Ahmed L, Negesse Y, Eshetie A. (2026) · DOI: 10.1186/s13104-026-07689-7

- [2]Early Baby Bathing Practice and its Associated Factors Among Mothers who Give Birth in the Past One Month in Gurage Zone, Ethiopia, 2022.Research articleBeyene Derribow A, Demissie M, Abebe S, Obsa M, Endeshaw F, Asnake H (2023) · DOI: 10.1177/23779608231168180

- [3]Factors associated with delayed neonatal bathing in Afghanistan: insights from the 2022-2023 multiple indicator cluster survey.Research articleStanikzai MH, Tawfiq E, Jafari M, Ezadi Z, Wasiq AW, Dadras O. (2025) · DOI: 10.1186/s13104-025-07495-7

- [4]Maternal and child factors associated with late neonatal bathing practices in Nigeria: evidence from a national survey.Research articleAppiah F, Adde KS, Boakye K, Fenteng JOD, Darteh AO, Salihu T (2023) · DOI: 10.1186/s12978-023-01676-y

## 임상 시나리오

Timing the First Newborn BathWHO guidance for healthy term infants
Delay the first bath until at least 24 hours after birth, or 6 hours minimum when a full day is not possible. This baby is only 5 hours old, so bathing should be postponed.

Bathe only when the axillary temperature is stable. A reading of 36.8 °C is normal, but age-based timing takes priority over temperature alone.

Keep the cord stump clean and dry with nothing applied. Sponge-bathing in warm water is preferred while the cord is still attached.

CautionEarly bathing risks hypothermia from evaporative and convective heat loss, even when the pre-bath temperature appears stable. Cold stress can increase pulmonary vascular resistance and compromise oxygenation.

## 핵심 개념

- **Thermoregulation** — The newborn's ability to maintain body temperature, which is fragile due to high surface-area-to-body-mass ratio and limited subcutaneous fat.
- **Cord stump care** — Keeping the umbilical cord remnant clean and dry with nothing applied until it falls off naturally.
- **WHO postnatal care** — Recommendations for routine care of mothers and newborns after birth, including timing of the first bath.
- **Evaporative heat loss** — Heat loss that occurs when water on the skin evaporates, a major risk during early bathing.
- **Cold stress** — Physiological response to hypothermia that can cause peripheral vasoconstriction and increased pulmonary vascular resistance.

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