الفهرس 
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Abstract
Daily bathing of neonates is a process that is usually done routinely in Neonatal Intensive Care Unit (NICU). It is one of nursing practices that increase manipulation and induce adverse effects on the stability of the physiological parameters as well as organization of behavioral responses among neonates. Swaddle bath is one of the best practice types of bathing that recommended by Association of Women’s Health, Obstetric and Neonatal Nurse. In this respect, nurses in NICUs play a proactive role in ongoing monitoring of physiological parameters of the neonates and diminishing the behavioral stress inducing factorssuch as bathing in addition to design a comprehensive individualized and developmental care plans for hospitalized neonates. The aim of the present study was todetermine the effect of swaddle bath on neonatal physiological parameters and their behavioral responses.
The study was conducted at NICUs of the Specialized University Hospital at Smouha and El Raml Children’s Hospital in Alexandria.A convenient sample of 60 neonates comprised the study subjects. Their ages ranged from 36-42 weeks and were feeder and grower neonates, have stable vital signs, not receiving analgesic, sedative, or muscle relaxant medications and free from septicemia. Neonates were randomly assigned into two equal groups (30 neonates for each)namely control group who were received routine bath and study group who were received swaddle bath beside routine care of the NICU.
Two tools were used to collect the necessary data.The first tool was Bio- physiological characteristics and ClinicalData of The Neonates’ Record which was developed by the researcher to assess bio-physiological characteristics and clinical data of the neonates. The second tool namely Neonatal Behavioral Responses Assessment Scale which was developedby the researcher to assess neonatal behavioral responses. It comprised five subsystems including motor, autonomic, states, the attention/ interaction and self-regulatory subsystem.The total items of all subsystems involved 16 items.
Content validity of tool Ι and Tool II was tested by five experts in the pediatric nursing field. Reliability of tool I and Tool II was ascertained using Cronbach’s alpha Coefficient. Reliability for tool I was 0.754 and tool II was 0.791.
Bio- physiological characteristics and clinical data of the neonates in both groups (study and control groups) were assessed. Physiological parameters of all neonates in both groups were measured five times as follow before bathing, immediately, at 5, at 10, and at 15 minutes after bathing including temperature, respiratory rate and heart rate were measured in full minute beside oxygen saturation (SPO2). The behavior of all neonates in both groups was observed before, during and after bathing. The data were collected during the period of 5 months which started from the beginning of May to the end of September 2021.
The main results of the current study revealed the following:
The mean gestational age of the neonates among the study group was 36.93± 1.17, while it was 37.03 ± 1.07 in the control group.
More than half of the neonates (56.7%) in the study group were full term compared to nearly two thirds (63.3%) of the neonates in the control group.
Nearly more than one third of the neonates (36.7%) in the study group were low birth weight compared to slightly more than half of them (53.3%) in the control group.
Respiratory distress syndrome and hyperbiliruinemia represent 53.5% and 26.6% of diagnoses in the study group compared to 56.8% and 29.9% in the control group respectively.
None of the neonates in the study group had low body temperature in all study periods. Whereas, in the control group it was observed that the neonates who had low body temperature were 26.7% of immediately, 20% at 5 minutes, 6.7% at 10 minutes and 6.7% at 15 minutes after bathing.
Respiratory rates of the neonates in the study and the control groups were normal along all periods of measurements after bathing.
Immediately and at 5 minutes after bathing, none of the neonates in the study group had low oxygen saturation (<95%) compared to 56.7%, 13.3% of them in the control group at the same times.
None of the neonates in both groups had low oxygen saturation at 10 minutes and 15 minutes after bathing.
No one of the neonates in the study group had increased heart rate immediately after bathing compared to 16.7% of the neonates in the control group.
The mean measurements of heart rate among neonates in the study group were less than those in the control one all over the study periods. It was noticed that the mean was 137.30 ± 7.13 and 146.63 ± 21.43 immediately, 133.43 ± 7.99 and 140.57 ± 16.18 at 5 minutes,127.97 ± 6.66 and 139.23 ± 15.83 at 10 minutes and 128.07 ± 5.49 and 136.33 ± 14.94 at 15 minutes in the study and the control groups after bathing respectively.
During bathing, none of the neonates in the study group had poorly organized behaviors versus nearly two thirds of the neonates (63.3%) in the control group.
Generally, all neonates in the study group had highly organized behaviors contrary to none of them in the control group.
It was amazing that after swaddle bath, 100% of neonates had highly organized behaviors compared to only 3.3% of neonates in the control group.
There were statistical significant differences between the study and the control groups before, during and after bathing in all behavioral responses of all subsystem where p ranged from <0.001 to <0.015.