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Preterm InfantsNCT07522892

Physiological Safety and Behavioral Comfort of Swaddle Bathing in Preterm Infants

A study testing Swaddle Bathing and Conventional Tub Bathing in people with Preterm Infants, run by Chang Gung University of Science and Technology at 1 site in Taiwan.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Background and Purpose: Bathing is a routine but essential part of care for preterm infants in the Neonatal Intensive Care Unit (NICU). However, traditional tub bathing can be a significant source of stress for these vulnerable infants, potentially leading to fluctuations in body temperature, heart rate, and oxygen… Read more about this study

Who is it for?
Ages 1 day to 7 days
Conditions the study is for
Preterm Infants
What is being tested?
Swaddle Bathing and Conventional Tub Bathing
Could I receive a placebo?
No, everyone receives an active treatment
How many people
36 participants
Where
1 siteTaiwan
Study dates
24 Apr 2024to 30 Jun 2026
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 1 day to 7 days
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

  • Gestational age between 32 and 36 weeks and 6 days
  • Birth weight greater than 1,500 grams
  • Clinically stable as determined by the attending neonatologist
  • Receiving the first bath after birth

Who cannot join

  • Major congenital anomalies, such as cyanotic heart disease, gastroschisis, or open spinal defects
  • Severe intraventricular hemorrhage (Grade III or IV)
  • Skin impairments or open wounds that contraindicate water immersion, including surgical sites
  • Continuous use of sedatives or muscle relaxants that may interfere with behavioral assessments

Trial locations and contacts

1 site in 1 country.

Taiwan1 site
  • Hsinchu Mackay Children's Hospital

    Hsinchu, 300

Other trials in Taiwan

About this study

Official title: Effects of Swaddle Bathing on Physiological Regulation and Stress-Reducing Behaviors in Preterm Infants in the Neonatal Intensive Care Unit: A Randomized Controlled Trial

Background and Purpose: Bathing is a routine but essential part of care for preterm infants in the Neonatal Intensive Care Unit (NICU). However, traditional tub bathing can be a significant source of stress for these vulnerable infants, potentially leading to fluctuations in body temperature, heart rate, and oxygen levels. Swaddle bathing-a technique where the infant is wrapped in a light cloth during the bath-is thought to provide a sense of security and better physiological stability.

The goal of this pilot randomized controlled trial is to compare the effects of swaddle bathing versus conventional tub bathing in preterm infants. The researchers want to determine if swaddle bathing is as safe as traditional methods while being more comfortable for the baby.

Read more

Main Questions to Answer:

  • Is swaddle bathing non-inferior to (as safe as) conventional tub bathing regarding the infant's physiological stability (e.g., body temperature and heart rate)?
  • Does swaddle bathing significantly reduce stress-related behaviors and crying in preterm infants compared to conventional bathing?

Study Design and Procedure:

Participants will be randomly assigned to one of two groups:

  1. Experimental Group: Infants will receive swaddle bathing, where they remain snugly wrapped in a towel or wrap while being gently immersed in water.
  2. Control Group: Infants will receive conventional tub bathing according to standard hospital protocols.

During and after the bath, the research team will monitor the infants' vital signs and video-record their behavioral responses (such as facial expressions and limb movements) to evaluate their level of comfort and stress. The results of this study will provide preliminary evidence to help clinical nurses decide the best bathing practices for promoting the neurodevelopmental care of preterm infants.

Read the detailed description

Study Overview:

This pilot randomized controlled trial (RCT) aims to evaluate the physiological safety and behavioral comfort of swaddle bathing compared to conventional tub bathing in preterm infants. The study is designed to provide preliminary evidence on whether swaddle bathing serves as a neurodevelopmental care intervention that maintains thermal and cardiovascular stability while reducing stress-related behaviors during a routine nursing procedure in the Neonatal Intensive Care Unit (NICU).

Research Methodology:

Participants will be recruited from a NICU and randomly assigned to either the experimental group (swaddle bathing) or the control group (conventional tub bathing) using a block randomization method. To ensure safety, all bathing procedures will be conducted by trained neonatal nurses and monitored for any signs of physiological distress.

Intervention Protocols:

Standardized Environmental Conditions To minimize the confounding effects of hunger or satiety on behavioral responses, all baths were scheduled approximately 30 to 60 minutes before the next scheduled feeding (or 1 hour after feeding). To ensure consistency across both groups, all bathing procedures were conducted in a temperature-controlled environment maintained at 25-26°C. A standardized stainless-steel basin (33 cm diameter, 10 cm height) was filled to 80% capacity with water at 39-40°C. The duration of the bathing procedure was strictly limited to 5 minutes for all participants.

  1. Experimental Group (Swaddle Bathing): The infant is snugly wrapped in a thin cotton cloth or swaddle. While maintaining the wrap, the infant is gently immersed into a tub of warm water (39 to 40°C). The nurse uncoils the wrap only partially to wash specific body parts, ensuring the infant remains contained and secure throughout the process.
  2. Control Group (Conventional Tub Bathing): The infant is undressed and placed directly into the tub according to standard hospital protocol, with the nurse providing manual support but without the use of a stabilizing wrap.

Data Collection and Outcome Measurement:

The study will record data at three time points: baseline (pre-bath, T0), immediately post-bath (T1), and 10 minutes post-bath (T2).

  • Physiological Safety:
  • Body Temperature: Measured using a rapid electronic thermometer (verified by the Bureau of Standards, Metrology and Inspection, MOEA; License No. 001618). Axillary temperature was measured, with the device remaining in place for 3-5 minutes after the beep to ensure accuracy.
  • Vital Signs Monitoring: Heart rate (HR) and oxygen saturation (SpO2) were measured using a General Electric B105 portable physiological monitor (License No. 022655). The device is calibrated and maintained every six months by biomedical engineers.
  • Behavioral Comfort: Infants will be video-recorded to assess stress signals and comfort levels. Blinded observers will use standardized neonatal pain and stress scales (e.g., Anderson Behavioral State Scale) to score the frequency of crying and stress-related motor activities.

Statistical Analysis:

Data will be analyzed using descriptive statistics and generalized estimating equations (GEE) to account for the repeated measures over time. As a pilot study, the results will be used to calculate the effect size required for a future full-scale clinical trial.

Conditions
Preterm Infants
Being tested
Swaddle Bathing, Conventional Tub Bathing
Keywords
swaddle bath, preterm infants

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Swaddle BathingOther

    Experimental Group: Swaddle Bathing

    The swaddle bathing intervention is a developmental care procedure designed to enhance neurodevelopmental stability. To ensure consistency, the bath is performed 30-60 minutes before or 1 hour after feeding in a 25-26°C temperature-controlled environment. The infant is snugly wrapped in a thin cotton cloth (swaddle) and gently immersed into a standardized stainless-steel basin (33 cm diameter, 10 cm height) filled with 39-40°C water. During the strictly 5-minute procedure, the nurse uncoils the wrap only partially to wash specific body parts. This method distinguishes itself by maintaining the infant in a contained, secure, and flexed midline position throughout the immersion, minimizing physiological and behavioral stress.

  • Conventional Tub BathingOther

    Control Group: Conventional Tub Bathing

    Infants in this group receive standard hospital tub bathing. To control for confounding variables, the environment and timing are identical to the experimental group: 30-60 minutes before or 1 hour after feeding at an ambient temperature of 25-26°C. The infant is undressed and placed directly into the same standardized stainless-steel basin (33 cm diameter, 10 cm height) with water at 39-40°C. The nurse provides manual support to the infant's head and body according to standard NICU protocol but without any stabilizing wrap or cloth containment. The procedure is strictly limited to 5 minutes. Unlike the experimental group, the infant's skin is directly exposed to the water and air without the tactile support of a swaddle.

Study groups in NCT07522892
Study groupRoleWhat they receive
Swaddle BathingExperimentalPreterm infants in this group will receive swaddle bathing, a developmental care intervention designed to maintain physiological stability and reduce stress during the bathing process.
Receives: Other: Swaddle Bathing
Conventional Tub BathingActive comparatorPreterm infants in this group will receive the standard conventional tub bathing according to the hospital's current clinical protocol.
Receives: Other: Conventional Tub Bathing

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Behavioral Stress Scores

    Behavioral stress is assessed using a checklist based on the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) principles (Als \& McAnulty, 2011), adapted from the Taiwan Society of Neonatology Developmental Care Manual (Taiwan Society of Neonatology, 2021).

    Assessment: The frequency of 10 stress-related behaviors (including motor and neurophysiological cues) is recorded during the 5-minute bathing procedure.

    Scoring: The Behavioral Stress Score is calculated as the sum of all observed behavioral frequencies. The total score ranges from 0 with no theoretical maximum. A higher cumulative frequency (score) indicates greater behavioral stress in the preterm infant.

    Measured: During the 5-minute bathing procedure

  2. Body Temperature

    Measured: baseline (pre-bath), immediately post-bath, and 10 minutes post-bath.

Secondary outcomes (3)
  1. Heart Rate

    Heart rate is monitored using a General Electric (GE) B105 portable physiological monitor (License No. 022655). Data are recorded in beats per minute (bpm). The device undergoes professional calibration and maintenance every six months by biomedical engineers to ensure measurement accuracy.

    Measured: baseline (pre-bath), immediately post-bath, and 10 minutes post-bath.

  2. Percentage of Crying Time

    The percentage of crying time is calculated by dividing the total duration of the infant's crying during the procedure by the total duration of the bathing procedure (5 minutes), and then multiplying by 100 to obtain a percentage (%). A higher percentage indicates greater behavioral distress during the intervention.

    Measured: During the 5-minute bathing procedure

  3. oxygen saturation

    Oxygen saturation is measured via a General Electric (GE) B105 portable physiological monitor (License No. 022655) and recorded as a percentage (%). The monitor is regularly calibrated and maintained every six months by certified biomedical engineers to ensure consistent data quality during the neonatal bath.

    Measured: baseline (pre-bath), immediately post-bath, 10 minutes post-bath

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted13 Apr 2026
  2. Study start24 Apr 2024
  3. Primary completion30 Jun 2026
  4. Study completion30 Jun 2026

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Supportive care
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Investigator
Enrolment
36 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07522892
Sponsor's protocol ID
23MMHIS389e
Other IDs
20231100016
Status last verified
Oct 2026
First submitted
30 Mar 2026
Last updated
22 Oct 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Sun X, Xu J, Zhou R, Liu B, Gu Z. Effectiveness of different bathing methods on physiological indexes and behavioral status of preterm infants: a systematic review and meta-analysis. BMC Pediatr. 2023 Oct 13;23(1):507. doi: 10.1186/s12887-023-04280-y.

    PubMed 37828460
  • Fernandez D, Antolin-Rodriguez R. Bathing a Premature Infant in the Intensive Care Unit: A Systematic Review. J Pediatr Nurs. 2018 Sep-Oct;42:e52-e57. doi: 10.1016/j.pedn.2018.05.002. Epub 2018 May 18.

    PubMed 29779763
  • Chandebois L, Nogue E, Bouschbacher C, Durand S, Masson F, Mesnage R, Nagot N, Cambonie G. Dissemination of newborn behavior observation skills after Newborn Individualized Developmental Care and Assessment Program (NIDCAP) implementation. Nurs Open. 2021 Nov;8(6):3547-3557. doi: 10.1002/nop2.904. Epub 2021 May 6.

    PubMed 33956404

Questions about this trial

What is this clinical trial studying?

A study testing Swaddle Bathing and Conventional Tub Bathing in people with Preterm Infants, run by Chang Gung University of Science and Technology at 1 site in Taiwan.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 22 Oct 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Taiwan. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Behavioral Stress Scores (time frame: During the 5-minute bathing procedure). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT07522892, which also lists 3 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 22 Oct 2026.

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