The Effects of Underrunning Water Bathing and Underrunning Water Bathing-Massage Combination on Bilirubin Levels in Term Newborns With Hyperbilirubinemia

Physiological hyperbilirubinemia is a common clinical condition in the neonatal period that requires clinical evaluation and medical monitoring. This prospective, randomized controlled experimental study aimed to compare the effects of underrunning water bathing and underrunning water bathing combined with massage on bilirubin levels in term newborns receiving phototherapy.

After obtaining institutional permission, ethics committee approval, and informed consent from the families, the study was conducted between June 2024 and March 2025 in the neonatal clinic of Kayseri City Hospital. The sample consisted of 90 term newborns who met the inclusion criteria. The newborns were randomly assigned to three groups: the Underrunning Water Bath Group (n=30), the Underrunning Water Bath+Massage Group (n=30), and the Control Group (n=30). No intervention other than routine clinical care was applied to the control group. The interventions in the experimental groups were performed by the researcher.

Data were collected using the Introductory Information Form and the Intervention Follow-up Form. Bilirubin levels were measured as total serum bilirubin before phototherapy and at the 12th and 24th hours. Data were analyzed using ANOVA, Bonferroni, Kruskal-Wallis, chi-square, and two-way repeated measures ANOVA tests.

A time-dependent decrease in bilirubin levels was observed in all groups. While no significant difference was found between the groups at the 12th hour (p>0.05), the bilirubin level in the underrunning water bathing combined with massage group was significantly lower than that of the control group at the 24th hour (p<0.05). The findings suggest that the combination of Underrunning water bathing and massage may be considered as a supportive nursing intervention for term newborns receiving phototherapy.

Inclusion criteria

• Term newborns with a gestational age between 38 and 42 weeks.
• Birth weight of 2500 g or higher.
• Newborns diagnosed with physiological hyperbilirubinemia.
• Newborns receiving phototherapy treatment.
• Postnatal age between 2 and 10 days.
• No congenital anomalies.
• No additional health problems.
• Apgar score ≥7 at the 1st minute after birth.
• Stable vital signs.

Exclusion criteria

• Birth weight ≤2500 g.
• Gestational age less than 38 weeks.
• Pathological jaundice (e.g., ABO incompatibility, Rh incompatibility, biliary atresia, glucose-6-phosphate dehydrogenase deficiency, or glucuronyl transferase enzyme deficiency).
• Inability to feed orally.
• Postnatal age on the first day of life.
• Receiving blood transfusion therapy.
• Newborns with secondary conditions such as asphyxia or infection.