Safe Infant Sleep Research Articles

Evidence summary for safety sleep protection strategy in infants

Objective: To systematically review and summarize the relevant evidence of safe sleep protection strategies for infants at home and abroad, to provide a reference for clinical evidence-based decision-making and guideline formulation. Methods: "Infant Death/Sudden Unexpected Infant Death/Sudden Infant Death Syndrome" and "Sleep protecting program/Sleep safety/Sleeping environment" were used as search keywords. The literature retrieval for all the Chinese and English evidence on safe sleep protection strategies for infants published before March 2020 was conducted by using the National Guideline Clearinghouse (NGC), Registered Nurse' Association of Ontario (RNAO), National Institute for Health and Clinical Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN), Guidelines International Network (GIN), JBI, Clinical Evidence, China Evidence-based Medicine Center, PubMed, Embase, CINAHL, Wanfang Data, CNKI and other databases. Inclusion criteria were guidelines, evidence summary and systematic reviews on infant safe sleep protection strategies for infants aged 0 to 1 years. The full text was available. Exclusion criteria include duplicates, directly translated documents as well as guide abstracts, discussion drafts, draft guides, interpretations, excerpts. The Appraisal of Guideline for research & Evaluation Instrument (AGREE Ⅱ) and A Measure Tool to Assess Systematic Reviews (AMSTAR 2) were used to compare and evaluate the selected literature, and extracted evidence from the literature that meets the quality standards. Results: A total of 12 articles were incorporated into study, including 1 Summary of evidence from UptoDate, 3 guidelines, and 8 systematic reviews. The results of the AGREE II quality evaluation showed that the overall quality of 3 guidelines was high. Among them, there was 1 with a recommendation level of "A", and 2 with a rating of "B". The AMSTAR 2 quality evaluation showed that the contents of the systematic reviews were relatively complete except for one literature. In the end, totally 39 terms of evidences were summarized, including 6 aspects of assessment, planning, implementation, health education (pregnant women, parents and other infant caregivers), evaluation, organization and policy. Conclusion: The evidence summary of infant safe sleep protection provides evidence support for formulating infant safe sleep care standards and carrying out scientific and high-quality clinical nursing practices.

Investigation of the Effect of Infant Sleep Safety Education on Nursing Intern Students

Investigation of the Effect of Infant Sleep Safety Education on Nursing Intern Students

A Quality Improvement Initiative on Implementing Hospital-Based Safe Infant Sleep Practices for High Risk Population.

A Quality Improvement Initiative on Implementing Hospital-Based Safe Infant Sleep Practices for High Risk Population.

Awareness of infant safe sleep messages and associated care practices: findings from an Australian cohort of families with young infants

ObjectiveTo investigate primary infant caregiver awareness of the current national public health safe sleep messages and the associations of awareness with care practices.Design and settingA cross-sectional survey in Queensland, Australia....

Poverty and Paternal Education Associated With Infant Safe Sleep Intentions in a Peri-Urban Community in Ecuador.

Ecuador’s annual mortality rate from SIDS is 0.4 per 100 000 people, 4 times higher than neighboring countries Peru, Bolivia, and Brazil. Modifying the infant sleep environment toward safe practice has been demonstrated to be the most effective risk reduction strategy in reducing mortality from SIDS and little is known about sleep practices in Ecuador. The purpose of this study is to describe baseline infant sleep intentions of pregnant women in a peri-urban, low resource community in Ecuador. We also aim to identify demographic and psychosocial factors associated with suboptimal sleep practices in this context to develop long-term strategies to identify infants with high risk for SIDS/SUID. A cross-sectional study design was employed with 100 women in their third trimester of pregnancy. The majority of women were partnered (82%), both parents had approximately 8 years of education, and over half reported that their incomes met or exceeded their basic needs (55%). Significant predictors of safer sleep intention included years of paternal education (P = .019) and income meeting their basic needs (P = .0049). For each additional year of paternal education, families were 23% more likely to report safer intended infant sleep practices. Compared to those whose income did not allow for basic needs, those who had sufficient income to meet (or exceed) basic needs were 425% more likely to report safer intended sleep practices. Targeted interventions to high-risk populations may reduce the burden of SIDS/SUID in this community.

Infant safe sleep practices and adherence to the updated AAP recommendations

Infant safe sleep practices and adherence to the updated AAP recommendations

Implementing a Hospital-Based Safe Sleep Program for Newborns and Infants.

An unsafe sleep environment remains the leading contributor to unexpected infant death. To determine the effectiveness of a quality improvement initiative developed to create a hospital-based safe sleep environment for all newborns and infants. A multidisciplinary team from the well-baby nursery (WBN) and neonatal intensive care unit (NICU) of a 149-bed academic, quaternary care, regional referral center developed and implemented safe sleep environments within the hospital for all prior to discharge. To monitor compliance, the following were tracked monthly: documentation of parent education, caregiver surveys, and hospital crib check audits. On the inpatient general pediatric units, only hospital crib check audits were tracked. Investigators used Plan-Do-Study-Act (PDSA) cycles to evaluate the impact of the initiative from October 2015 through February 2018. Safe sleep education was documented for all randomly checked records (n = 440). A survey (n = 348) revealed that almost all caregivers (95.4%) reported receiving information on safe infant sleep. Initial compliance with all criteria in WBN (n = 281), NICU (n = 285), and general pediatric inpatient units (n = 121) was 0%, 0%, and 8.3%, respectively. At 29 months, WBN and NICU compliance with all criteria was 90% and 100%, respectively. At 7 months, general pediatric inpatient units' compliance with all criteria was 20%. WBN, NICU and general pediatric inpatient unit collaboration with content experts led to unit-specific strategies that improved safe sleep practices. Future studies on the impact of such an initiative at other hospitals are needed.

Understanding the barriers and facilitators to safe infant sleep for mothers of preterm infants.

Objective:To identify barriers and facilitators to adherence to safe sleep practices (SSP) among mothers of preterm infants using qualitative methodology.Design:We conducted 23 in-depth interviews in English or Spanish with mothers of preterm infants who were recently discharged from 4 hospitals, utilizing a grounded-theory approach and framework of the Theory of Planned Behavior (attitudes, perceived control, social norms).Results:For attitudes, mothers’ fear about their infants’ vulnerable preterm state related to suffocation, apnea of prematurity, and reflux influenced infant sleep practices. For social norms, education received in the NICU and advice from other healthcare providers, family, friends, and media impacted their choices. For perceived control, mothers adapted infant sleep practices to meet their own needs and address the perceived safety and comfort of infants.Conclusion:Factors identified that influence maternal decision-making about infant sleep practices can inform interventions to address sudden unexpected infant death reduction in preterm infants.

Racial and Ethnic Disparities in Sudden Unexpected Infant Death and Sudden Infant Death Syndrome Rates in the USA: a Complex Problem Mired in a Deeply Entangled Web

In this review, we examine the slow decline in the US infant mortality rate by evaluating disparate racial and ethnic improvements in sudden unexpected infant death/sudden infant death syndrome rates. The US infant mortality rate continues to be higher in minority groups. Limited data associates specific genetic variations with increased risk of SIDS in African Americans. Public health campaigns to reduce SIDS risks have focused on vulnerable groups and used messaging that can be perceived as guilt/blame based. Qualitative studies have found that many Black mothers view SUIDS/SIDS as a random, unpreventable event. Consequently, cultural beliefs and traditions may override healthcare advice for safe infant sleeping. Analysis of SIDS rates in other countries shows that some behaviors considered SIDS risks are common in countries with low SIDS rates. Studies show that social forces perpetuating racial inequity contribute to disparate racial/ethnic improvements in mortality rates. Approaching healthcare campaigns for safe infant sleeping from a culturally sensitive perspective may improve individual risks, but large impacts on infant mortality and SUID/SIDS rates will require changes that decrease racial inequities in the US society.

Coming Together to Save Babies: Our Institution's Quality Improvement Collaborative to Improve Infant Safe Sleep Practices.

Physicians from our institution's primary care clinics, EDs, neonatal intensive care units, and general inpatient units created and led multidisciplinary safe sleep teams. Teams have used standardized data tools to collect information on infant patient ages and sleep position and environment, both in the hospital and at home. Based on audit data, teams have implemented multiple Plan-Do-Study-Act cycles during this collaborative. We have calculated changes in safe sleep practices in the hospital and changes in screening and education on safe sleep behaviors over time. Our teams have significantly increased compliance with safe sleep practices in the inpatient and neonatal intensive care unit settings (P < 0.01). We have also increased screening and education on appropriate safe sleep behaviors by ED and primary care providers (P < 0.01). Our county's sleep-related death rate has not significantly decreased during the collaborative. Our collaborative has increased American Academy of Pediatrics-recommended safe sleep practices in our institution, and we decreased sleep-related deaths in our primary care network. We have created stronger ties to our community partners working to decrease infant mortality rates. More efforts will be needed, both within and outside of our institution, to lower our community's sleep-related death rate.

Screening and Support for Infant Safe Sleep: A Quality Improvement Project.

Infant sleep is an anticipatory guidance topic that is discussed frequently at well child checks, starting with the newborn visit. It is challenging to cover a large amount of information in a short visit. This article describes a quality improvement project implemented at a pediatric primary care practice to improve screening for infant safe sleep. The screening form was updated to include questions from the Pregnancy Risk Assessment Monitoring System (PRAMS). This updated screening better captured actual sleeping practices, allowing for more targeted education.

Racial/Ethnic Differences in Prenatal and Postnatal Counseling About Maternal and Infant Health-Promoting Practices Among Teen Mothers.

Disparities in perinatal counseling among all pregnant women exist, yet teen data are lacking. We evaluated racial/ethnic differences in (1) prenatal and (2) postnatal counseling of teen mothers. This retrospective cross-sectional study included Pregnancy Risk Assessment Monitoring System data from 2012-2016 and included mothers 19years of age and younger. Counseling measures included tobacco, alcohol and illicit drugs, weight gain, HIV testing, influenza vaccination, breastfeeding, infant safe sleep, postpartum depression, and contraception. Bivariate associations of maternal/infant characteristics and counseling were estimated using χ2 tests. Multivariable logistic regression was used to assess the independent relationship between race/ethnicity and counseling. A weighted sample of 544,930 teen mothers was analyzed. Compared with non-Hispanic white (NHW) teens, non-Hispanic black teens were more likely to receive counseling on tobacco (adjusted odds ratio [aOR], 1.4; 95% confidence interval [CI], 1.10-1.77), alcohol (aOR, 1.77; 95% CI, 1.28-2.46), illicit drugs (aOR, 1.79; 95% CI, 1.33-2.41), and HIV testing (aOR, 1.62; 95% CI, 1.26-2.09). Compared with NHW teens, Hispanic teens were less likely to receive tobacco counseling (aOR, 0.78; 95% CI, 0.64-0.97) and more likely to receive influenza vaccine counseling (aOR, 1.44; 95% CI, 1.18-1.76). No difference was found in receipt of postnatal counseling. Racial/ethnic differences in receipt of perinatal counseling exist, with non-Hispanic black teens being more likely to receive counseling on substance use and HIV testing and Hispanic teens being more likely to receive influenza vaccine recommendations compared with NHW teens. Ongoing investigation is needed to understand drivers of these differences.

Book Review: Safe Infant Sleep: Expert Answers to Your Breastfeeding Questions

Book Review: Safe Infant Sleep: Expert Answers to Your Breastfeeding Questions

Improving infant sleep safety via electronic health record communication: a randomized controlled trial

BackgroundWith increased use of telehealth, interventions to improve infant sleep environments have not been explored. This study sought to assess the feasibility and efficacy of using electronic health record patient portals to transmit photographs of infant sleep between mothers and healthcare professionals as part of an intervention to promote sleep environments consistent with AAP guidelines.MethodsOne hundred eighty-four mother-newborn dyads consented to participate in a randomized trial requiring patient portal registration within 1 month of delivery. We first assessed feasibility as measured by a) the proportion of consented mothers enrolling in the portal and b) maternal adherence to prompts to submit photographs of their infant sleeping to the research team through the patient portal. Intervention group mothers were prompted at 1 and 2 months; controls were prompted only at 2 months. Efficacy was determined via research assistant review of submitted photographs. These assistants were trained to detect sudden unexplained infant death risk factors utilizing AAP guidelines. Standardized feedback was returned to mothers through the patient portal. We used Fisher’s Exact test to assess group differences in guideline adherence at 2 months.ResultsOne hundred nine mothers (59%) enrolled in the patient portal and were randomized to intervention (N = 55) and control (N = 54) groups. 21 (38, 95% CI 25–52%) intervention group participants sent photographs at 1 month and received personalized feedback. Across both groups at 2 months, 40 (37, 95% CI 28–46%) sent photographs; 56% of intervention group participants who submitted photographs met all safe sleep criteria compared with 46% of controls (difference 0.10, 95% CI − 0.26 to 0.46, p = .75). Common reasons for guideline non-adherence were sleeping in a room without a caregiver (43%), loose bedding (15%) and objects (8%) on the sleep surface.ConclusionsUtilizing the patient portal to individualize safe infant sleep is possible, however, we encountered numerous barriers in this trial to assess its effects on promoting safe infant sleep. Photographs of infants sleeping showed substantial non-adherence to AAP guidelines, suggesting further needs for improvement to promote safe infant sleep practices.Trial registrationName: Improving Infant Sleep Safety With the Electronic Health Record; Clinicaltrials.gov: NCT03662048; Date of Registration: September 7, 2018;Data Sharing Statement: None

Using Photovoice to Understand Perspectives on Safe Infant Sleep Practices among Caregivers Enrolled in Perinatal Home Visiting

Sudden and unexpected infant death (SUID), often associated with unsafe infant sleep practices, remains a leading cause of infant mortality in the United States. Maternal, Infant, and Early Childhood Home Visiting (MIECHV) programs provide evidence-based individualized education, support, and resources to promote infant and child health, including promotion of safe infant sleep guidelines. The purpose of this qualitative evaluation was to explore barriers, facilitators, and home visitor influences on infant sleep practices; this component elicited caregivers’ perspectives using Photovoice methodology. Photovoice is a community-based participatory research method which aims to bring forward participants’ perspectives and everyday experiences through visual means. Five MIECHV participants submitted 21 pictures that were discussed in individual interviews. The main facilitators were access to appropriate furnishing, knowledge about safe sleep practices, and effective bedtime routines. Barriers included housing-related issues, other caregivers’ practices, and caring for siblings. These results highlighted the importance of the practitioner-client relationship and inform the program on factors that affect parents’ decision-making and infant sleep practices.

Effects of Implementing a Simulation-Learning Based Training Using a Train-The-Trainer Model on the Acquisition and Retention of Knowledge about Infant Safe Sleep Practices Among Licensed Nurses

PurposeThe purpose of this study was to evaluate the effectiveness of the implementation of a simulation-learning based training using a train-the-trainer model on the acquisition and retention of knowledge about infant safe sleep practices among nursing staff employed at a women's and children's hospital. Design and methodsThis was a two-phase, quasi-experimental study with repeated measure in a women's and children's hospital in Southwest XXXX. A total of 120 nurses completed phase I of the study, while 74 completed phase II. Kolb's Experiential Learning Theory and Observational Experiential Theory were used to guide the development of the methods and research question. ResultsOverall, there was statistically significant (p < .001) increases between pre-test and post-test scores immediately and at three months. The post-partum, well-baby nursery, and pediatric department had statistically significant (p < .001) increases between pre-test and post-test scores immediately and at three months. The pediatric intensive care unit did not have statistically significant increases between pre-test and post-test scores immediately and at three months (p = .086). ConclusionsA train-the-trainer program in simulation and infant safe sleep can positively affect nurses' knowledge about safe sleep and SUID. Future research should include longer follow-up assessments to better determine long-term impact.

Priority setting: Consensus for Australia's infant safe sleeping public health promotion programme

To develop focused priorities to inform the revision of Australia's Sudden Unexpected Death in Infancy (SUDI) risk reduction public health programme. A content expert consensus research activity was designed using two consensus techniques. The two-phase study employed a Delphi process (phase 1) and a Nominal Group workshop technique (phase 2). The Delphi invited 56 national and international content experts. The Nominal Group comprised 17 Australasian experts and stakeholders to ensure priority setting was relevant to the Australian context. Phase 1 established a ranked thematic list of 10 key SUDI risk reduction themes. Phase 2 addressed three nominal questions producing prioritised lists for: key-message wording; contextual information and strategies to support caregiver implementation of key messages; and considerations in redesigning and dissemination of a safe sleep campaign. The top four priority themes were: sleep position, sleep space, smoking and surface-sharing. This two-phase priority setting was successful in establishing clearly defined infant safe sleep priorities. International content expert participation in phase 1 strengthened priority setting outcomes while phase 2 ensured final outcomes provided a strong national focus reflective of identified needs of Australian families. Findings provide a foundation from which important components can be considered when revising and developing future SUDI risk reduction programmes.

Safe to sleep: Community-based caregiver training.

Annually, thousands of infant deaths are classified as sudden unexpected infant deaths (SUIDs). In an effort to reduce the risk of SUIDs, the American Academy of Pediatrics has made a number of recommendations to educate caregivers, childcare providers, and healthcare professionals on safe infant sleep practices. The purpose of the current study was to extend the literature on safe infant sleep practices by teaching caregivers to arrange safe infant sleep environments using a mannequin and common infant items. We partnered with community-based agencies to evaluate the effectiveness of behavioral skills training delivered in a single training session as part of the ongoing pre- or postnatal care these agencies provided. Following training, all participants demonstrated a substantial change in responding and returned favorable social validity ratings. We discuss these outcomes in light of previous studies, limitations, and future directions.

Infant Safe Sleep Interventions in African American Communities

Background: Despite recommendations from the American Academy of Pediatrics (AAP) regarding infant safe sleep practices, 39% of sleep-related infant deaths (SRID) occur among African American (AA) families each year. Effective interventions that promote AA parents/caregivers’ safe sleep practices for infants could help reduce SRID. Objective: To identify appropriate safe sleep interventions that increased compliance of AAP recommendations to reduce the risk of SRID among AA mothers/caregivers, a literature review was conducted. Methods: PubMed, EBSCOhost, and Google Scholar search engines were utilized to identify evidence-based research studies, published in English from 2000-2019 in the U.S that demonstrated the effectiveness of safe sleep interventions for AA parents/caregivers based on the AAP recommendations. Findings: The literature review revealed that multiple-element interventions such as free cribs and related materials, and safe sleep education increased adherence to AAP recommendations as evidenced by the majority mothers using the crib and adopting safe sleep recommendations. Conclusion and Recommendations: Although multiple interventions including education are valuable, culturally appropriate research is needed to better understand what specific intervention(s) will work to increase adherence to the AAP safe sleep recommendations among the remaining 39% of AA parents/caregivers who contribute disproportionately to the SRID disparity. Behavioral and environmental barriers preventing the adoption of safe sleep interventions also need to be studied in this target group of AA parents/caregivers. It is recommended that findings from these highly targeted evidence-based culturally appropriate studies be used to focus on funding, prevention programming, and policies toward the causes of SRID to close the disparity gap.

Malos hábitos de sueño en lactantes: factor de riesgo para síndrome de muerte súbita del lactante. Estudio piloto

La Academia Americana de Pediatría recomienda que los lactantes menores de un año duerman en posición supina para prevenir el síndrome de muerte súbita en lactantes (SMSL).Objetivo: Describir la posición en que duermen un grupo de lactantes y factores de riesgo asociados al SMSL.Sujetos y Método: Estudio piloto, prospectivo concurrente, de lactantes &lt; 45 días de vida en control sano en Centro Médico San Joaquín UC Christus. Criterios de exclusión: prematurez (edad gestacional &lt; 37 semanas) y patología de base (respiratorias, metabólicas, cardiológicas). Se aplicó encuesta al cuidador principal respecto a datos demográficos y hábitos de sueño, basada en encuesta BISQ (Brief Screening Questionnaire for Infant Sleep Problems) validada en español, dado la inexistencia de instrumentos para &lt; 3 meses.Resultados: Se obtuvo muestra de 100 lactantes de edad 16,78 ± 12,88 días de vida, siendo 57% mujeres. La madre fue el principal informante (84%). El 79% de los lactantes dormían en decúbito supino, 19% lo hacía de lado y 2% en prono. El 66% dormía en cuna en habitación de los padres, 31% en la cama de los padres. El 74% se quedaban dormidos durante la alimentación.El 28% de los lactantes estaban expuestos a tabaquismo pasivo. El 91% cuidadores estaba informado sobre la posición segura de sueño, siendo el principal informante el pediatra (54%).Conclusiones: En esta muestra se encontró alto porcentaje de lactantes &lt; 45 días que duermen en posición no segura, siendo frecuente el colecho. Es importante implementar campañas locales de prevención del SMSL que refuercen el hábito de dormir seguro.