Infant Sleep Position Research Articles

A study of Samoan, Tongan, Cook Island Māori, and Niuean infant care practices in the Growing Up in New Zealand study

BackgroundDespite a low rate of infant mortality, Aotearoa New Zealand has a high rate of Sudden Unexpected Death in Infants (SUDI), with disproportionate impact for Pacific infants. This study explored the infant care practices, factors and relationships associated with increased risk of SUDI amongst Tongan, Samoan, Cook Islands Māori, and Niuean mothers in New Zealand, to inform evidence-based interventions for reducing the incidence of SUDI for Pacific families and their children.MethodsAnalysis comprised of data collected in 2009–2010 from 1089 Samoan, Tongan, Cook Islands Māori and Niuean mothers enrolled in the Growing Up in New Zealand longitudinal cohort study. The sleeping environment (bed-sharing and sleep position) of the infants was assessed at 6 weeks. Multivariable logistic regression analysis were conducted, controlling for sociodemographic factors to explore the association between selected maternal and pregnancy support and environment factors and the sleeping environment for infants.ResultsMothers who converse in languages other than English at home, and mothers who consulted alternative practitioners were less likely to follow guidelines for infant sleeping position. Similarly language, smoking, alcohol, household dwelling, crowding and access to a family doctor or GP were associated with mothers following guidelines for bed-sharing.ConclusionThe impact of SUDI on Pacific infants may be lessened or prevented if communication about risk factors is more inclusive of diverse ethnic, cultural worldviews, and languages. Societal structural issues such as access to affordable housing is also important. This research suggests a need for more targeted or tailored interventions which promote safe sleeping and reduce rates of SUDI in a culturally respectful and meaningful way for Pasifika communities in Aotearoa, New Zealand.

Safe Infant Sleep Practices and Associated Factors Among Mothers Attending Vaccination Service at Dessie Town Governmental Health Care Facilities, 2021

Background: Babies spend a lot of their time with sleeping thus they need to have a safe sleep. Inadequate sleeping arrangements might heighten the likelihood of Sudden Unexpected mortality in Infancy (SUDI), including SIDS and lethal sleeping mishaps, which continue to be the most prevalent cause of mortality for individuals aged 1 to 1 year. Objective: The study aimed to assess safe baby sleep practices and associated factors among women receiving immunizations at government healthcare facilities in Dessie Town. Design: An institution-based cross-sectional study Methods: We conducted interviews with a total of 392 mothers using semi-structured questionnaires at public health facilities of Dessie town, in 2021. After the data were entered into the EPI data version 3.1, SPSS 23 was utilized for the analysis. Additionally, multivariate and binary logistic regression analyses were carried out. In multivariate analysis, a P-value less than .05 indicate a significant association. Results: About 38.3%, 21.9%, and 14.7% had safe infant sleep practice regarding sleep position, no soft-bedding and sleep arrangement respectively. Significant association was observed between safe infant sleep position with baby age less than 3 months (AOR = 2.96, 95% CI = 1.50-5.84), baby age of 7 to 9 months (AOR = 3.84, 95% CI = 2.15-6.85), maternal level of education(AOR = 4.48, 95% CI = 1.87-10.76), relative/friend as their source of information (AOR = 1.98, 95% CI = 1.14-3.44), grandmother as their source of information (AOR = 1.89, 95% CI = 1.00-3.57).Additionally, baby age 4 to 6 months (AOR = 0.93, 95% CI = 0.19-0.94) and maternal level of education (AOR = 0.19, 95% CI = 0.04-0.92) shows a significant safe infant bed arrangement practice. Furthermore, baby age of 10 to 12 months (AOR = 0.49, 95% CI = 0.25-0.98) and maternal education level of college and above (AOR = 3.44, 95% CI = 1.18-10.03) also shows significant association with safe soft-bedding practice. Conclusion: Mothers’ safe infant sleep practices were found to be low in Dessie town. Therefore, efforts should be made to enhance mothers’ attentiveness and engagement. This will help them follow healthy infant sleep practices.

"Things changed very quickly": Maternal intentions and decision-making about infant sleep surface, location, and position.

Approximately 3400 infants die suddenly and unexpectedly each year in the United States; many of these deaths include modifiable risk factors (such as a non-supine position, sleeping on a soft surface, or loose bedding or items in the environment). Interventions have been successful at improving parental knowledge about recommendations to reduce risk of sleep-related infant deaths, as well as improving intention to adopt recommendations. However, follow-up studies have found a disconnect between knowledge/intentions to adhere to recommendations and actual practices. Exploring maternal decision-making about infant sleep practices can better elucidate the disconnect between knowledge of infant sleep recommendations and the practice of it, and thus, inform more effective safe sleep interventions. The purpose of this study was to gain a more in-depth understanding of decision-making around infant sleep practices, and barriers and facilitators to adopting safe infant sleep recommendations. Semi-structured in-home interviews were conducted with 22 families (20 mothers and 2 mother-father dyads) of infants up to 6 months of age. Thematic analysis of the transcripts revealed six themes: Plans changed when baby came, Trying things to figure out what works (infant preferences), Safety concerns, What's comfortable for me (maternal preferences), They say…(advice), and Trying to be careful. These results suggest that knowledge of infant sleep recommendations alone is not enough to ensure adherence and that decision-making is a dynamic and ongoing process affected by multiple factors. Findings have implications for timing and content of risk reduction efforts, as well as for data collection in research studies.

Steering the Titanic: One tertiary care children's hospital's experience navigating safe sleep for hospitalized infants

BackgroundSudden Unexpected Infant Death (SUID) is the leading cause of death in infants 1 month to 1 year of age in the United States. Despite extensive efforts in research and public education, rates of sleep-related infant death have plateaued since the late-1990s, largely due to unsafe sleep practices and environments. Local problemA multidisciplinary team assessed our institution's compliance with its own infant safe sleep policy. Data was collected on infant sleep practices, nurses' knowledge and training on the hospital policy, and teaching practices for parents and caregivers of hospitalized infants. Zero crib environments from our baseline observation met all the American Academy of Pediatrics recommendations for infant safe sleep. MethodsA comprehensive safe sleep program was implemented in a large pediatric hospital system. The purpose of this quality improvement project was to improve compliance with safe sleep practice from 0% to 80%, documentation of infant sleep position and environment every shift from 0% to 90%, and documentation of caregiver education from 12% to 90% within 24 months. InterventionsInterventions included revision of hospital policy, staff education, family education, environmental modifications, creation of a safe sleep taskforce, and electronic health record modifications. ResultsDocumented compliance with infant safe sleep interventions at the bedside improved from 0% to 88%, while documentation of family safe sleep education improved from 12% to 97% during the study period. ConclusionsA multifaceted, multidisciplinary approach can lead to significant improvements in infant safe sleep practices and education in a large tertiary care children's hospital system.

Qualitative assessment of infant sleep practices and other risk factors of sudden infant death syndrome (SIDS) among mothers in Lusaka, Zambia

BackgroundThere is very little information on the beliefs and perceptions of mothers about SIDS and its related risk factors in Africa. To better understand parental decisions about infant sleep practices and other risk factors for SIDS, we conducted focus group discussions (FGDs) with mothers of infants in Lusaka, Zambia.MethodsFGDs involved 35 purposively sampled mothers aged 18–49 years. FGDs were conducted using a semi-structured interview guide in the local language, Nyanja. These were translated, transcribed verbatim into English, and then coded and analyzed using thematic analysis in NVivo 12.ResultsSix FGDs were conducted with 35 mothers in April-May 2021 across two study sites. FGD Participants were generally aware of sudden unexplained infant deaths, with several describing stories of apparent SIDS in the community. The side sleeping position was preferred and perceived to be safer for the infant with most believing the supine position posed an aspiration or choking risk to the infant. Bedsharing was also preferred and perceived to be convenient for breastfeeding and monitoring of the infant. Experienced family members such as grandmothers and mothers-in-law, and health care workers were frequently cited as sources of information on infant sleep position. A heightened awareness of the infant’s sleeping environment was suggested as a mechanism to prevent SIDS and smothering.ConclusionsDecisions about bedsharing and infant sleep position were guided by maternal beliefs and perceptions about what is convenient for breastfeeding and safer for the infant. These concerns are vital to designing tailored interventions to address sleep-related sudden infant losses in Zambia. Public health campaigns with tailored messages that address these concerns are likely to be effective at ensuring optimal uptake of safe sleep recommendations.

Evaluation of Baby Sleep Position Practices and Sleep Environment

Objective: The aim of this current study was to determine mothers’ infant sleep position practices and their awareness of a safe sleeping environment. Material and Methods: This descriptive survey was conducted with 418 mothers who had infants aged 0-6 months and who agreed to participate in pediatric outpatient polyclinics of two hospitals. Data were collected between January-December 2020 via-structured questionnaires by face-to-face interview. Results: Of the 418 mothers; 28% placed their babies in the supine sleeping position, 59.6% used a pillow when they put their babies in bed and 76.8% used a soft mattress. 42.3% of mothers covered their babies’ faces during sleep; primary school graduate mothers were more intended on covering their babies’ faces than high school and university graduates (p<0.001). 4.1% of mothers smoked during pregnancy, 9.8% during the lactation period and 15.3% were exposed to household smoke. All of the mothers shared a room with their babies without sharing a bed. There was also a positive correlation between the number of prenatal visits of mothers and their preference to put their babies to sleep in the supine position (p=0.010). Conclusion: Most of the mothers placed their babies in a side sleeping position. Mothers’ avoiding sharing beds and smoking cigarettes and prone positioning their children at a very low frequency were pleasing measures. Mothers who had more prenatal visits were found to place their babies more in the supine sleep position. Increasing the awareness of healthcare providers and other secondary caregivers about a safe sleeping environment and baby sleep position during pre and postnatal visits would make right practices become widespread.

The Practice of Infant Sleep Position among Mothers in Jimma Town Public Health Institutions, Jimma, Oromia, South West Ethiopia, 2022.

One of the important interventions in the infantile period is the selection of appropriate infant sleeping position. Unsafe infant sleep position is associated with sudden unexpected death in infancy. Yet, little is known about the practice of infant sleep position in Ethiopia. This study aimed to assess the practice of infant sleep position among mothers attending mother and child health service in Jimma town public health institutions, South West Ethiopia, 2022. An institutional based cross-sectional study design was conducted on 409 women attending Maternal and child health service in Jimma town public health facilities. The data were collected using a pre-tested and semi- structured questionnaire. Binary Logistic regression was used to analyze the association between the practice infant sleeping positions and explanatory variables. The strength of association was evaluated using an odds ratio at a 95% confidence interval and a P-value ≤ .05 was considered to declare significant associations. Four hundred nine women participated in the study, with a response rate of 97%. The practice of recommended infant sleeping position (supine position) in this study was 33.5% [95% CI (28.9% - 38.6%)]. Being married Adjusted odds ratio (AOR) 2.6; 95% CI (1.04-6.48)), residence (AOR 1.88; 95% CI (1.1-3.31)) multi gravidity (AOR 1.6; 95% CI (1.02-2.59)) and having good knowledge of sleeping position (AOR 1.55; 95% CI (1.01-2.38)) were significantly associated with the practice of infant sleep position. The practice of medically recommended infant sleep position in this study was low. Being married, residence, multi gravidity and having good knowledge of sleeping position were significantly associated with the practice of infant sleep position. Therefore, considering these associated factors during health care provision and disseminating information on safe sleep practices for mothers is needed. Also, different stakeholders, including the federal ministry of health, health professionals, and health institutions at different levels, need to give attention to such problems in addition to the service to reduce infant mortality.

O68 - Addressing Caregiver Challenges with Inconsistent and Unrealistic Safe Sleep Messaging: a Safer Sleep Guideline informed by Risk Minimisation

Safe sleep messaging varies considerably in clinical practice and guidelines within and between Australian states and territories. Risk elimination approaches which attempt to enforce idealistic expectations of where and how a baby sleeps have been demonstrated to alienate parents. Risk minimisation approaches which support ‘safer sleep’ offer flexibility and practical strategies that are more likely to engage families in risk reduction and infant health promoting behaviours. This analysis aims to share safe sleep messages that parents identified as most challenging to implement and introduce the Safer Infant Sleep clinical guideline designed to address common barriers encountered. A cross-sectional survey of 3341 Queensland families with infants aged approximately 3-months, birthed April-May 2017. Data included family characteristics, infant care practices used and engagement with safe sleep recommendations. Qualitative free-text items explored challenges with current safe sleep recommendations. Of caregivers, 1033 (31%) reported difficulty with at least one recommendation. Infant sleep position and avoiding a shared-sleep surface presented the greatest challenges. Families experiencing challenges were significantly less likely to employ advice compared to those not reporting difficulty (sleep position: 198/473, 42% vs 2548/2837, 90%[p<0.0001]; own sleep space: (269/344, 78% vs 1331/2884, 46%[ p <0.0001]). Parenting strategies believed to be unsupported weren’t disclosed, reducing opportunities between family and health professionals to share information and inform safer strategies. A tiered approach to tailor interventions for priority families based on identified vulnerabilities has been designed to develop safer sleep plans for every sleep. Structured support such as the Pēpi-Pod® Program is included. Many families encounter difficulties in implementing safe sleep advice; these challenges negatively impact infant care practices. The Safer Sleep guideline provides families a voice for collaborative and informed decision-making and provides professionals a tiered approach to manage risk whilst recognising their clinical judgement and reasoning to meet the needs of families.

A Good Time to Be Born

A Good Time to Be Born

Assessment of Nurses' Performance Regarding Infant Sleep Position on Sudden Infant Death Syndrome at Neonatal Intensive Care Units

Background: Sudden infant death syndrome (SIDS) is the sudden unexplained death of an infant during sleep. It is the most common cause of post neonatal mortality. Aim: This study aimed to assess nurses' performance regarding infant sleep position on sudden infant death syndrome at Neonatal Intensive Care Units (NICUs). Design: A descriptive research design was used to conduct this study. Settings: This study was carried out at NICUs in Helwan General Hospital affiliated to Ministry of health and Mustafa Hassan Pediatric Hospital affiliated to Fayoum University Hospitals. Sample: A convenience sample of seventy nurses who providing care for preterm and low birth weight infants admitted to NICUs in the previous mentioned settings. Tools: Two tools were used for data collection; 1st tool: A structured interview questionnaire sheet consists of two parts: Part (1) to assess characteristics of studied sample, Part (2) to assess nurses' knowledge regarding infant sleep position on SIDS, 2nd tool: Observational checklist to assess nurses' practice regarding infant sleep position on SIDS. Results: The mean age of studied nurses was 25.47±4.26 years and the mean gestational age of infants was 32.43±2.71 weeks, 55.7% of the studied nurses had unsatisfactory level of knowledge regarding infant sleep position on SIDS. Also, the study proved that, 58.6% of studied nurses had incompetent level of practice regarding infant sleep positions at NICUs. Conclusion: It can be concluded that, more than half of the studied nurses had unsatisfactory total level of knowledge regarding infant sleep position on SIDS and more than half of them had incompetent practice. Additionally, there were statistically significant differences between nurses’ total level of knowledge and their characteristics namely educational qualifications (P =0.033) and attendance of previous educational courses about the infant sleeping position at the NICUs (P =0.005), while there were highly statistically significant differences between nurses’ total level of practice and their years of experience at NICUs (P&lt;0.001).Recommendations: Continuous training program for nurses to improve their performance regarding infant sleep position on sudden infant death syndrome.

Infant care practices among mothers attending well-baby clinics at primary health care centers in Unaizah city.

Infant care, crucial for the well-being of infants, is an inherent human practice. Although there are important implications of infant care practices on infant health, there is a dearth of comprehensive studies covering all important aspects of infant care in an individual study. To determine practices regarding infant feeding, infant sleep, use of pacifiers, and immunization, and to explore the association of these practices with mother's demographic data. A cross-sectional study was conducted using a self-administrated questionnaire distributed among mothers attending well-baby clinics in Primary Health Care Centers (PHCCs), Unaizah city, Qassim region, Saudi Arabia. By using the two-stage cluster sampling method, 50 women participated from each of the four selected PHCCs, leading to a total of 200 participants. The survey was conducted from December 2020 to February 2021. Data were analyzed using SPSS software. A total of 124 (62%) respondents were between the ages of 26 and 35 years, 64% had a bachelor's degree, and 69.5% were housewives. Breastfeeding was practiced by 88% of women, 48% began infant weaning at 6 months of age, and 49% put their infant to sleep on their back. Up-to-date vaccination was reported for 188 (94%) infants. Infant pacifier use was reported by 58% of the respondents, and 82.5% of the participants had been offered formula milk for the newborn at the hospital. Vaginal delivery, absence of complications during pregnancy or labor, presence of a housemaid, and family income of more than 10,000 Saudi Riyals were significantly associated with better infant care practices. The study participants have good practices for certain infant care aspects such as immunization; however, improvement is needed for other practices, including weaning at the proper age, infant sleep position, and the use of pacifiers. Administrative measures are required to monitor the use of formula milk at hospitals and to enhance health education for mothers.

Challenges parents encounter when implementing infant safe sleep advice.

To understand which safe sleep recommendations parents find most challenging to implement, identifying common barriers encountered; and investigate whether challenges are associated with practices employed. A cross-sectional survey of 3341 Australian families with young infants who birthed a live baby during April-May 2017. Caregivers were asked about infant care practices and family characteristics. Qualitative free-text items explored challenges faced with current safe sleep recommendations. Nearly one-third (n=1033, 31%) of caregivers reported difficulty with at least one safe sleep recommendation. Infant sleep position and avoiding bed-sharing were identified as the most challenging recommendations. Caregivers described barriers which influenced consistency in uptake of advice. Families who described difficulty with a recommendation were significantly less likely to consistently employ that advice compared to those who did not report difficulty (sleep position: 198/473,42% vs 2548/2837,90% [p<0.0001]; own sleep space: (269/344,78% vs 1331/2884,46% [p<0.0001]). When families encountered challenges, they often proposed alternate strategies with an inference their substitute action compensated potential increased risk. Many families encounter difficulties implementing safe sleep advice; these challenges negatively impact care practices. Effective interventions meeting individual family needs, to provide safe sleep environments consistently, are necessary to improve sleep-related infant care and further reduce infant mortality.

State-level trends in sudden unexpected infant death and immunization in the United States: an ecological study

BackgroundSudden unexpected infant death (SUID) continues to be a major contributor to infant mortality in the United States. The objective was to analyze time trends in SUID and their association with immunization coverage.MethodsThe number of deaths and live births per year and per state (1992–2015) was obtained from the Centers for Disease Control and Prevention (CDC). We calculated infant mortality rates (i.e., deaths below one year of age) per 1000 live births for SUID. We obtained data on immunization in children aged 19–35 months with three doses or more of diphtheria-tetanus-pertussis (3+ DTP), polio (3+ Polio), and Haemophilus influenzae type b (3+ Hib) as well as four doses or more of DTP (4+ DTP) from the National Immunization Survey, and data on infant sleep position from the Pregnancy Risk Assessment Monitoring System (PRAMS) Study. Data on poverty and race were derived from the Current Population and American Community Surveys of the U.S. Census Bureau. We calculated mean SUID mortality rates with 95% confidence interval (CI) as well as the annual percentage change using breakpoint analysis. We used Poisson regression with random effects to examine the dependence of SUID rates on immunization coverage, adjusting for sleep position and poverty (1996–2015). In a second model, we additionally adjusted for race (2000–2015).ResultsOverall, SUID mortality decreased in the United States. The mean annual percent change was − 9.6 (95% CI = − 10.5, − 8.6) between 1992 and 1996, and − 0.3 (95% CI = − 0.4, − 0.1) from 1996 onwards. The adjusted rate ratios for SUID mortality were 0.91 (95% CI = 0.80, 1.03) per 10% increase for 3+ DTP, 0.88 (95% CI = 0.83, 0.95) for 4+ DTP, 1.00 (95% CI = 0.90, 1.10) for 3+ polio, and 0.95 (95% CI = 0.89, 1.02) for 3+ Hib. After additionally adjusting for race, the rate ratios were 0.76 (95% CI = 0.67, 0.85) for 3+ DTP, 0.83 (95% CI = 0.78, 0.89) for 4+ DTP, 0.81 (95% CI = 0.73, 0.90) for 3+ polio, and 0.94 (95% CI = 0.88, 1.00) for 3+ Hib.ConclusionsSUID mortality is decreasing, and inversely related to immunization coverage. However, since 1996, the decline has slowed down.

Does Sleep Position Influence Sleep-Disordered Breathing in Infants With Cleft Palate: A Feasibility Study?

Objective:Cleft palate (CP) can affect breathing, leading to sleep-disordered breathing (SDB). Sleep position can affect SDB, but the optimum sleep position for infants with CP is unknown. We aimed to determine the design of a pragmatic study to investigate the effect of the 2 routinely advised sleep positions in infants with CP on oxygen saturations.Design:A multicentered observational cohort.Setting:Four UK-based cleft centers, 2 advising supine- and 2 side-lying sleep positions for infants with CP.Participants:Infants with isolated CP born July 1, 2015, and December 31, 2016. Of 48 eligible infants, 30 consented (17 side-lying; 13 supine).Interventions:Oxygen saturation (SpO2) and end-tidal carbon dioxide (ETCO2) home monitoring at age 1 and 3 months. Qualitative interviews of parents.Outcome Measures:Willingness to participate, recruitment, retention, and acceptability/success (>90 minutes recording) of SpO2 and ETCO2 monitoring.Results:SpO2 recordings were obtained during 50 sleep sessions on 24 babies (13 side-lying) at 1 month (34 sessions >90 minutes) and 50 sessions on 19 babies (10 side-lying) at 3 months (27 sessions >90 minutes). The ETCO2 monitoring was only achieved in 12 sessions at 1 month and 6 at 3 months; only 1 was >90 minutes long. The ETCO2 monitoring was reported by the majority as unacceptable. Parents consistently reported the topic of sleep position in CP to be of importance.Conclusions:This study has demonstrated that it is feasible to perform domiciliary oxygen saturation studies in a research setting and has suggested that there may be a difference in the effects of sleep position that requires further investigation. We propose a study with randomization is indicated, comparing side-lying with supine-lying sleep position, representing an important step toward better understanding of SDB in infants with CP.

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.

Applying a Social Exclusion Framework to Explore the Relationship Between Sudden Unexpected Deaths in Infancy (SUDI) and Social Vulnerability.

Background: Sudden Unexpected Death in Infancy (SUDI) is a leading cause of preventable infant mortality and strongly associated with social adversity. While this has been noted over many decades, most previous studies have used single economic markers in social disadvantage analyses. To date there have been no previous attempts to analyze the cumulative effect of multiple adversities in combination on SUDI risk.Methods: Based on sociological theories of social exclusion, a multidimensional framework capable of producing an overall measure of family-level social vulnerability was developed, accounting for both increasing disadvantage with increasing prevalence among family members and effect of family structures. This framework was applied retrospectively to all cases of SUDI that occurred in Queensland between 2010 and 2014. Additionally, an exploratory factor analysis was performed to investigate whether differing “types” of vulnerability could be identified.Results: Increased family vulnerability was associated with four major known risk factors for sudden infant death: smoking, surface sharing, not-breastfeeding and use of excess bedding. However, families with lower levels of social vulnerability were more likely to display two major risk factors: prone infant sleep position and not room-sharing. There was a significant positive relationship between family vulnerability and the cumulative total of risk factors. Exploratory factor analysis identified three distinct vulnerability types (chaotic lifestyle, socioeconomic and psychosocial); the first two were associated with presence of major SUDI risk factors. Indigenous infants had significantly higher family vulnerability scores than non-Indigenous families.Conclusion: A multidimensional measure that captures adversity across a range of indicators highlights the need for proportionate universalism to reduce the stalled rates of sudden infant death. In addition to information campaigns continuing to promote the importance of the back-sleeping position and close infant-caregiver proximity, socially vulnerable families should be a priority population for individually tailored or community based multi-model approaches.

Ultra-Low Power Wearable Infant Sleep Position Sensor.

Numerous wearable sensors have been developed for a variety of needs in medical/healthcare/wellness/sports applications, but there are still doubts about their usefulness due to uncomfortable fit or frequent battery charging. Because the size or capacity of battery is the major factor affecting the convenience of wearable sensors, power consumption must be reduced. We developed a method that can significantly reduce the power consumption by introducing a signal repeater and a special switch that provides power only when needed. Antenna radiation characteristics are an important factor in wireless wearable sensors, but soft material encapsulation for comfortable fit results in poor wireless performance. We improved the antenna radiation characteristics by a local encapsulation patterning. In particular, ultra-low power operation enables the use of paper battery to achieve a very thin and flexible form factor. Also, we verified the human body safety through specific absorption rate simulations. With these methods, we demonstrated a wearable infant sleep position sensor. Infants are unable to call for help in unsafe situations, and it is not easy for caregivers to observe them all the time. Our wearable sensor detects infants’ sleep positions in real time and automatically alerts the caregivers when needed.

The use of post-mortem lividity to determine sleep position in sudden unexpected deaths in infancy.

To compare parental reports of position found in sudden unexpected deaths in infancy (SUDI) to autopsy reports of lividity and to more accurately classify infant sleep position. Cases of SUDI in Queensland between 2010 and 2014 were reviewed to determine the position in which infants were reported to have been placed and found. This was compared to the distribution of post-mortem lividity at autopsy. Evidence of lividity present during early death scene investigation was also recorded. There was a discordance between the position an infant was reported to have been found and the position of lividity at autopsy in 22/228 SUDI (9.6%). All infants had anterior lividity despite 13 reportedly found supine, three on their side and six in an unknown position. Using anterior lividity at autopsy to change the position found increased the proportion of prone infants from 37.7% to 47.4%. In 47.8% cases, anterior or lateral lividity reported at the scene was no longer present at autopsy. Previously published odds ratios may have underestimated the risk of sudden infant death associated with prone sleep position. SUDI death scene investigation protocols should require photographic documentation of lividity prior to transporting an infant.

Prevalence and associated factors of supine sleep position in 3-month-old infants: findings from the 2015 Pelotas (Brazil) Birth Cohort

BackgroundNon-supine infant sleep position is an important modifiable risk factor for sudden unexpected death in infancy. The aim of this study was to assess the prevalence of supine sleep position and associated factors among 3-month-old infants from a birth cohort in the city of Pelotas, southern Brazil.MethodsThe present study evaluated longitudinal data from the 2015 Pelotas Birth Cohort. Study outcome was supine infant sleep position, defined as the appropriate position, among 3-month-old children. Demographic, socioeconomic, behavioral, and health characteristics collected at birth and at the 3-month follow-up were investigated as possible associated factors. The prevalence of each associated factor was investigated, and crude and hierarchical adjusted analyses were performed using Poisson regression.ResultsAmong the 4108 infants assessed in this study, 2274 (55.4%) slept in supine position at 3 months and only 66 (1.6%) in prone position. Maternal white skin color, higher family income and maternal schooling, advanced maternal age, maternal cohabiting with a partner, receiving counseling from health care professionals and non-bed-sharing were associated with higher prevalence of infants sleeping in supine position at 3 months. All these variables remained associated in our hierarchical adjusted analyses except maternal cohabitation with a partner. Participants with white mothers were more likely to sleep in supine position (PR: 1.23; 95%CI: 0.75–0.89) compared to participants with black mothers. Those belonging to the richest quintile were more likely to sleep in supine position (PR: 1.49; 95%CI: 1.35–1.65) compared to those who belong to the poorest. Mothers aged 31–36 years were more likely to choose supine sleep position (PR: 1.65; 95%CI: 1.42–1.92) compared to mothers younger than 19 years.ConclusionsThe findings of the present study showed the influence of maternal age, socioeconomic status, and counseling on infant sleep habits as predictors of choice of infant sleep position in a Brazilian population. It is recommended to implement informative campaigns and public policies to at-risk population and to improve recommendations from health care professionals.

Mediators of Improved Adherence to Infant Safe Sleep Using a Mobile Health Intervention.

To determine mediators of improvements in infant safe-sleep (SS) practices in a mobile health intervention. In a cluster-randomized controlled trial, mothers received SS intervention or breastfeeding control videos for 60 days. Maternal responses about infant sleep position and location (outcomes) and mediators (attitudes, perceived social norms, and perceived control) from the theory of planned behavior were assessed. Intervention effects on mediators and association between mediators and outcomes were examined. Of 1600 recruited, 1263 mothers participated. Mothers receiving SS videos were more likely to have positive attitudes and norms for supine sleep (attitudes: adjusted odds ratio [aOR] = 2.35 [95% confidence interval (CI) 1.72 to 3.20]; norms: aOR = 1.75 [95% CI 1.27 to 2.42]) and recommended sleep location (attitudes: aOR = 1.91 [95% CI 1.54 to 2.36]; norms: aOR = 1.37 [95% CI 1.13 to 1.66]). Positive attitudes and norms toward supine sleep and room-sharing without bed-sharing were associated with higher odds of both practices (supine: aOR = 8.25 [95% CI 4.72 to 14.43] for positive attitudes and aOR = 6.67 [95% CI 4.25 to 10.46] for norms; room-sharing: aOR = 7.14 [95% CI 5.35 to 9.53] for positive attitudes and aOR = 4.44 [95% CI 3.03 to 6.51] for norms). Both positive attitudes and positive norms mediated the effect of the intervention. The intervention achieved success in improving adherence to SS recommendations by changing maternal attitudes and norms about supine sleeping and room-sharing without bed-sharing. Recognition that these attitudes and norms appear to be the main drivers of mothers' choices regarding infant-sleep practices should inform health messaging strategies to promote SS.