Safe Sleep Research Articles

Safe Sleep and Your Baby: How Parents Can Reduce the Risk of SIDS and Suffocation—Vietnamese

Safe Sleep and Your Baby: How Parents Can Reduce the Risk of SIDS and Suffocation—Vietnamese

Safe Sleep and Your Baby: How Parents Can Reduce the Risk of SIDS and Suffocation—Russian

Safe Sleep and Your Baby: How Parents Can Reduce the Risk of SIDS and Suffocation—Russian

Safe Sleep and Your Baby: How Parents Can Reduce the Risk of SIDS and Suffocation—French

Safe Sleep and Your Baby: How Parents Can Reduce the Risk of SIDS and Suffocation—French

Maternity Care Clinicians’ Experiences Promoting Infant Safe Sleep and Breastfeeding During the COVID-19 Pandemic

ObjectiveTo explore the phenomenon of clinicians’ perceptions and experiences of promoting infant safe sleep (ISS) and breastfeeding during the COVID-19 pandemic. DesignDescriptive qualitative hermeneutical phenomenology of key informant interviews conducted as part of a quality improvement initiative. SettingMaternity care services of 10 U.S. hospitals from April through September 2020. ParticipantsTen hospital teams, including 29 clinicians. InterventionParticipants were part of a national quality improvement intervention focused on promoting ISS and breastfeeding. Participants were asked about challenges and opportunities promoting ISS and breastfeeding during the pandemic. ResultsWe identified four themes summarizing the experiences and perceptions of clinicians promoting ISS and breastfeeding in the COVID-19 pandemic: Strain on Clinicians Related to Hospital Policies, Coordination, and Capacity; Effects of Isolation for Parentsin Labor and Delivery; ReevaluatingOutpatient Follow-Up Care andSupport; and AdoptingShared Decision-Makingaround ISS andBreastfeeding. ConclusionsOur results support the need for physical and psychosocial care to reduce crisis-related burnout for clinicians to encourage the continued provision of ISS and breastfeeding education, particularly while navigating capacity constraints. Our findings also suggest that clinicians perceived that parents may require additional support to enhance potentially limited ISS and breastfeeding education. These findings may be used to inform approaches to parental and clinician maternity care support in future public health crises.

The provision of the baby box was associated with safe sleep practices in a low-resource community: a randomized control trial in Ecuador

BackgroundSudden Unexpected Infant Deaths (SUID) can occur between 1 month and 1 year of age and are inequitably distributed with a greater burden in populations with numerous health disparities. Modifying the infant sleep environment to promote safe sleep is the most effective risk reduction strategy to reduce SUID. The provision of baby boxes with a mattress and infant supplies has been part of a larger anti-poverty social justice maternity package for decades in Finland. While infant mortality rates have generally improved after the maternity package was introduced, little is known about whether the provision of the baby box increased safe sleep practices. The purpose of the study was to evaluate whether the provision of a Finnish-style baby box reinforced safe infant sleep practice in the home in a low-resource community in Ecuador.MethodsIn this longitudinal randomized controlled trial all participants received the same safe sleep education in their third trimester of pregnancy (n = 100). This was followed by randomization into two groups; the control received a diaper bag and newborn gifts, and the intervention group received a baby box and the same gifts at each timepoint. Four infant sleep practices (room sharing, bed sharing/co-sleeping, position, and soft items in the sleep environment) were assessed at 1 month and 1 months post-delivery during a home visit where safe sleep education was also reinforced with both groups.ResultsThose in the baby box group were 2.5 times more likely to report safe sleep practices compared with mothers in the diaper bag group at 1 month (odds ratio [OR] = 2.45 and 95% confidence interval [CI]: 1.03–5.86; χ2 = 4.1, p = .043). The group difference was also present at 6-months post-birth: those in the baby box group were 2.9 times more likely to report safe sleep practices compared with those in the diaper bag group (OR = 2.86 and 95% CI: 1.16–7.05; χ2 = 5.2, p = .022).ConclusionsWhile not all participants used the box regularly, the mothers who received the box were more likely to practice safe sleep at 1 month and 6 months. This suggests the baby box may have served as an important prompt towards safer infant sleep practice.Trial registration(Clinical Trial Registry, per clinicaltrials.gov: not applicable under 42 CFR 11.22(b) as the study Facility Location was not in the United States (took place in Ecuador), does not involve FDA IND or IDE, and does not involve a drug, biological or device product that is manufactured in and exported from the US for study in another country. The University of San Francisco Quito, Research Ethics Committee in Human Beings approved the study, #2017- 127 M. The University of Kentucky Office of Research Integrity also approved the study, IRB # 42965).

Implementation of safe infant sleep recommendations during night-time sleep in the first year of life in a German birth cohort

The aim of our study was to assess the extent to which families followed recommendations, issued by the German society for sleep medicine, for the prevention of sudden infant death syndrome (SIDS) during night-time sleep. Analyzing longitudinal data from a birth cohort located at the University Children’s Hospital Regensburg in Bavaria (Germany), we determined data regarding the infant's sleep location, sleep settings and body position, and exposure to environmental factors. Data were collected in a structured interview after birth and by standardized questionnaires at 4 weeks, 6 months, and 1 year of life, respectively. The majority of 1,400 surveyed infants (94% at 4 weeks) were reported to sleep in the parents’ sleeping room during the first months of life. While the most common furniture was a bedside sleeper (used by 48%), we also observed a considerable proportion of families who regularly practiced bed-sharing and, for 16% of infants, the parents’ bed was the default sleeping place. 12% of infants were still put regularly in the prone position. The vast majority (87%) of the infants were breastfed at some timepoint and 17% lived in a household with one or more smokers. Although most parents implemented many SIDS recommendations, our analysis illustrates a considerable gap between recommendations and intentions after birth on the one hand and actual implementation in real life on the other. The number-one deviation from the current SIDS guidelines during night-time sleep was bed-sharing with an adult.

Safe Newborn Sleep Practices on a Large Volume Maternity Service.

Reinforcing safe infant sleep conditions in the hospital setting supports continuation of safe sleep practices after hospital discharge and should be considered the first line of defense for reducing risk for sudden unexpected infant death (SUID) and sudden infant death syndrome (SIDS) at home. The purpose of this study is to determine knowledge of perinatal nurses, nursing assistants, physicians, and ancillary personnel about safe sleep recommendations and implementation of safe sleep practices on the mother-baby unit. Nurses and other members of the perinatal health care team in a level III maternity service were invited to participate in a survey about safe sleep knowledge and practices. An audit for safe sleep adherence was conducted on the mother-baby unit for 120 mother-baby couplets over 1 year as a process improvement project. N = 144 surveys were completed; most participants (86%) were nurses. They had high levels of knowledge about safe sleep recommendations and 74% reported making at least one safe sleep adjustment during one shift per week. The most common modifications at least once per week were removing baby from a sleeping caregiver (30%) and removing items from baby's bassinet (26%). Safe sleep audit findings revealed 32 out of 120 couplets were not fully following safe sleep recommendations, with most common unsafe sleep practice metrics being items in the baby's bassinet (18%) and bassinets propped up (8%). During the hospitalization for childbirth, new parents can learn about safe sleep practices from the perinatal health care team. Sharing information and role modeling safe sleep practices can promote continuation of safe sleep practices for the newborn at home after hospital discharge.

Safety Baby Shower Intervention Improves Safe Sleep Knowledge and Self-Efficacy among Expectant Teens.

Young, minority women are less likely to follow recommendations to prevent infant sleep-related deaths putting their children at risk. This study extended the past pre/post study designs to an RCT design and included both parent report and objective observation of the sleep environment. This study focused on this population in a quantitative, randomized controlled trial using a low-cost, brief educational intervention, a Safety Baby Shower (SBS). Pregnant teens aged 13-19 (N = 147) were recruited as a dyad with a senior female caregiver and randomized to intervention or control groups. Comparing self-report, safe sleep knowledge, attitudes, beliefs, and intent (KABI) to act scores across the two groups found intervention dyads to have more positive views on all four constructs than controls. Specifically, intervention dyad young mothers were significantly more likely to have positive beliefs about safe sleep and were more likely to report intent to practice infant safe sleep than control young mothers. Intervention dyad young mothers also had higher self-efficacy related to infant safety and more positive attitudes about safe sleep practices than control young mothers. Observations at a home visit conducted after delivery found no differences in the safe sleep practices by intervention status. Participant report of behaviors at the home visit also showed no differences in the use of safe position between the intervention and control groups. It appears that even when young mothers gain knowledge and self-efficacy, they have difficulty implementing this knowledge. In practice, this suggests that exploring barriers prenatally with this population and offering suggestions to overcome them may be indicated.

Perceptions and Use of Safe Sleep Baby Boxes at Hospital Discharge by New Mothers.

A large community hospital in South Texas began distributing safe sleep baby boxes to reduce sudden unexplained infant death (SUID) in 2017. To describe safe sleep practices among new mothers who received a safe sleep baby box at hospital discharge. An information sheet containing a link to an online survey was mailed to all women who received a safe sleep baby box prior to discharge from the hospital from January 2018 to January 2019. N = 84 women participated. Most reported using the safe sleep baby box only during nap time (n = 62, 88.6%). Only 70.2% of participants reported that baby always slept their back (n = 59). Most reported their baby did not use a pacifier (n = 62, 73.8%), and many reported they were not breastfeeding their baby (n = 38, 45.2%). Many women were not using the safe sleep baby box as intended and were not following many of the other safe sleep guidelines. Nurses should ask their patients about plans for infant safe sleep after discharge to provide individualized education or recommend specific resources to address the family's needs.

The impact of a neonatal sleep intervention on sleep quality in the postpartum period

To determine the impact of a novel neonatal sleep intervention on maternal sleep quality in the postpartum period in individuals with a hypertensive disorder of pregnancy (HDP) and assess the relationship between maternal sleep quality and blood pressure. In this single institution pilot randomized controlled trial, 110 individuals with a HDP were randomized to receive a neonatal sleep intervention, a SNOO smart bassinet, plus usual care of safe sleep education (n=54) or usual care alone (n=56). Individuals were included if they were 18+ years old, had a singleton term live birth of a non-anomalous infant without a prolonged neonatal intensive care unit stay, and had a new HDP without prior chronic hypertension. Remote follow-up visits conducted at 6 weeks postpartum included vital signs and subjective sleep quality questionnaires including the Pittsburgh Sleep Quality Index (PSQI), Patient-Reported Outcomes Measurement Information System Sleep Disturbance (PROMIS-SD) questionnaire, and the Epworth Sleepiness Scale (ESS). Maternal sleep quality was a prespecified secondary outcome of this trial. Clinical and demographic characteristics were similar between arms (Table 1). Follow-up sleep data was available for 82 (75%) participants at 6 weeks (mean of 41.8±4.8 days) postpartum, with a higher follow rate in the SNOO arm (89% vs 61%) (Table 2). PSQI, PROMIS-SD, and ESS scores were similar between the two groups (p>0.05). The majority (88%) noted poor subjective sleep quality with PSQI score >5. There was no significant correlation between blood pressure and sleep quality (p>0.05) at 6 weeks postpartum. Use of the SNOO bassinet as a neonatal sleep intervention did not result in improved maternal subjective sleep quality at 6 weeks postpartum in our cohort of individuals with HDP. Self-reported sleep quality was not associated with blood pressure in this cohort of individuals with HDP.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

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.

Racial and incident discrepancies in news media reporting of sudden unexpected infant death (SUID)

BackgroundRegardless of injury prevention and outreach efforts, there continue to be low rates of adherence with the American Academy of Pediatrics (AAP) safe sleep recommendations. Media is an important tool for parental education and may influence risk perception and caregiver choices. Due to media reports potentially serving as an opportunity for shaping social norms, caregiver education and injury prevention, an evaluation was undertaken to evaluate Georgia local news reporting of sudden unexpected infant death (SUID) as compared to drownings, homicides, and firearm injuries. Our objective was to evaluate incident and racial discrepancies in Georgia news media reporting of SUID as compared to other pediatric injury deaths.ResultsDespite its high incidence, SUID was far less commonly mentioned in the news media, with only 1.9% (10/525) mentioned as compared to 8.1% of drownings (17/211), 11.4% (74/649) of MVC’s, 14.7% (59/402) of homicides between ages 1–18, 20% (11/55) of fire-related deaths and 25% (15/59) of homicides under age one (infant homicides). Across SUID and homicide, deaths of White infants were reported in the news media at 2.5 times the rate of Black infants.ConclusionDespite SUID being a leading cause of infant death, it is infrequently mentioned in the news media. When mentioned, the news media are more likely to highlight the deaths of White infants as compared to Black infants, though the incidence rate of SUID is higher in Black infants as compared to White.

Decreasing Sudden Unexpected Infant Death

Background: Sleep-related sudden unexpected infant death (SUID) is an alarming, potentially preventable event with over 3,500 annual occurrences in the United States (US). In response to sleep-related SUIDs, the American Academy of Pediatrics and National Institutes of Health advocate for safe sleep practices to promote establishment of safe sleep environments for infants through the Safe to Sleep initiative. However, research evidence shows that lack of knowledge in hospital staff and community members (parents/caregivers) and cultural barriers/biases are factors associated with the inability or resistance to adopting safe sleep practices for infants.

When there is no air, the cradle will fall: A narrative review of tobacco-related content across infant safe sleep interventions.

Sudden Unexpected Infant Death (SUID) from sleep-related causes is a leading cause of infant mortality worldwide. Sudden Infant Death Syndrome (SIDS) is one of the primary causes of SUID attributed to one or more environmental or behavioral determinants surrounding safe sleep practices among infants. The focus of many interventions on mitigating sleep-related infant deaths have addressed visible determinants pertaining to bed sharing, safe sleep surfaces, and removal of blankets, toys and other choking or strangulation hazards. Tobacco reduction and cessation have not been at the heart of any infant safe sleep interventions although addressing tobacco exposure is one of the primary safe sleep recommendations of the American Academy of Pediatrics. To date, there has not been a comprehensive review published on tobacco-related components across safe sleep interventions to reduce the risk of SIDS and SUID as the basis to contribute towards decreasing the rate of infant mortality. This review synthesizes the best practices, strategies, education, and additional interventions centered on addressing tobacco exposure as a risk factor for sleep-related infant deaths. Ten peer-reviewed studies were identified between 1995 and 2021 and integrated into this narrative review. There were three cross-sectional studies, three campaigns, one multi-center case control study, two randomized controlled trials, and two group comparison studies. Strengths and limitations of each approach are delineated followed by recommendations for future campaign, research, program, and practice endeavors to account for the totality of pertinent modifiable risk factors that contribute towards heightened infant mortality from sleep-related causes.

Risk Factors for Suffocation and Unexplained Causes of Infant Deaths.

Observational studies have improved our understanding of the risk factors for sudden infant death syndrome, but separate examination of risk for sleep-related suffocation and unexplained infant deaths has been limited. We examined the association between unsafe infant sleep practices and sudden infant deaths (sleep-related suffocation and unexplained causes including sudden infant death syndrome). We conducted a population-based case-control study using 2016 to 2017 Centers for Disease Control and Prevention data. Controls were liveborn infants from the Pregnancy Risk Assessment Monitoring System; cases were from the Sudden Unexpected Infant Death Case Registry. We calculated risk factor prevalence among cases and controls and crude and adjusted odds ratios. We included 112 sleep-related suffocation cases with 448 age-matched controls and 300 unexplained infant death cases with 1200 age-matched controls. Adjusted odds for sleep-related suffocation ranged from 18.7 (95% confidence interval [CI]: 6.8-51.3) among infants not sharing a room with their mother or caregiver to 1.9 (95% CI: 0.9-4.1) among infants with nonsupine sleep positioning. Adjusted odds for unexplained death ranged from 7.6 (95% CI: 4.7-12.2) among infants not sharing a room with their mother or caregiver to 1.6 (95% CI: 1.1-2.4) among nonsupine positioned infants. We confirmed previously identified risk factors for unexplained infant death and independently estimated risk factors for sleep-related suffocation. Significance of associations for suffocation followed similar patterns but was of larger magnitude. This information can be used to improve messaging about safe infant sleep.

Addressing Structural Racism in Infant Safe Sleep Education: HHS to Fund First Candle Community-Based Project

Addressing Structural Racism in Infant Safe Sleep Education: HHS to Fund First Candle Community-Based Project

Addressing Structural Racism in Infant Safe Sleep Education: HHS to Fund First Candle Community-Based Project

Addressing Structural Racism in Infant Safe Sleep Education: HHS to Fund First Candle Community-Based Project

Ensuring Safe Sleep in the Pediatric Intensive Care Unit: A Systematic Review of Informed Development of Clinical Guidelines for Implementation in Practice

Although general safe sleep guidelines have been established, their utility and implementation have yet to be examined systematically for inpatient populations for application to infants in the pediatric intensive care unit (PICU) setting. This study aimed to complete a systematic review of inpatient safe sleep practices studies to develop then safe sleep clinical guidelines for implementation in the care of medically complex infants in the PICU. This review was registered with PROSPERO and adheres to Preferred Reporting Items for Systematic reviews and Meta-Analyses systematic review guidelines. Nineteen articles met the inclusion criteria. A safe sleep guideline algorithm for medically complex infants in the PICU was created for implementation. Consistent and comprehensive safe sleep education and modeling by health care professionals in the inpatient setting is an effective technique to reduce the risk of harm and promote safe sleep behaviors in the home setting.

Infant Safe Sleep in the District of Columbia: Better for Both.

Sudden unexpected infant death (SUID) rates within the District of Columbia (DC) vary, with rates 3 times higher in certain geographical areas than the cumulative rate in DC and 7 times higher than the national rate. The majority SUIDs are due to unsafe sleep practices. Although safe sleep education and resources are available in these areas, the high sleep-related infant mortality suggests unmet barriers to infant safe sleep. We sought to investigate potential contributions to local infant mortality through focus groups regarding infant sleep practices among DC caregivers. In this qualitative study, caregivers were probed regarding barriers and facilitators of infant sleep practices. Data were collected until thematic saturation was reached, then coded. Themes were developed and revised in an iterative manner. Fifteen caregivers participated in three focus groups. Themes included sources of infant sleep knowledge, challenges for infant sleep, and motivators for infant sleep choice. All caregivers reported knowledge of safe sleep practices. Infant sleep practices varied, and included unsafe practices such as bed sharing, co-sleeping, and use of swings or bouncers for infant sleep. Challenges of adhering to safe sleep practices included infant needs, competing family demands, the overwhelming nature of newborn sleep, threats, and conflicting information. Motivators for infant sleep practices included better sleep, convenience, safety, tradition, and needs of the infant and caregiver. Although caregivers report knowledge of safe sleep recommendations, actual infant sleep practices vary and include unsafe sleep practices. More focused interventions are needed to address this gap between safe sleep knowledge and practice.

Falls of newborn infants in a New Zealand hospital: A case series.

The fall of a newborn baby to the hospital floor is a devastating experience for the family and staff caring for the mother and baby. The aim of this study was to report our experience in an ethnically diverse and socioeconomically disadvantaged community. The study was a retrospective case series of all baby falls in the Counties Manukau Health (New Zealand) post-natal care wards, birthing suites and birthing units from 2015 to 2018. Information from the incident reporting system was used to identify the circumstances surrounding the fall. In addition, medical records of the mother and the baby were examined for the admission during which the fall occurred. There were 32 cases (rate 12.1/10 000 live births). Mothers of babies who fell were more likely to present late for antenatal care, to smoke and be obese. They were more likely to have delivered by caesarean. Falls were more likely to occur at night and around weekends. In most instances (84%) the mother fell asleep with baby on the bed while breastfeeding. There were no major injuries. The rate of baby falls is considerably greater than previous reports. Recommendations are made to reduce this occurrence. These can be incorporated into safe sleep education.