Sudden Infant Death Research Articles

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.

Objective evaluation of chest findings in infants by postmortem computed tomography

PurposeThe purpose of this study was to review the findings of computed tomography (CT) performed early postmortem on infants and to clarify the postmortem CT lung findings that occur in the absence of abnormal histopathological findings. Materials and methodsFrom July 2016 to March 2022, 72 infants were autopsied with postmortem CT (41 boys 31 girls, aged 0–36 (mean 8.2) months). Autopsy and postmortem CT lung findings were compared with the causes of death identified by the autopsies, namely sudden infant death syndrome (n = 37), acute circulatory system disease (18), drowning (7), asphyxia (5), and dehydration/undernutrition (5). ResultsThe %aerated lung volume (−700 HU or less) ranged from 0 % to 33 % (mean 1.5 %, median 0 %), being <1 % in 61 cases (84.7 %) and >3 % in 3/5 (60 %) of the dehydration/undernutrition group. The dehydration/undernutrition group showed significant preservation of lung field air content compared with the other causes of death groups (p < 0.05). Receiver characteristic curve analysis showed a cut off value of 0.8 % and area under the curve of 0.88806. The drowning group had significantly greater pleural cavity fluid retention than the other causes of death groups (p < 0.05). No correlation was found between postmortem interval and pleural cavity fluid retention. However, resuscitation time and pleural cavity fluid retention were correlated. ConclusionEvaluation of CT values on postmortem lung fields of infants usually reveals a marked decrease in air content. When air content exceeds 0.8% on infant postmortem CT, dehydration/undernutrition should be considered in the differential diagnosis.

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.

50 Years Ago in TheJournalofPediatrics: Sudden Infant Death Syndrome: 50 Years Later

50 Years Ago in TheJournalofPediatrics: Sudden Infant Death Syndrome: 50 Years Later

Mothers Knowledge Toward Correct Infant Sleep Practices and Sudden Infant Death Syndrome In Al-Najaf Provence

Objective: "The current study aims to assess the proportion of newborns that sleep well and investigates the awareness and comprehension of SIDS and its associated risk factors among mothers of infants in Al Najaf Provence". Methodology: In order to accomplish the study's goals, a descriptive cross-sectional study was used throughout. The study took place between November 2021 and February 2022. a Non-Probability (Purposive Sample) of 100 moms who arrived with infants (under 1 year old) at the Hospital for Maternity and Children and the primary healthcare facilities in Al-Najaf Provence. Results: The study's findings revealed that (49%) of newborns were found to be sleeping on their sides, (37%) were found to be dozing off, and (14%) were found to be sleeping on their prone backs. Participants as a whole (60%) stated that (40%) child doctors were the main information source they used to learn about SIDS. Conclusion: In our study, women had limited understanding about sudden infant death syndrome, and a substantial percentage of them were unaware that smoking exposure during pregnancy and after delivery had been linked to an elevated risk of SIDS. In our study, a large percentage of moms were unaware that giving their babies pacifiers while they slept reduced the risk of SIDS. Keywords: knowledge, mother, sudden infant death syndrome.

Neonatal mortality in singleton pregnancies: a 20-year retrospective study from a tertiary perinatal unit in Hong Kong.

The global neonatal death (NND) rate has been declining in recent decades, but there are no comprehensive data concerning the characteristics of NNDs in Hong Kong. This study investigated the trends and aetiologies of NNDs among singleton pregnancies in Hong Kong. This study included all cases of NND from singleton pregnancies in a tertiary hospital in Hong Kong between 2000 and 2019. The rates, clinical characteristics, and aetiologies of NND were compared between the first (2000-2009) and the second (2010-2019) decades. The NND rate decreased from 1.66/1000 livebirths (97 cases) in the first decade to 1.32/1000 livebirths (87 cases) in the second decade. Congenital or genetic abnormalities (82 cases) caused 44.6% of all NNDs. There was a significant reduction from 0.82/1000 livebirths in the first decade to 0.52/1000 livebirths in the second decade (P=0.037). Other causes of NND were prematurity (69 cases; 37.5%), sepsis (16 cases; 8.7%), hypoxic-ischaemic encephalopathy (15 cases; 8.2%), and sudden infant death syndrome (2 cases; 1.1%). Gestational age-specific neonatal mortality for moderately preterm neonates (31-33 weeks of gestation) significantly decreased from 34.73/1000 in 2000-2009 to 8.63/1000 in 2010-2019 (P=0.001), but there were no significant changes in neonatal mortality for other gestations. The NND rate in Hong Kong is among the lowest worldwide. Neonatal deaths in our centre declined over the past two decades, mainly because of improvements in the prenatal diagnosis and treatment of congenital or genetic abnormalities, as well as an improved survival rate among moderately preterm neonates.

Knowledge and Self-Reported Practice of Postnatal Mothers on Sudden Infant Death Syndrome Prevention: A Cross-Sectional Study

AbstractThe word “Sudden Infant Death Syndrome (SIDS)” is used for a sleeping infant, who has apparently been quite well, is found unexpectedly dead. There are varied discussions throughout the world trying to find the possible reasons and preventive measures toward these sudden deaths. However, limited studies are undertaken regarding knowledge of mothers related to SIDS. The present study aimed at identifying the knowledge gaps present among the postnatal mothers toward SIDS and assess their practices that may influence SIDS among infants. The research design was a descriptive cross-sectional design and a 107 postnatal mothers were recruited focusing on the aim of the study through purposive sampling technique. A structured knowledge questionnaire and self-reported practice checklist was prepared and validated from experts.The findings of the study revealed that the majority of subjects 57 (53.3%) had good knowledge with a mean score of 9.34 ± 1.83 (maximum score-15). The mean practice score on prevention of SIDS among subjects was 13.76 ± 1.13 (maximum score-16). There was no significant correlation between knowledge and practice (r = −0.38, p = 0.7). However, significant association was seen between knowledge on prevention of SIDS and baseline variables such as education (p = 0.001), occupation (p = 0.001), place of residence (p = 0.001), and family income (p = 0.01). Moreover, there was a significant association between self-reported practice and age of mothers (p = 0.03).The study findings showed good knowledge level among majority of the mothers and executed good practice toward care of the infant. However, 30.8% of the mothers had average to poor level of knowledge, which is significant and needs attention.

Brief Resolved Unexplained Event: What Parents and Caregivers Need to Know

A brief resolved unexplained event (or BRUE for short) occurs suddenly and can be scary for parents and caregivers. A brief resolved unexplained event is a diagnosis made after your baby’s doctor or health care professional has examined your baby and determined that there was no known concerning cause for the event.When a brief resolved unexplained event occurs, babies may seem to stop breathing, their skin color may change to pale or blue, their muscles may relax or tighten, or they may seem to pass out. After a brief period of time, they recover (with or without any medical help) and are soon back to normal.Though we can never say that a baby who has had a brief resolved unexplained event is at no risk for future problems, we can say that babies are at lower risk ifQ: Why did my baby have this event?A: Your baby’s doctor was unable to find a cause based on the results of your baby’s examination and cannot tell you why this event happened. If it happens again or your baby develops additional problems, contact your baby’s doctor or health care professional. The doctor may decide to have your baby return for another visit.Q: Should my baby stay in the hospital? A: Babies who are felt to be at lower risk by their doctors or health care professionals do not need to stay in the hospital. They are safe to go home without doing blood tests or imaging that uses x-rays, and they do not need home monitoring of their heart or lungs.Q: Does having a brief resolved unexplained event increase my baby’s risk for sudden infant death syndrome (SIDS)?A: No—though the causes of SIDS are not known, events like these do not increase the risk of SIDS. For all babies, it is important to create a safe home and sleeping environment. Your baby should not be exposed to smoky environments. Visit www.HealthyChildren.org/safesleep to learn more about how to create a safe sleeping environment for your baby.Q: What should I do if it happens again?A: If you are worried that this new event is life threatening, call 911 or your local emergency numbers. If not, call your baby’s doctor if you have any questions or worries and to let the doctor know about the event.Q: Does my baby need extra care after having a brief resolved unexplained event? Is my baby more delicate or weak?A: No special care is needed. Continue to love and care for your baby as you normally do.Listing of resources does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of external resources. Information was current at the time of publication.The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Assessing infant sleep practices and other risk factors of SIDS in Zambia: a cross-sectional survey of mothers in Lusaka, Zambia

BackgroundHaving infants sleep with their parents and sleeping face down or on their sides are the two most proximate and modifiable risk factors for sudden infant death syndrome (SIDS). Little is known about the burden of SIDS or the prevalence of these risk factors in Africa. Our primary objective was to determine the prevalence of modifiable risk factors of SIDS in Lusaka, Zambia.MethodsWe conducted cross-sectional surveys with recent mothers of infants aged < 1 year across two busy urban clinic sites in Lusaka, Zambia. We used log-binomial regression analysis to identify factors predictive of bedsharing and prone sleeping.ResultsSurveys were conducted with 478 mothers between April-May 2021. The sleep-related risk factors, bedsharing and side sleeping, were widely prevalent. 89.5% of respondents indicated that they share a bed with the infant during sleep, 73.0% preferred putting their baby on its side, and 19.9% preferred the prone position. Only 6.7% of respondents described using the safer, supine position. Age of infant was the only factor which was predictive of prone sleeping. Infants > 2 months old were twice as likely to be put to sleep in a prone position compared to infants aged less than 2 months old. Mothers reported that they rarely (24.1%) received advice from medical caregivers to use the supine position. Maternal use of alcohol (12.0%) and tobacco (0.8%) during pregnancy were uncommon.ConclusionsBedsharing and placing the infant to sleep on the side were commonly reported among the mothers we interviewed. Whether this represents an opportunity to reduce SIDS in Zambia is unclear since accurate data on the burden of SIDS in Zambia is not available. There is a need for increased awareness of SIDS and more prospective data collection on its burden and related risk factors in these African populations.

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.

O033 Butyrylcholinesterase is a potential biomarker for Sudden Infant Death Syndrome

Abstract Background Autonomic dysfunction has been implicated in the pathophysiology of Sudden Infant Death Syndrome (SIDS). Butyrylcholinesterase (BChE) is an enzyme of the cholinergic system, a major branch of the autonomic system, and may provide a measure of autonomic (dys)function. This study was undertaken to evaluate BChE in infants and young children who had died from SIDS or Sudden Unexpected Death. Methods We measured BChE specific activity (BChEsa) in the eluate of 5μL spots punched from the dried blood spots (DBS) taken at birth as part of the newborn screening program. Results for each of 67 SUDI deaths classified by the coroner (aged 1 week – 104 weeks) = Cases, were compared to 10 date of birth - and gender-matched surviving controls (Controls), with five cases reclassified to meet criteria for SIDS. Findings Conditional logistic regression showed that in groups where cases were reported as “SIDS death” there was strong evidence that lower BChEsa was associated with death (OR=0·73 per U/mg, 95% CI 0·60 – 0·89, P=0·0014), whereas in the “Non-SIDS death” group there was no evidence of a linear association between BChEsa and death (OR=1·001 per U/mg, 95% CI 0·89 – 1·13, P=0·99). Conclusion BChEsa, measured in DBS taken 2-3 days after birth, was lower in babies who subsequently died of SIDS compared to surviving controls and other Non-SIDS deaths. We conclude that a previously unidentified cholinergic deficit, identifiable by abnormal BChEsa, is present at birth in SIDS babies and represents a measurable, specific vulnerability prior to their death.

Chronic, episodic nicotine exposure alters GABAergic synaptic transmission to hypoglossal motor neurons and genioglossus muscle function at a critical developmental age.

Regulation of GABAergic signaling through nicotinic acetylcholine receptor (nAChR) activation is critical for neuronal development. Here, we test the hypothesis that chronic episodic developmental nicotine exposure (eDNE) disrupts GABAergic signaling, leading to dysfunction of hypoglossal motor neurons (XIIMNs), which innervate the tongue muscles. We studied control and eDNE pups at two developmentally vulnerable age ranges: postnatal days (P)1-5 and P10-12. The amplitude and frequency of spontaneous and miniature inhibitory postsynaptic currents (sIPSCs, mIPSCs) at baseline were not altered by eDNE at either age. In contrast, eDNE increased GABAAR-α1 receptor expression on XIIMNs and, in the older group, the postsynaptic response to muscimol (GABAA receptor agonist). Activation of nAChRs with exogenous nicotine increased the frequency of GABAergic sIPSCs in control and eDNE neurons at P1-5. By P10-12, acute nicotine increased sIPSC frequency in eDNE but not control neurons. In vivo experiments showed that the breathing-related activation of tongue muscles, which are innervated by XIIMNs, is reduced at P10-12. This effect was partially mitigated by subcutaneous muscimol, but only in the eDNE pups. Taken together, these data indicate that eDNE alters GABAergic transmission to XIIMNs at a critical developmental age, and this is expressed as reduced breathing-related drive to XIIMNs in vivo.NEW & NOTEWORTHY Here, we provide a thorough assessment of the effects of nicotine exposure on GABAergic synaptic transmission, from the cellular to the systems level. This work makes significant advances in our understanding of the impact of nicotine exposure during development on GABAergic neurotransmission within the respiratory network and the potential role this plays in the excitatory/inhibitory imbalance that is thought to be an important mechanism underlying neonatal breathing disorders, including sudden infant death syndrome.

Identification of Decreased Butyrylcholinesterase in Sudden Infant Death Syndrome Is, at Best, a First Step Toward Preventive Screening.

The identification of a biomarker associated with increased risk of sudden infant death syndrome (SIDS), as described by Harrington et al. (1) is an exciting yet cautionary tale combining the incremental progress of scientific research and the hazards of media hype. The authors propose an association of decreased butyrylcholinesterase (BChE) activity levels in newborn screening (NBS) dried blood spots collected from infants who died of SIDS compared to surviving controls. This association was not seen in a cohort of non-SIDS deaths when compared to surviving controls. The authors theorize that decreased BChE activity is a marker for autonomic dysfunction, a vulnerability previously suspected to be implicated in the triple risk model for SIDS (2). While considerable decreases in SIDS deaths have been accomplished through NBS programs and safe sleep education, a significant number of infants still die of SIDS, and other promising diagnostic approaches (e.g., genomic analyses) are so far only pursued in the research environment (3). Harringtons study had a robust design with well-defined cases and controls. Utilizing NBS dried blood samples recognizes the need for future screening to work within existing systems for sample collection and availability, and takes advantage of preserved samples for the potential benefit of babies and families in the future. This study was made possible in part by the recognition that stored NBS blood samples can provide valuable information for future expansion of NBS panels. The rarity of most conditions targeted for NBS precludes prospective case identification. Regions that destroy samples after short retention periods are limiting opportunities for improvement and expansion of screening programs, as well as for families to obtain critical information from these samples.

Investigating genetic variants in microRNA regulators of Neurokinin-1 receptor in sudden infant death syndrome.

To identify sequence variants in the miRNAs within a study cohort (27 cases of SIDS and 28 controls) and determine if there was a difference in the frequencies in male and female SIDS infants. Genomic DNA prepared from stored blood spots was amplified and sequenced to identify genetic variants in miR500A, miR500B and miR320D2. No novel variants in the miRNAs were identified in our study cohort. We identified one known single-nucleotide polymorphism (SNP) in miR320D2: rs5907732 G/T, in both cases and controls. No significant difference in the SNP frequency was observed between male and female SIDS cases. This pilot study suggests that sequence variants in three miRNAs do not contribute to the reported higher prevalence of SIDS in male infants and do not contribute to the pathogenesis of SIDS in our cohort.

The added value of molecular-based diagnostics in the African forensic medical setting.

Sudden unexpected infant death (SUDI) is reported to be an extraordinarily high burden in sub-Saharan Africa, with the incidence rate in South Africa among the highest in the world. It is common for the cause of many such infant deaths to remain unexplained even after a full medico-legal death investigation, and then to be categorised as a sudden unexplained infant death (SUID). Fortunately, advances in molecular-based diagnostics allow researchers to identify numerous underlying inherited cardiac arrhythmogenic disorders in many SUDI cases, with a predominance of variants identified in the SCN5A gene. Such cardiac arrhythmogenic-related sudden deaths generally present with no structural alterations of the heart that are macroscopically identifiable at autopsy, therefore highlighting the importance of post mortem genetic testing. We report on a significant genetic finding that was made on a SUDI case in which the cause was ascribed to an acute bacterial pneumonia but it was still subjected to post mortem genetic testing of the SCN5A gene. The literature shows that many SUDI cases diagnosed with inherited cardiac arrhythmogenic disorders have demonstrated a viral prodrome within days of their death. It is therefore not uncommon for these cardiac disorders in infants to be mistaken for flu, viral upper respiratory tract infection or pneumonia, and without the incorporation of post mortem genetic testing, any other contributory causes of these deaths are often disregarded. This study highlights the need for research reporting on the genetics of inherited cardiac disorders in Africa.

Intervention during the Perinatal Period: Synthesis of the Clinical Practice Guidelines from the French National College of Midwives.

These clinical practice guidelines from the French National College of Midwives (CNSF) are intended to define the messages and the preventive interventions to be provided to women and co-parents by the different professionals providing care to women or their children during the perinatal period. These guidelines are divided into 10 sections, corresponding to 4 themes: 1/ the adaptation of maternal behaviors (physical activity, psychoactive agents); 2/ dietarybehaviors; 3/ household exposure to toxic substances (household uses, cosmetics); 4/ promotion of child health (breastfeeding, attachment and bonding, screen use, sudden unexplained infant death, and shaken baby syndrome). We suggest a ranking to prioritize the different preventive messages for each period, to take into account professionals' time constraints.

Subject Matter Expert Nurses in Safe Sleep Program Implementation.

Pennsylvania sudden unexpected infant death rates rank among the highest nationally. A nursing team developed, implemented, evaluated, and disseminated an evidence-based quality improvement (QI) program at birthing hospitals in Pennsylvania to address this issue. To facilitate implementation, clinical nurses were educated as Subject Matter Experts (SMEs) to empower them to transform and sustain outcomes-driven QI for infant safe sleep nursing practice. This descriptive study examined outcomes from 268 nurses who received comprehensive education on infant safe sleep and the SME role. Likert-type scale surveys measured knowledge gained and progress made in practice following education. A programmatic dashboard tracked program implementation. Descriptive statistics were used to report findings. SME nurses ( N = 268) completed two interactive learning modules addressing safe sleep guidelines and teaching strategies and attended a workshop to acquire skills for program implementation. Key competencies included data collection and dissemination, policy development, and communication techniques. Immediate posteducation surveys completed by SMEs indicated that over 98% of respondents strongly agreed or agreed they were able to effectively demonstrate communication strategies, identify SME role components, provide environment surveillance, and demonstrate best practices in infant safe sleep. To allow time for assimilation of the of SME role, a survey was initiated at 6 months to capture progress made. Seventy-eight SMEs responded to the survey and reported exceptional or substantial progress in 10 areas for SME responsibilities. Use of the SME role for program implementation led to highly favorable SME-reported outcomes in leading a hospital-based QI program.

Survey of Korean daycare personnel on safe sleep practices related to sudden unexplained infant death: a cross-sectional exploratory study.

Safe sleep practices (SSP) are among the main strategies to reduce sleep-related sudden unexplained infant death (SUID). Daycare personnel must be knowledgeable and trained in SSP related to SUID. This study explored the experience, knowledge, and confidence regarding SSP associated with SUID of daycare personnel. A cross-sectional survey was conducted with 395 staff members at 61 daycare centers to measure their experience related to SSP (10 items), related to sleep position and location, bedding materials, and other topics; knowledge of SSP (18 items); and confidence in SSP (1 item) related to SUID. A substantial proportion (23.6%) of respondents used the lateral or prone positions for infant sleep. On average, 4.5 bedding materials were used for infant sleep. Participants showed a lack of knowledge about SSP as indicated by a 56.6% knowledge of SSP related to SUID correct answer rate. Personnel who received SUID education were more knowledgeable and had more confidence regarding SSP than those who did not. More knowledge and confidence related to SSP were associated with better adherence to SSP. Standard SSP guidelines should be developed based on South Korea's culture of childcare for educating both childcare professionals and parents at home.

Modeling of infant safe sleep practice in a newborn nursery: a quality improvement initiative

Sudden infant death syndrome (SIDS) is a leading cause of infant mortality in the US. The American Academy of Pediatrics has provided recommendations for infant sleeping position and environment to decrease SIDS rates. These recommendations reinforce the importance of modeling safe sleep practices in the newborn nursery. Although many quality improvement initiatives have been undertaken to improve safe sleep in the nursery, such efforts are sparse in low-volume birth hospitals. This project aimed to improve infant sleep practices in a 10-bed level I nursery using visual cues (crib cards) and nursing education. We defined “safe sleep practice” if a newborn slept in a safe position in a flat bassinet and in a safe environment. We measured safe sleep practices before and after the intervention using an audit tool. As a result, safe sleep practices improved from 32% (30/95) preintervention to 75% (86/115) postintervention (P < 0.01). This study demonstrates that implementing a quality improvement initiative to improve infant sleep practices in a low-volume nursery is feasible and impactful.

Parental Knowledge on Prevention of SUID

Abstract Background According to the 2018 America’s Health Ranking Annual Report, the U.S. infant mortality rate (IMR) was 5.9 deaths per 1,000 live infant births, which placed the U.S. at No. 33 out of 36 countries with the world’s largest economies in 2018. The IMR in Georgia has been on the rise since 2014. Even though there was a sharp decline in sudden unexpected/unexplained causes of death (SUID) beginning in 1990, the decrease has considerably slowed down since 1999. In 2017, the top ten leading causes of infant death were responsible for 67.8% of all infant deaths in the United States. Sudden Infant Death Syndrome (SIDS) and death from unintentional injuries were in third and fourth place. Therefore, the purpose of this research is to utilize qualitative research guided by the Socio-Ecological model to understand better how prepared first-time mothers are to take care of their infant upon hospital release. Methods An intensity sampling was utilized to recruit participants. The inclusion criteria for the participants included first-time mothers with children under one year of age, women, Georgia residents over 18 years of age, and English speaking. A semi-structured guide was based on research queries and the ideological concepts of the Socio-Ecological Model. For the qualitative data examination, the thematic analysis was performed. All the interviews were transcribed verbatim and coded by using the program NVivo 11. Results A total of 25 women participated in the study. We will finish the data analysis by the end of May, 2022. The results of this qualitative study will help to fully understand the knowledge, perceptions, skills, and confidence of mothers about infant care. Conclusions The study’s results will help develop an information guide on primary infant care. Besides, health professionals and community organizations can utilize the study results to determine the information and support needed for new mothers. Key messages • The results of this qualitative study will help to fully understand the knowledge, perceptions, skills, and confidence of mothers about infant care. • This study’s results will help develop an information guide (electronic or/and printed) on primary infant care based on first-time mothers’ needs.