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Caraballo M, Abbe M, Tidwell J, Dutton H, Garcia MG, Punzalan G, Axon A. Steering the Titanic: One tertiary care children's hospital's experience navigating safe sleep for hospitalized infants. J Pediatr Nurs 2023; 73:e1-e9. [PMID: 37330278 DOI: 10.1016/j.pedn.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Sudden 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 PROBLEM A 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. METHODS A 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. INTERVENTIONS Interventions included revision of hospital policy, staff education, family education, environmental modifications, creation of a safe sleep taskforce, and electronic health record modifications. RESULTS Documented 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. CONCLUSIONS A multifaceted, multidisciplinary approach can lead to significant improvements in infant safe sleep practices and education in a large tertiary care children's hospital system.
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Affiliation(s)
- Michelle Caraballo
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9063, United States of America.
| | - Marisa Abbe
- Children's Health System of Texas, 1935 Medical District Drive, Dallas, TX 75235, United States of America
| | - Jerithea Tidwell
- Children's Health System of Texas, 1935 Medical District Drive, Dallas, TX 75235, United States of America
| | - Hayden Dutton
- Children's Health System of Texas, 1935 Medical District Drive, Dallas, TX 75235, United States of America
| | - Mayra G Garcia
- Children's Health System of Texas, 1935 Medical District Drive, Dallas, TX 75235, United States of America
| | - Gemmarie Punzalan
- Children's Health System of Texas, 1935 Medical District Drive, Dallas, TX 75235, United States of America
| | - Alison Axon
- Children's Health System of Texas, 1935 Medical District Drive, Dallas, TX 75235, United States of America
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Parental Insights into Improving Home Pulse Oximetry Monitoring in Infants. Pediatr Qual Saf 2022; 7:e538. [PMID: 35369408 PMCID: PMC8970095 DOI: 10.1097/pq9.0000000000000538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 12/09/2021] [Indexed: 12/03/2022] Open
Abstract
Home pulse oximeters prescribed for infants with cardiorespiratory conditions generate many false alarms, which create caregiver stress and sleep disturbance and can lead to unsafe practices. Additionally, relationships among oximeters, alarms, and everyday living demands are not well understood. Therefore, we aimed to gather parent perspectives on home pulse oximetry monitoring during the problem analysis phase of a quality improvement (QI) initiative.
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Flores-Fenlon N, Wright N, Lew C, Stavroudis TA, Wee CP, Davidson Ward SL, Bansal M. Retrospective analysis of inpatient polysomnogram characteristics and discharge outcomes in infants with bronchopulmonary dysplasia requiring home oxygen therapy. Pediatr Pulmonol 2021; 56:88-96. [PMID: 33107696 PMCID: PMC8260179 DOI: 10.1002/ppul.25129] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 02/03/2023]
Abstract
RATIONALE Little is known about the polysomnogram (PSG) characteristics in infants with bronchopulmonary dysplasia (BPD), especially severe BPD, who do not need home ventilatory support but are at increased risk for chronic hypoxia and are vulnerable to its effects. OBJECTIVE This study aims to assess PSG characteristics and change in discharge outcomes in premature infants with BPD who required oxygen therapy at discharge. METHODS This is a retrospective chart review of premature infants with BPD who were admitted to a quaternary newborn and infant intensive care unit from January 1, 2012 to December 31, 2015 and who underwent polysomnography before discharge. MEASUREMENTS AND MAIN RESULTS Data from 127 patients were analyzed. The median gestational age of our patients was 26 weeks and 1 day (interquartile range [IQR]: 24.71, 28.86). The majority of the patients had moderate-to-severe BPD. The median obstructive apnea-hypopnea index was 5.3 events/h (IQR: 2.2, 10.1). The median oxygen desaturation index was 15.7 events/h (IQR: 4.7, 35). Nadir oxygen saturation measured by pulse oximeter was 81% (IQR: 76-86) and the arousal/awakening index was 21.9 (IQR: 13.3-30.9). No statistically significant difference was noted between severe and nonsevere BPD groups for PSG characteristics. However, average end-tidal CO2 was significantly higher in the severe BPD group (p = .0438). Infants in the severe BPD group were intubated longer than infants with nonsevere BPD (p = .0082). The corrected gestational age (CGA) at the time of discharge (CGA-PSG) and PSG (CGA-DC) was higher in severe BPD patients but not statistically different. The majority of premature infants who underwent a PSG were discharged home with oxygen, and 69% required a titration of their level of support based on results from the PSG. CONCLUSION Our results highlight the presence of abnormal PSG characteristics in BPD patients, as early as 43 weeks CGA. These findings have not been previously described in this patient population prior to initial discharge from the hospital. A severe BPD phenotype tends to be associated with higher respiratory morbidity compared with a nonsevere BPD phenotype for the comparable CGA. PSG, when available, may be helpful for individualizing and streamlining treatment in preparation for discharge home and mitigating the effects of intermittent hypoxic episodes.
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Affiliation(s)
- Nicole Flores-Fenlon
- Division of Neonatology, Department of Pediatrics, LAC+USC Medical Center, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Noah Wright
- Rocky Vista University College of Osteopathic Medicine, Parker, Colorado, USA
| | - Cheryl Lew
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, Keck School of Medicine, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California, USA
| | - Theodora A Stavroudis
- Division of Neonatology, Department of Pediatrics, Keck School of Medicine, Children's Hospital Los Angeles, Fetal and Neonatal Institute, University of Southern California, Los Angeles, California, USA
| | - Choo Phei Wee
- Southern California Clinical and Translational Science Institute (SC-CTSI), The Saban Research Institute (TSRI) Biostatistics Core, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Sally L Davidson Ward
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, Keck School of Medicine, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California, USA
| | - Manvi Bansal
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, Keck School of Medicine, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California, USA
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Honda M, Som R, Seang S, Tung R, Iwamoto A. One year outcome of high-risk newborn infants discharged from the neonatal care unit of the National Maternal and Child Health Center in Cambodia. Heliyon 2019; 5:e01446. [PMID: 31008390 PMCID: PMC6458445 DOI: 10.1016/j.heliyon.2019.e01446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 01/12/2019] [Accepted: 03/26/2019] [Indexed: 11/30/2022] Open
Abstract
Background In the National Maternal and Child Health Center in Cambodia, about 7,500 newborn infants are born every year. Around 10% of them are admitted to the neonatal care unit. After recovery from the acute phase that presented neonatal care unit admissions, they are discharged even if they are very low birth weight infants, but there is no official follow-up system available after discharge. This research aims to identify the prognosis of high-risk infants one year after discharge using regular telephone interviews, identifying the factors that may determine their prognosis. Methods When a small and sick newborn infant was admitted to and discharged from the neonatal care unit, we collected health information from medical records. After discharge, we interviewed their caretakers by telephone when the infants were one, six, and 12 months (one year) old. We used structured questionnaires on feeding, history of illness, and development of growth and gross motor skills. Findings Between September 2014 and April 2015, 175 infants were discharged. At one year old, 111 (63%) had survived, 12 (6.9%) had died, and 52 (30%) were lost to follow-up. Nine cases died within one month of discharge. Our data suggested low birth weight may lead to re-hospitalization. Infants vaccinated less than twice at six months old were more likely to be re-hospitalized. According to results of our telephone interview, three infants showed psychomotor retardation at one year old. Among the 50 cases lost to follow-up, 26 (52%) of these patients were discharged without permission by doctors. Interpretation After one year, we noted that 63% of discharged infants survived, although 30% were lost to follow-up. There was a limitation of collecting more detailed data by telephone interview than questions about survival. The follow-up for high-risk newborn infants is an important challenge in Cambodia.
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Affiliation(s)
- Mari Honda
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo 162-8655, Japan
| | - Rithy Som
- National Maternal and Child Health Center, #31A, St.47, Sras Chork, Daun Penh, Phnom Penh, Cambodia
| | - Sody Seang
- National Maternal and Child Health Center, #31A, St.47, Sras Chork, Daun Penh, Phnom Penh, Cambodia
| | - Rathavy Tung
- National Maternal and Child Health Center, #31A, St.47, Sras Chork, Daun Penh, Phnom Penh, Cambodia
| | - Azusa Iwamoto
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo 162-8655, Japan
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Polysomnography in Preterm Infants with Bronchopulmonary Dysplasia for Monitoring Sleep-Disordered Breathing and Pulmonary Reserve. CURRENT SLEEP MEDICINE REPORTS 2019. [DOI: 10.1007/s40675-019-00141-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Joosten K, de Goederen R, Pijpers A, Allegaert K. Sleep related breathing disorders and indications for polysomnography in preterm infants. Early Hum Dev 2017; 113:114-119. [PMID: 28711234 DOI: 10.1016/j.earlhumdev.2017.07.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
There is a range of breathing problems which occur and may persist in preterm infants, such as central apneas, obstructive apneas and periodic breathing. Preterm infants may also suffer from respiratory distress syndrome and chronic lung disease necessitating prolonged use of oxygen therapy after discharge from the hospital. Due to these persistent breathing pattern abnormalities in preterm infants, there is a higher risk of altered sleep and apparent life threatening events. Polysomnography can be a helpful tool to identify those infants who have abnormalities in their breathing pattern, to identify those infants who have an increased risk to get a sleep related breathing event at home and to decide about the discontinuation of oxygen therapy.
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Affiliation(s)
- Koen Joosten
- Erasmus MC, Sophia Children's Hospital, Pediatric Intensive Care, Rotterdam, The Netherlands.
| | - Robbin de Goederen
- Dutch Craniofacial Center, Department of Plastic, Reconstructive and Hand Surgery, Sophia Children's Hospital - Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Angelique Pijpers
- Kempenhaeghe Academic Center for Epileptology, Sleep Medicine and Neurocognition, Heeze, The Netherlands
| | - Karel Allegaert
- Department of Pediatric Surgery, Erasmus University Medical Center - Sophia, Rotterdam, The Netherlands; Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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Arya R, Williams G, Kilonback A, Toward M, Griffin M, Blair PS, Fleming P. Is the infant car seat challenge useful? A pilot study in a simulated moving vehicle. Arch Dis Child Fetal Neonatal Ed 2017; 102:F136-F141. [PMID: 27694399 PMCID: PMC5339573 DOI: 10.1136/archdischild-2016-310730] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 06/23/2016] [Accepted: 06/27/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVE The American Academy of Pediatrics recommends that preterm infants complete a predischarge 'car seat challenge' observation for cardiorespiratory compromise while in a car seat. This static challenge does not consider the more upright position in a car or the vibration of the seat when the car is moving. This pilot study was designed to assess the cardiorespiratory effects of vibration, mimicking the effect of being in a moving car, on preterm and term infants. METHODS A simulator was designed to reproduce vertical vibration similar to that in a rear-facing car seat at 30 mph. 19 healthy newborn term and 21 preterm infants, ready for hospital discharge, underwent cardiorespiratory measurements while lying flat in a cot (baseline), static in the seat (30°), simulator (40°) and during motion (vibration 40°). RESULTS Median test age was 13 days (range 1-65 days) and median weight was 2.5 kg (IQR: 2.1-3.1 kg).Compared with baseline observations, only the total number of desaturations was significantly increased when infants were placed at 30° (p=0.03). At 40°, or with vibration, respiratory and heart rates increased and oxygen saturation decreased significantly. Profound desaturations <85% significantly increased during motion, regardless of gestational age. CONCLUSIONS This is the first study to assess the effect of motion on infants seated in a car safety seat. Term and preterm infants showed significant signs of potentially adverse cardiorespiratory effects in the upright position at 40°, particularly with simulated motion, not identified in the standard challenge. A larger study is required to investigate the significance of these results.
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Affiliation(s)
- Renu Arya
- Department of Paediatrics, Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Georgina Williams
- Department of Paediatrics, Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Anna Kilonback
- Department of Paediatrics, Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Martin Toward
- Institute of Sound and Vibration Research, University of Southampton, Southampton, UK
| | - Michael Griffin
- Institute of Sound and Vibration Research, University of Southampton, Southampton, UK
| | - Peter S Blair
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Peter Fleming
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Interdisciplinary Care of Children with Severe Bronchopulmonary Dysplasia. J Pediatr 2017; 181:12-28.e1. [PMID: 27908648 PMCID: PMC5562402 DOI: 10.1016/j.jpeds.2016.10.082] [Citation(s) in RCA: 241] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 09/20/2016] [Accepted: 10/26/2016] [Indexed: 01/02/2023]
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Caraballo M, Shimasaki S, Johnston K, Tung G, Albright K, Halbower AC. Knowledge, Attitudes, and Risk for Sudden Unexpected Infant Death in Children of Adolescent Mothers: A Qualitative Study. J Pediatr 2016; 174:78-83.e2. [PMID: 27113377 DOI: 10.1016/j.jpeds.2016.03.031] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 02/29/2016] [Accepted: 03/10/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate practices, knowledge, attitudes, and beliefs regarding infant sleep among adolescent mothers, a demographic at high risk for sudden unexpected infant death, and to identify novel public health interventions targeting the particular reasons of this population. STUDY DESIGN Seven targeted focus groups including 43 adolescent mothers were conducted at high school daycare centers throughout Colorado. Focus groups were recorded, transcribed, validated, and then analyzed in NVivo 10. Validation included coding consistency statistics and expert review. RESULTS Most mothers knew many of the American Academy of Pediatrics recommendations for infant sleep. However, almost all teens reported bedsharing regularly and used loose blankets or soft bedding despite being informed of risks. Reasons for nonadherence to recommendations included beliefs that babies are safest and sleep more/better in bed with them, that bedsharing is a bonding opportunity, and that bedsharing is easier than using a separate sleep space. The most common justifications for blankets were infant comfort and concern that babies were cold. Participants' decision making was often influenced by their own mothers, with whom they often resided. Participants felt that their instincts trumped professional advice, even when in direct contradiction to safe sleep recommendations. CONCLUSIONS Among focus group participants, adherence with safe sleep practices was poor despite awareness of the American Academy of Pediatrics recommendations. Many mothers expressed beliefs and instincts that infants were safe in various unsafe sleep environments. Future study should investigate the efficacy of alternative educational strategies, including education of grandmothers, who have significant influence over adolescent mothers.
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Affiliation(s)
- Michelle Caraballo
- Pulmonary Section, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO.
| | - Suzuho Shimasaki
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado, Aurora, CO
| | | | - Gregory Tung
- Department of Health Systems, Management and Policy, Colorado School of Public Health, University of Colorado, Aurora, CO
| | - Karen Albright
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado, Aurora, CO; The Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO
| | - Ann C Halbower
- Pulmonary Section, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
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Hunt CE, Darnall RA, McEntire BL, Hyma BA. Assigning cause for sudden unexpected infant death. Forensic Sci Med Pathol 2015; 11:283-8. [PMID: 25634430 PMCID: PMC4415994 DOI: 10.1007/s12024-014-9650-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2014] [Indexed: 12/14/2022]
Abstract
We have reached a conundrum in assigning cause of death for sudden unexpected infant deaths. We summarize the discordant perspectives and approaches and how they have occurred, and recommend a pathway toward improved consistency. This lack of consistency affects pediatricians and other health care professionals, scientific investigators, medical examiners and coroners, law enforcement agencies, families, and support or advocacy groups. We recommend that an interdisciplinary international committee be organized to review current approaches for assigning cause of death, and to identify a consensus strategy for improving consistency. This effort will need to encompass intrinsic risk factors or infant vulnerability in addition to known environmental risk factors including unsafe sleep settings, and must be sufficiently flexible to accommodate a progressively expanding knowledge base.
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Affiliation(s)
- Carl E Hunt
- Department of Pediatrics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814-4799, USA,
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Peter C, Boberski B, Bohnhorst B, Pirr S. Prescription of home oxygen therapy to very low birth weight infants in Germany: a nationwide survey. Clin Pediatr (Phila) 2014; 53:726-32. [PMID: 24671872 DOI: 10.1177/0009922814528037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE There is no consensus on prescription of home oxygen therapy to infants in Germany. We hypothesized that this causes considerable variability in prescribing home oxygen to infants. STUDY DESIGN A structured questionnaire involving management of home oxygen therapy was sent to all German pediatric departments (n = 293). RESULTS Response rate was 84% (247/293). SpO2 cutoff values below which oxygen therapy was considered indicated showed a wide range (80% to 94%, mean 90%). Respondents admitting >50 very low birth weight infants annually significantly more frequently prescribed home oxygen (P < .001) and aimed for SpO2 levels closer to the physiological range than those admitting less very low birth weight infants (P = .046). CONCLUSION Management of pediatric home oxygen therapy is diverse in Germany. Optimal SpO2 targets have to be further investigated by controlled studies and German guidelines should be established. Until then practice should abide by existing foreign guidelines.
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Abstract
BACKGROUND It has been proposed that the use of body positioning may be a more effective way to reduce clinically significant apnoea than the use of more invasive measures. OBJECTIVES To determine the effect of body positioning on cardiorespiratory functioning in spontaneously breathing preterm infants with clinically significant apnoea. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2011), MEDLINE (1966 to March 2011), EMBASE (1988 to March 2011) and CINAHL (1988 to March 2011), abstracts of conference proceedings and citations of published articles. SELECTION CRITERIA All studies in which infants or their sequence of body positioning was randomised or quasi-randomised. We included cross-over studies. DATA COLLECTION AND ANALYSIS We performed assessment of trial quality, data extraction and synthesis of data using standard methods of the Cochrane Neonatal Review Group. MAIN RESULTS Five studies (N = 114) were eligible for inclusion. None of the individual studies or the meta-analyses showed a reduction in apnoea, bradycardia, oxygen desaturation or oxygen saturation with body positioning (supine versus prone; prone versus right lateral; prone versus left lateral; right lateral versus left lateral; prone horizontal versus prone head elevated; right lateral horizontal versus right lateral head elevated and left lateral horizontal versus left lateral head elevated). AUTHORS' CONCLUSIONS There is insufficient evidence to determine the role of body positioning on apnoea, bradycardia, oxygen desaturation and oxygen saturation. Large randomised controlled trials are needed to determine the effect of body positioning on cardiorespiratory function in spontaneously breathing preterm infants.
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Affiliation(s)
- Sandie L Bredemeyer
- Perinatal Nursing, Centre for Nursing & Midwifery Research, RPA Women and Babies, School of Nursing, University of Sydney,Sydney, Australia.
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McGrath-Morrow SA, Ryan T, McGinley BM, Okelo SO, Sterni LM, Collaco JM. Polysomnography in preterm infants and children with chronic lung disease. Pediatr Pulmonol 2012; 47:172-9. [PMID: 21815283 PMCID: PMC4751876 DOI: 10.1002/ppul.21522] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Accepted: 06/12/2011] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine the utility of overnight polysomnography (PSG) in assessing pulmonary reserve in stable preterm children with chronic lung disease (CLD). STUDY DESIGN A retrospective review and descriptive study of overnight PSGs and clinic visits of preterm infants/children less than 3 years of age who were diagnosed with bronchopulmonary dysplasia at discharge from the hospital and enrolled in the Johns Hopkins CLD patient registry between 2008 and 2010. RESULTS Sixty-two clinically stable patients underwent at least one overnight polysomnogram for clinical indications. The majority of patients were referred for oxygen titration (71%). PSGs from first studies revealed a mean respiratory disturbance index (RDI) of 8.2 ± 10.1 events/hr and a mean O(2) saturation (SaO(2) ) nadir of 86.2 ± 5.7%. In patients who underwent more than one PSG (n = 23), a significant decrease in RDI (P < 0.001) was found between the first study (mean age: 8.0 ± 3.3 months) and second study (mean age: 13.4 ± 5.2 months). Outpatient clinical measures of mean room air SaO(2) and respiratory rate were not predictive of PSG measures of RDI and SaO(2) nadir. CONCLUSION Mean RDI was higher in stable preterm infants/children with CLD compared to previously published controls. RDI decreased with age in stable preterm infants/children with CLD suggesting improved pulmonary reserve with age. Outpatient clinical measures (respiratory rate and room air SaO(2) ) did not correlate with RDI and SaO(2) nadir indicating that overnight PSG is more sensitive in assessing pulmonary reserve than outpatient clinical measures.
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Affiliation(s)
- Sharon A McGrath-Morrow
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287-2533, USA.
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Weber MA, Ashworth MT, Risdon RA, Brooke I, Malone M, Sebire NJ. Sudden unexpected neonatal death in the first week of life: Autopsy findings from a specialist centre. J Matern Fetal Neonatal Med 2009; 22:398-404. [PMID: 19529996 DOI: 10.1080/14767050802406677] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kugelman A, Reichman B, Chistyakov I, Boyko V, Levitski O, Lerner-Geva L, Riskin A, Bader D. Postdischarge infant mortality among very low birth weight infants: a population-based study. Pediatrics 2007; 120:e788-94. [PMID: 17908737 DOI: 10.1542/peds.2006-3765] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The objective of this study was to identify factors that were associated with death after discharge from the NICU of very low birth weight infants in a population-based study. METHODS From a national cohort of 13,430 very low birth weight infants who were born in Israel from 1995 to 2003, 10,602 infants were discharged from the hospital and composed the study population. Demographic and clinical data regarding the pregnancy, delivery, and neonatal course were obtained from the Israel national very low birth weight infant database. Data on each case of death during the postdischarge period until 1 year of age were provided by the Ministry of Health from national linked birth and death certificates. Univariate analyses and a multivariable logistic regression analyses were performed to examine the perinatal and neonatal risk factors for postdischarge death. RESULTS The postdischarge mortality rate was 7.5 per 1000 (80 of 10,602 infants discharged from the hospital). The death rate was significantly higher in non-Jewish infants, infants who were born to young mothers, and infants who were born to low-educated mothers. After adjustment for demographic characteristics and perinatal and neonatal variables, postdischarge mortality was independently associated with congenital malformations, neonatal seizures, necrotizing enterocolitis, and bronchopulmonary dysplasia. CONCLUSION Although the postdischarge death rate was relatively low in our cohort of very low birth weight infants, attention should be focused on the subgroups of infants who are at higher risk to decrease their mortality further.
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Affiliation(s)
- Amir Kugelman
- Department of Neonatology, Bnai Zion Medical Center, Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
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Rao H, May C, Hannam S, Rafferty GF, Greenough A. Survey of sleeping position recommendations for prematurely born infants on neonatal intensive care unit discharge. Eur J Pediatr 2007; 166:809-11. [PMID: 17103188 DOI: 10.1007/s00431-006-0325-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2006] [Accepted: 09/27/2006] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Prematurely born infants are at an increased risk of sudden infant death syndrome (SIDS), particularly when sleeping prone. Parents are strongly influenced in their choice of sleeping position for their infant by practitioners. The aim of this study was to determine the neonatal units' recommendations regarding the sleeping position for premature infants prior to and after discharge and ascertain whether there had been changes from those recorded in a survey performed in 2001-2002. MATERIALS AND METHODS A questionnaire survey was sent to all 229 neonatal units in the United Kingdom; 80% responded. RESULTS AND DISCUSSION The majority (83%) of units utilized the supine sleep position for infants at least 1-2 weeks prior to discharge, but after discharge, only 38% of the units actively discouraged prone sleeping and 17% additionally recommended side sleeping. Compared to the previous survey, significantly more units started infants with supine sleeping 1-2 weeks prior to discharge (p < 0.0001) and fewer recommended side sleeping after discharge (p = 0.0015). However, disappointingly, less actively discouraged prone sleeping after discharge (p = 0.0001). CONCLUSION Recommendations regarding sleeping position for prematurely born infants after neonatal discharge by some practitioners remain inappropriate. Evidence-based guidelines are required as these would hopefully inform all neonatal units' recommendations.
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Affiliation(s)
- Harish Rao
- Division of Asthma, Allergy and Lung Biology, King's College London, MRC-Asthma Centre, Denmark Hill, UK
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Esposito L, Hegyi T, Ostfeld BM. Educating parents about the risk factors of sudden infant death syndrome: the role of neonatal intensive care unit and well baby nursery nurses. J Perinat Neonatal Nurs 2007; 21:158-64. [PMID: 17505237 DOI: 10.1097/01.jpn.0000270634.89240.a9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Nurses in newborn nurseries and neonatal intensive care units are instrumental in educating parents about reducing the risk for SIDS. Nurse participation is acknowledged and encouraged in the current policy statement on SIDS Risk Reduction put forth by the American Academy of Pediatrics. Despite the decline in SIDS, it remains the leading cause of postneonatal infant mortality, and despite greater public compliance with the risk reduction guidelines there is room for improvement in how effectively and consistently they are disseminated. To facilitate nursing participation as educators, role models, and collaborators in the development of relevant hospital policies and procedures, we review the current recommendations, addressing issues that may serve as barriers to participation, describing the biological plausibility underlying risk-reducing practices, and presenting resources from which nurses may obtain teaching materials and model policies.
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Affiliation(s)
- Linda Esposito
- SIDS Center of New Jersey, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ 08901, USA
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Blair PS, Platt MW, Smith IJ, Fleming PJ. Sudden infant death syndrome and sleeping position in pre-term and low birth weight infants: an opportunity for targeted intervention. Arch Dis Child 2006; 91:101-6. [PMID: 15914498 PMCID: PMC2082697 DOI: 10.1136/adc.2004.070391] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To determine the combined effects of sudden infant death syndrome (SIDS) risk factors in the sleeping environment for infants who were "small at birth" (pre-term (<37 weeks), low birth weight (<2500 g), or both). METHODS A three year population based, case-control study in five former health regions in England (population 17.7 million) with 325 cases and 1300 controls. Parental interviews were carried out after each death and reference sleep of age matched controls. RESULTS Of the SIDS infants, 26% were "small at birth" compared to 8% of the controls. The most common sleeping position was supine, for both controls (69%) and those SIDS infants (48%) born at term or > or =2500 g, but for "small at birth" SIDS infants the commonest sleeping position was side (48%). The combined effect of the risk associated with being "small at birth" and factors in the infant sleeping environment remained multiplicative despite controlling for possible confounding in the multivariate model. This effect was more than multiplicative for those infants placed to sleep on their side or who shared the bed with parents who habitually smoked, while for those "small at birth" SIDS who slept in a room separate from the parents, the large combined effect showed evidence of a significant interaction. No excess risk was identified from bed sharing with non-smoking parents for infants born at term or birth weight > or =2500 g. CONCLUSION The combined effects of SIDS risk factors in the sleeping environment and being pre-term or low birth weight generate high risks for these infants. Their longer postnatal stay allows an opportunity to target parents and staff with risk reduction messages.
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Affiliation(s)
- P S Blair
- Institute of Child Life and Health, Department of Clinical Science, South Bristol, University of Bristol, UK
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Blair PS, Sidebotham P, Berry PJ, Evans M, Fleming PJ. Major epidemiological changes in sudden infant death syndrome: a 20-year population-based study in the UK. Lancet 2006; 367:314-9. [PMID: 16443038 DOI: 10.1016/s0140-6736(06)67968-3] [Citation(s) in RCA: 215] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Results of case-control studies in the past 5 years suggest that the epidemiology of sudden infant death syndrome (SIDS) has changed since the 1991 UK Back to Sleep campaign. The campaign's advice that parents put babies on their back to sleep led to a fall in death rates. We used a longitudinal dataset to assess these potential changes. METHODS Population-based data from home visits have been collected for 369 consecutive unexpected infant deaths (300 SIDS and 69 explained deaths) in Avon over 20 years (1984-2003). Data obtained between 1993 and 1996 from 1300 controls with a chosen "reference" sleep before interview have been used for comparison. FINDINGS Over the past 20 years, the proportion of children who died from SIDS while co-sleeping with their parents, has risen from 12% to 50% (p<0.0001), but the actual number of SIDS deaths in the parental bed has halved (p=0.01). The proportion seems to have increased partly because the Back to Sleep campaign led to fewer deaths in infants sleeping alone-rather than because of a rise in deaths of infants who bed-shared, and partly because of an increase in the number of deaths in infants sleeping with their parents on a sofa. The proportion of deaths in families from deprived socioeconomic backgrounds has risen from 47% to 74% (p=0.003), the prevalence of maternal smoking during pregnancy from 57% to 86% (p=0.0004), and the proportion of pre-term infants from 12% to 34% (p=0.0001). Although many SIDS infants come from large families, first-born infants are now the largest group. The age of infants who bed-share is significantly smaller than that before the campaign, and fewer are breastfed. INTERPRETATION Factors that contribute to SIDS have changed in their importance over the past 20 years. Although the reasons for the rise in deaths when a parent sleeps with their infant on a sofa are still unclear, we strongly recommend that parents avoid this sleeping environment. Most SIDS deaths now occur in deprived families. To better understand contributory factors and plan preventive measures we need control data from similarly deprived families, and particularly, infant sleep environments.
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Affiliation(s)
- Peter S Blair
- Institute of Child Life and Health, Department of Clinical Science, University of Bristol, UK
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