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Horne RS, Harrewijn I, Hunt CE. Physiology during sleep in preterm infants: Implications for increased risk for the sudden infant death syndrome. Sleep Med Rev 2024; 78:101990. [PMID: 39116607 DOI: 10.1016/j.smrv.2024.101990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 07/14/2024] [Accepted: 07/26/2024] [Indexed: 08/10/2024]
Abstract
Approximately 15 million babies are born preterm (<37 weeks of completed gestation) worldwide annually. Although neonatal and perinatal medicine have contributed to the increased survival rate of preterm newborn infants, premature infants are at increased risk of mortality in the first years of life. Infants born preterm are at four times the risk of Sudden Infant Death Syndrome (SIDS) compared to infants born at term. SIDS is believed to be multifactorial in origin. The Triple Risk hypothesis has been proposed to explain this. The model suggests that when a vulnerable infant, such as one born preterm, is at a critical but unstable developmental period in homeostatic control, death may occur if exposed to an exogenous stressor, such as being placed prone for sleep. The highest risk period is at ages 2-4 months, with 90 % of deaths occurring before 6 months. The final pathway to SIDS is widely believed to involve some combination of immature cardiorespiratory control and a failure of arousal from sleep. This review will focus on the physiological factors which increase the risk for SIDS in preterm infants and how these factors may be identified and potentially lead to effective preventative strategies.
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Affiliation(s)
| | | | - Carl E Hunt
- Uniformed Services University, Bethesda, MD, USA
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2
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Butler SC, Carroll K, Catalano K, Atkinson C, Chiujdea M, Kerr J, Severtson K, Drumm S, Gustafson K, Gingrasfield J. Sleeping Safe and Sound: A Multidisciplinary Hospital-wide Infant Safe Sleep Quality Improvement Initiative. J Pediatr Health Care 2024; 38:604-614. [PMID: 38647508 DOI: 10.1016/j.pedhc.2024.02.007] [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: 10/08/2023] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Promoting safe sleep to decrease sudden unexpected infant death is challenging in the hospital setting. LOCAL PROBLEM Concern for adherence to safe sleep practice across inpatient units at a large pediatric hospital. METHODS Used quality improvement methodologies to promote safe sleep across all units. INTERVENTIONS Development of a multidisciplinary expert group, hospital-wide guidelines, targeted interventions, and bedside audits to track progress. RESULTS Adherence to safe sleep practices improved from 9% to 53%. Objects in the crib were a major barrier to maintaining a safe sleep environment. Safe sleep practices were less likely to be observed in infants with increased medical complexity (p = .027). CONCLUSIONS Quality improvement methodology improved adherence to infant safe sleep guidelines across multiple units. Medically complex infants continue to be a challenge to safe sleep. Therefore, ongoing education for staff and further research into best practices for the most complex infant populations are necessary.
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Plunkett G, Yiallourou S, Voigt A, Segumohamed A, Shepherd K, Horne R, Wong F. Short apneas and periodic breathing in preterm infants in the neonatal intensive care unit-Effects of sleep position, sleep state, and age. J Sleep Res 2024:e14253. [PMID: 38837291 DOI: 10.1111/jsr.14253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/23/2024] [Accepted: 05/15/2024] [Indexed: 06/07/2024]
Abstract
This observational study investigated the effects of sleep position and sleep state on short apneas and periodic breathing in hospitalized preterm infants longitudinally, in relation to postmenstrual age. Preterm infants (25-31 weeks gestation, n = 29) were studied fortnightly after birth until discharge, in prone and supine positions, and in quiet sleep and active sleep. The percentage of time spent in each sleep state (percentage of time in quiet sleep and percentage of time in active sleep), percentage of total sleep time spent in short apneas and periodic breathing, respectively, the percentage of falls from baseline in heart rate, arterial oxygen saturation and cerebral tissue oxygenation index during short apneas and periodic breathing, and the associated percentage of total sleep time with systemic (arterial oxygen saturation < 90%) and cerebral hypoxia (cerebral tissue oxygenation index < 55%) were analysed using a linear mixed model. Results showed that the prone position decreased (improved) the percentage of falls from baseline in arterial oxygen saturation during both short apneas and periodic breathing, decreased the proportion of infants with periodic breathing and the periodic breathing-associated percentage of total sleep time with cerebral hypoxia. The percentage of time in quiet sleep was higher in the prone position. Quiet sleep decreased the percentage of total sleep time spent in short apneas, the short apneas-associated percentage of falls from baseline in heart rate, arterial oxygen saturation, and proportion of infants with systemic hypoxia. Quiet sleep also decreased the proportion of infants with periodic breathing and percentage of total sleep time with cerebral hypoxia. The effects of sleep position and sleep state were not related to postmenstrual age. In summary, when sleep state is controlled for, the prone sleeping position has some benefits during both short apneas and periodic breathing. Quiet sleep improves cardiorespiratory stability and is increased in the prone position at the expense of active sleep, which is critical for brain maturation. This evidence should be considered in positioning preterm infants.
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Affiliation(s)
- Georgina Plunkett
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- The Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Stephanie Yiallourou
- The Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Aimee Voigt
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- The Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Aishah Segumohamed
- The Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Kelsee Shepherd
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- The Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Rosemary Horne
- The Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Flora Wong
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- The Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
- Monash Newborn, Monash Children's Hospital, Melbourne, Victoria, Australia
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4
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Johnson M, Simonovich SD, Neuman ME, Gidd-Hoffman K, Simo A, Spurlark RS. Ensuring Safe Sleep in the Pediatric Intensive Care Unit: A Systematic Review of Informed Development of Clinical Guidelines for Implementation in Practice. J Pediatr Health Care 2022; 37:234-243. [PMID: 36402627 DOI: 10.1016/j.pedhc.2022.10.004] [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: 06/15/2022] [Revised: 10/13/2022] [Accepted: 10/13/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION 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. METHOD This review was registered with PROSPERO and adheres to Preferred Reporting Items for Systematic reviews and Meta-Analyses systematic review guidelines. RESULTS Nineteen articles met the inclusion criteria. A safe sleep guideline algorithm for medically complex infants in the PICU was created for implementation. DISCUSSION 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.
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Affiliation(s)
- Maura Johnson
- Maura Johnson, Graduate Student, Doctor of Nursing Practice Program, School of Nursing, DePaul University, Chicago, IL
| | - Shannon D Simonovich
- Shannon D. Simonovich, Associate Professor, School of Nursing, DePaul University, Chicago, IL.
| | - Michelle E Neuman
- Michelle E. Neuman, Assistant Professor, School of Nursing, DePaul University, Chicago, IL
| | - Kirsten Gidd-Hoffman
- Kirsten Gidd-Hoffman, Assistant Manager, Pediatric Intensive Care Unit, Rush University Medical Center, Chicago, IL
| | - Amanda Simo
- Amanda Simo, Clinical Educator, Pediatric Intensive Care Unit, Rush University Medical Center, Chicago, IL
| | - Roxanne S Spurlark
- Roxanne S. Spurlark, Assistant Professor, School of Nursing, DePaul University, Chicago, IL
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5
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Mothers' Decision Making Concerning Safe Sleep for Preterm Infants: What Are the Influencing Factors? Adv Neonatal Care 2022; 22:444-455. [PMID: 34967776 DOI: 10.1097/anc.0000000000000952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Parental decisions regarding infant sleep practices vary widely, resulting in a lack of adherence to the American Academy of Pediatrics safe sleep recommendations (SSR) and consequently an increased risk of sudden infant death syndrome (SIDS). Preterm infants are among those at a highest risk for SIDS, yet few studies focus on parental decision-making surrounding sleep practices for preterm infants. PURPOSE The purpose of this study was to identify factors influencing decisions concerning infant sleep practices of mothers of preterm infants. METHODS This study used a mixed-methods design. Recruitment was through social media messaging by 2 parent support organizations. An online survey was used to assess factors influencing mothers' decisions regarding sleep practices for preterm infants. FINDINGS/RESULTS Survey participants (n = 98) were from across the United States. Mothers of preterm infants (mean gestational age at birth = 29.42 weeks) most often reported positioning infants on their back to sleep (92.3%) and a low (15.4%) use of a pacifier at sleep time. Three themes emerged for the decisions made: adherence to SSR; nonadherence to SSR; and infant-guided decisions. Regardless of the decision, mothers indicated that anxiety over the infant's well-being resulted in a need for sleep practices that facilitated close monitoring of the infant. IMPLICATIONS FOR PRACTICE AND RESEARCH The findings of this study indicate the need for understanding the underlying anxiety preventing mothers from adhering to SSR despite knowing them, along with tailoring infant sleep messaging and education to improve safety of sleep practices for preterm infants. Research is needed to examine decision making in more diverse populations.
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Infant Safe Sleep Initiative in a Small Volume Maternity Service. MCN Am J Matern Child Nurs 2022; 47:189-194. [PMID: 35749764 DOI: 10.1097/nmc.0000000000000836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE Despite the 2016 American Academy of Pediatrics recommendations for preventing sudden unexpected infant death, there are approximately 3,400 sudden unexpected infant deaths annually in the United States. Modeling of safe sleep practices by nurses in the hospital influences parents' practice at home; however, safe sleep practices are not consistently modeled during the childbirth hospitalization. METHODS A quality improvement project was conducted to implement a safe sleep initiative based on the 2016 American Academy of Pediatrics recommendations for nurses caring for hospitalized infants after birth. Evaluation included testing of nurses' knowledge, infant crib audits, and nurses' evaluation of the intervention. RESULTS A significant improvement was found in overall nurse education scores. Crib audits demonstrated a significant improvement in the following elements: use of multiple blankets, swaddling of the infant, and parent teaching. Nursing surveys reported an increase in confidence to practice safe sleep recommendations and educate and redirect parents. CLINICAL IMPLICATIONS Implementing a safe sleep initiative can increase nurses' knowledge, improve adherence to recommendations with modeling safe sleep practices, and increase parent awareness of safe sleep recommendations, potentially positively affecting adherence after discharge.
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Tucker MH, Toburen C, Koons T, Petrini C, Palmer R, Pallotto EK, Simpson E. Improving safe sleep practices in an urban inpatient newborn nursery and neonatal intensive care unit. J Perinatol 2022; 42:515-521. [PMID: 34987167 DOI: 10.1038/s41372-021-01288-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 11/19/2021] [Accepted: 11/25/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To improve safe sleep compliance in a newborn nursery (NN) and neonatal intensive care unit (NICU) to >80% in 1 year. STUDY DESIGN Prospective quality improvement study of infants admitted to a NN and NICU. Interventions were targeted at parent education, staff education, and system processes. RESULTS Compliance with safe sleep improved to >80% in both units. Tracking of process measures revealed NICU parents received safe sleep education 98-100% of the time. No change was observed in the balancing measures. Transfers from the NN to the NICU for temperature instability did not increase. Parent satisfaction with discharge preparedness did not change (98.2% prior to and 99.6% after). CONCLUSION We achieved improved compliance with safe sleep practices in our NN and NICU through education of staff and parents and improved system processes. We believe this will translate to improved safe sleep practices used by parents at home.
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Affiliation(s)
- Megan H Tucker
- Division of Neonatology, Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City, Kansas City, MO, United States.
| | - Cristy Toburen
- General Academic Pediatrics, Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City, Kansas City, MO, United States
| | - Trudy Koons
- Division of Neonatology, Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City, Kansas City, MO, United States
| | - Carol Petrini
- Department of Neonatology, Truman Medical Center, University of Missouri-Kansas City, Kansas City, MO, United States
| | - Rebecca Palmer
- Division of Neonatology, Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City, Kansas City, MO, United States.,Department of Neonatology, Children's Medical Center, Dallas, TX, United States
| | - Eugenia K Pallotto
- Division of Neonatology, Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City, Kansas City, MO, United States.,Department of Neonatology, Levine Children's Hospital, Atrium Health, Charlotte, NC, United States
| | - Elizabeth Simpson
- Division of Neonatology, Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City, Kansas City, MO, United States
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Salm Ward TC, Yasin T. Hospital-Based Inpatient Quality Improvement Initiatives on Safe Infant Sleep: Systematic Review and Narrative Synthesis. Sleep Med Rev 2022; 63:101622. [DOI: 10.1016/j.smrv.2022.101622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 11/25/2022]
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Transition to Safe Sleep at Home Needs a Consistent Approach for NICU Babies and Their Parents. MCN Am J Matern Child Nurs 2021; 47:53. [PMID: 34860789 DOI: 10.1097/nmc.0000000000000781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Goodstein MH, Stewart DL, Keels EL, Moon RY. Transition to a Safe Home Sleep Environment for the NICU Patient. Pediatrics 2021; 148:peds.2021-052045. [PMID: 34155134 DOI: 10.1542/peds.2021-052045] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Of the nearly 3.8 million infants born in the United States in 2018, 8.3% had low birth weight (ie, weight <2500 g) and 10% were born preterm (ie, gestational age of <37 weeks). Ten to fifteen percent of infants (approximately 500 000 annually), including low birth weight and preterm infants and others with congenital anomalies, perinatally acquired infections, and other diseases, require admission to a NICU. Every year, approximately 3600 infants in the United States die of sudden unexpected infant death (SUID), including sudden infant death syndrome (SIDS), unknown and undetermined causes, and accidental suffocation and strangulation in an unsafe sleep environment. Preterm and low birth weight infants are 2 to 3 times more likely than healthy term infants to die suddenly and unexpectedly. Thus, it is important that health care professionals prepare families to maintain their infant in a safe home sleep environment as per recommendations of the American Academy of Pediatrics. Medical needs of the NICU infant often require practices such as nonsupine positioning, which should be transitioned as soon as medically possible and well before hospital discharge to sleep practices that are safe and appropriate for the home environment. This clinical report outlines the establishment of appropriate NICU protocols for the timely transition of these infants to a safe home sleep environment. The rationale for these recommendations is discussed in the accompanying technical report "Transition to a Safe Home Sleep Environment for the NICU Patient," included in this issue of Pediatrics.
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Affiliation(s)
- Michael H Goodstein
- Division of Newborn Services, WellSpan Health, York, Pennsylvania .,Department of Pediatrics, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
| | - Dan L Stewart
- Department of Pediatrics, Norton Children's and School of Medicine, University of Louisville, Louisville, Kentucky
| | - Erin L Keels
- National Association of Neonatal Nurse Practitioners, National Association of Neonatal Nurses, Chicago, Illinois.,Neonatal Advanced Practice, Nationwide Children's Hospital, Columbus, Ohio
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Goodstein MH, Stewart DL, Keels EL, Moon RY. Transition to a Safe Home Sleep Environment for the NICU Patient. Pediatrics 2021; 148:peds.2021-052046. [PMID: 34155135 DOI: 10.1542/peds.2021-052046] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Of the nearly 3.8 million infants born in the United States in 2018, 8.3% had low birth weight (<2500 g [5.5 lb]) and 10% were born preterm (gestational age of <37 completed weeks). Many of these infants and others with congenital anomalies, perinatally acquired infections, and other disease require admission to a NICU. In the past decade, admission rates to NICUs have been increasing; it is estimated that between 10% and 15% of infants will spend time in a NICU, representing approximately 500 000 neonates annually. Approximately 3600 infants die annually in the United States from sleep-related deaths, including sudden infant death syndrome International Classification of Diseases, 10th Revision (R95), ill-defined deaths (R99), and accidental suffocation and strangulation in bed (W75). Preterm and low birth weight infants are particularly vulnerable, with an incidence of death 2 to 3 times greater than healthy term infants. Thus, it is important for health care professionals to prepare families to maintain their infant in a safe sleep environment, as per the recommendations of the American Academy of Pediatrics. However, infants in the NICU setting commonly require care that is inconsistent with infant sleep safety recommendations. The conflicting needs of the NICU infant with the necessity to provide a safe sleep environment before hospital discharge can create confusion for providers and distress for families. This technical report is intended to assist in the establishment of appropriate NICU protocols to achieve a consistent approach to transitioning NICU infants to a safe sleep environment as soon as medically possible, well before hospital discharge.
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Affiliation(s)
- Michael H Goodstein
- Division of Newborn Services, WellSpan Health, York, Pennsylvania .,Department of Pediatrics, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
| | - Dan L Stewart
- Department of Pediatrics, Norton Children's and School of Medicine, University of Louisville, Louisville, Kentucky
| | - Erin L Keels
- National Association of Neonatal Nurse Practitioners, National Association of Neonatal Nurses, Chicago, Illinois.,Neonatal Advanced Practice, Nationwide Children's Hospital, Columbus, Ohio
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Abstract
BACKGROUND An unsafe sleep environment remains the leading contributor to unexpected infant death. PURPOSE To determine the effectiveness of a quality improvement initiative developed to create a hospital-based safe sleep environment for all newborns and infants. METHODS A multidisciplinary team from the well-baby nursery (WBN) and neonatal intensive care unit (NICU) of a 149-bed academic, quaternary care, regional referral center developed and implemented safe sleep environments within the hospital for all prior to discharge. To monitor compliance, the following were tracked monthly: documentation of parent education, caregiver surveys, and hospital crib check audits. On the inpatient general pediatric units, only hospital crib check audits were tracked. Investigators used Plan-Do-Study-Act (PDSA) cycles to evaluate the impact of the initiative from October 2015 through February 2018. RESULTS Safe sleep education was documented for all randomly checked records (n = 440). A survey (n = 348) revealed that almost all caregivers (95.4%) reported receiving information on safe infant sleep. Initial compliance with all criteria in WBN (n = 281), NICU (n = 285), and general pediatric inpatient units (n = 121) was 0%, 0%, and 8.3%, respectively. At 29 months, WBN and NICU compliance with all criteria was 90% and 100%, respectively. At 7 months, general pediatric inpatient units' compliance with all criteria was 20%. IMPLICATIONS FOR PRACTICE WBN, NICU and general pediatric inpatient unit collaboration with content experts led to unit-specific strategies that improved safe sleep practices. IMPLICATIONS FOR RESEARCH Future studies on the impact of such an initiative at other hospitals are needed.
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Abstract
As part of our special topics issue on inpatient maternity care, experts were asked to offer their thoughts about the main issues putting mothers and babies at risk in the maternity inpatient setting and what quality and safety practices may be beneficial in keeping them safe from harm. Each of the experts has a unique perspective. Loraine O'Neill was one of the original perinatal patient safety nurses who were established as part of an effort by a professional liability company to promote patient safety in birthing hospitals that they covered in several states (). She now is the perinatal patient safety officer in a large academic medical center in New York City. Lisa Miller is a well-known expert on fetal assessment during labor, certified nurse midwife, attorney, educator, patient safety expert, and editor of a popular fetal monitoring textbook (). She has taught fetal monitoring to nurses, midwives, and physicians in multidisciplinary groups all over the United States and consulted on numerous patient safety initiatives. Annie Rohan is a dual-certified neonatal and pediatric nurse practitioner with a 30-plus year clinical practice career with infants, children, and families facing critical and chronic illness. She is currently a healthcare researcher, and oversees advanced practice and doctoral nursing programs at SUNY Downstate Health Sciences University.
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Cho JA, Sohn M, Lee S, Ahn YM. Knowledge on sudden unexplained infant death-related safe sleep practices and infant cardiopulmonary resuscitation in pediatric nurses. CHILD HEALTH NURSING RESEARCH 2020; 26:454-462. [PMID: 35004489 PMCID: PMC8650866 DOI: 10.4094/chnr.2020.26.4.454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/05/2020] [Accepted: 10/09/2020] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Sudden unexplained infant death (SUID) is a major contributor to infant mortality, and pediatric nurses have the responsibility to educate parents on SUID-reducing strategies. This study was conducted to measure pediatric nurses' knowledge of SUID-related safe sleep practices (K-SSSP) and infant cardiopulmonary resuscitation (K-ICPR). METHODS In total, 136 pediatric nurses were administered a survey including K-SSSP (13 items), K-ICPR (5 items), confidence in K-SSSP education (1 item; 5 points), and other factors relating to SUID experiences or education. RESULTS The correct answer rates of the K-SSSP and K-ICPR were 62.6% and 62.5%, retrospectively. The mean score for confidence in K-SSSP education was 2.6±0.9. Only 18 nurses (13.2%) responded that they educated parents on the content of the K-SSSP, while 76 nurses had received education on SUID. Positive relationships were observed between K-SSSP scores and higher education, between K-ICPR scores and having own child(ren) and clinical experience, and between confidence in K-SSSP education and higher education or having one's own child(ren). Nurses caring for newborns performed more SUID education than nurses working in other units. CONCLUSION There is a profound need to implement a systemic educational program on SUID and strategies to reduce SUID for pediatric nurses.
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Affiliation(s)
- Jung Ae Cho
- Graduate Assistant, Department of Nursing, College of Medicine, Inha University, Incheon, Korea
| | - Min Sohn
- Professor, Department of Nursing, College of Medicine, Inha University, Incheon,Korea
| | - Sangmi Lee
- Associate Professor, Department of Nursing, Dongyang University, Yeongju, Korea
| | - Young Mee Ahn
- Professor, Department of Nursing, College of Medicine, Inha University, Incheon,Korea
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Hitchcock SC, Ruhl C. Nurses Leading Safe Infant Sleep Initiatives in the Hospital Setting. Nurs Womens Health 2019; 23:148-162. [PMID: 30975288 DOI: 10.1016/j.nwh.2019.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 09/22/2018] [Accepted: 01/01/2019] [Indexed: 06/09/2023]
Abstract
Every day, 10 otherwise healthy infants die from sleep-related deaths in the United States. These deaths, termed sudden unexpected infant death, remain the leading cause of post-neonatal death in the United States despite known modifiable risk factors and prevention recommendations. In birthing hospitals, many parents report being given incorrect and sometimes no information about infant sleep safety, which creates immediate and long-term safety concerns. In this article, we provide an overview of sudden unexpected infant death, including sudden unexpected postnatal collapse, and the latest safe sleep recommendations from the American Academy of Pediatrics. We also offer practical guidelines for nurses-those working at the bedside and those in leadership positions-who may be seeking to improve the quality of infant sleep practices in their organizations.
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Abstract
BACKGROUND Perinatal substance exposure is an increasing concern in infants being cared for in neonatal intensive care units. Current recommendations support nonpharmacologic treatments for this population of infants. Multimodal (motion, sound) seats are often employed to soothe infants. PURPOSE The purpose of this study was to survey neonatal intensive care unit nurses on their practices regarding the use of a motion/sound infant seat. METHODS Sixty-six nurses (52% of 126 total nurses) completed the survey about their self-disclosed practices that included (1) reasons for use; (2) rationale for choice of settings of motion and sound; (3) duration of time infants spent in seat in one session; (4) perception of positive infant response; (5) who places infants in the seat; and (6) nursing instructions dispensed prior to use. RESULTS Chief reasons for use were infant state, lack of persons to hold infants, and a diagnosis of neonatal abstinence syndrome. Rationale for choice of motion and sound settings included trial and error, prior settings, personal preferences/patterns, assumptions, and random selection. Nurse responses regarding the amount of time the infant was placed in the seat in a single session ranged from 10 to 360 minutes, with determining factors of infant cues, sleeping, feeding, and someone else to hold the infant. IMPLICATIONS FOR PRACTICE As nonpharmacologic treatments evolve, nurses need guidelines for safe, effective interventions to care for infants. IMPLICATIONS FOR RESEARCH Further research is necessary to ascertain the responses of withdrawing infants and to establish guidelines and education for use of the motion/sound infant seat.
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Creating a Safe Sleep Environment for the Infant: What the Pediatric Nurse Needs to Know. J Pediatr Nurs 2019; 44:119-122. [PMID: 30683277 DOI: 10.1016/j.pedn.2018.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 12/02/2018] [Accepted: 12/03/2018] [Indexed: 11/23/2022]
Abstract
Despite the release of guidelines by the American Academy of Pediatrics (AAP) on safe infant sleep and public service campaigns aimed at reducing risk factors over the past 25 years, deaths due to Sudden Infant Death Syndrome (SIDS) and Sudden Unexplained Infant Death (SUID) are still the 4th leading causes of infant death in the United States. Findings from several studies demonstrate that nurses do not consistently model safe sleep practices with infants due to a lack of education on evidence-based practice and misconceptions regarding safe infant sleep. The aim of this paper is to demonstrate the need for expanded education to both nurses and parents on the principles of safe infant sleep and the impact it can have on decreasing risk factors for SIDS and SUID. Strategies are outlined for additional education for nurses and parents to enhance adherence to safe sleep guidelines and quality improvement projects aimed at the implementation of culture change are discussed. Going forward it is critical that nurses take an active role in seeking additional education on modifiable risk factors linked to SIDS and SUID and use that education to model and teach safe infant sleep practices with every infant at every encounter.
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Geraghty S, Doleman G, De Leo A. Midwives' attitudes towards pregnant women using substances: Informing a care pathway. Women Birth 2018; 32:e477-e482. [PMID: 30270017 DOI: 10.1016/j.wombi.2018.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 09/19/2018] [Accepted: 09/19/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to identify midwives' attitudes towards women using substances during pregnancy, which informed the development of an integrated care pathway for the provision of optimal care. METHODS A mixed methods research design was used, that included an online survey via the online survey tool Qualtrics™ which collected quantitative data, and interviews and focus groups were used to collect qualitative data. FINDINGS Participants held a positive or neutral view towards women who used substances during pregnancy, and the participants had an empathetic perception of the issue of substance use within pregnancy, believing that women were using substances due to the environment and circumstances that they lived in, and that they had been raised and socialised in. CONCLUSION Caring for women during pregnancy with substance misuse issues is complex and requires coordination and multidisciplinary care. Midwives have the capacity to provide sensitive midwifery care but require the framework to ensure women needing additional resources during pregnancy receive the services available and specific to their needs. The midwives in this study were supportive of developing an integrated care pathway to allow for collaborative care, and to enable a specialised midwifery approach.
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Affiliation(s)
- Sadie Geraghty
- Edith Cowan University, Perth, Western Australia, Australia.
| | - Gemma Doleman
- Edith Cowan University, Perth, Western Australia, Australia
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Evaluation of Nursing School Educators' Knowledge and Attitudes Regarding Infant Sleep Safety. Nurs Educ Perspect 2018; 39:E7-E13. [PMID: 29923948 DOI: 10.1097/01.nep.0000000000000334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM The purpose of this study was to evaluate nursing educators' attitudes and knowledge regarding current American Academy of Pediatrics recommendations for a safe infant sleeping environment. METHOD This was a cross-sectional prospective survey of all nursing programs with associate degrees or higher in the United States. Instructors teaching pediatric and obstetric didactic or clinical material at an Accreditation Commission for Education in Nursing-approved nursing school could participate. RESULTS Of 396 educators surveyed, 70 percent identified all sudden infant death syndrome risk factors. Correct responses for individual safe sleep recommendations ranged from 99 percent for correct room temperature to 53 percent for pacifier use; 9 percent said it was safest for infants to sleep in a position other than on the back. CONCLUSION Nursing educators need ongoing training on infant sleep safety to maintain mastery of the information that students need for competency in the workforce involving infant care.
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20
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Prone sleeping position in infancy: Implications for cardiovascular and cerebrovascular function. Sleep Med Rev 2018; 39:174-186. [DOI: 10.1016/j.smrv.2017.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 09/30/2017] [Accepted: 10/09/2017] [Indexed: 01/14/2023]
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Implementation of safe sleep practices in Massachusetts NICUs: a state-wide QI collaborative. J Perinatol 2018; 38:593-599. [PMID: 29410541 DOI: 10.1038/s41372-018-0046-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/29/2017] [Accepted: 12/12/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To increase the use of safe sleep practices (SSP) among high-risk infants discharged from Massachusetts (MA) NICUs to 90% in 2 years. DESIGN/METHODS The Neonatal Quality Improvement Collaborative of MA (NeoQIC) is a consortium of neonatal providers that provides infrastructure to lead and manage state-wide quality improvement initiatives. The safe sleep initiative was started in July 2015 with participation of all 10 MA level III NICUs. Based upon the project algorithm, infants are eligible for two sleep practices: SSP or NICU therapeutic positioning (NTP) depending on their gestational age, weight, and clinical illness. Compliance with SSP is defined as: (1) supine positioning, (2) in a flat crib with no incline, (3) without positioning devices, and (4) without soft objects. NTP comprised usual NICU care. Local improvement teams devise intervention strategies, perform weekly crib audits for all NICU infants, and submit data on overall compliance and compliance with each SSP component on a monthly basis to NeoQIC. RESULTS From July 2015 to June 2017, 7261 cribs were audited. Statistical process control charts showed significant improvement in the primary outcome of interest, overall compliance with SSP, for all participating NICUs. Compliance increased from 47.7% at the start of the project to 75.5% by the end of year 1 and to 81.0% by June 2017. CONCLUSIONS This state-wide collaborative has improved SSP compliance in all level III MA NICUs and demonstrated that on a state-wide level, SSPs can be routinely integrated into the care of high-risk infants.
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Miller TJ, Salm Ward TC, McClellan MM, Dawson L, Ford K, Polatty L, Walcott RL, Corso PS. Implementing a Statewide Safe to Sleep Hospital Initiative: Lessons Learned. J Community Health 2018; 43:768-774. [PMID: 29476308 DOI: 10.1007/s10900-018-0483-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Sleep-related infant deaths continue to be a major, largely preventable cause of infant mortality, especially in Georgia. The Georgia Department of Public Health (DPH), as part of a multi-pronged safe infant sleep campaign, implemented a hospital initiative to (1) provide accurate safe infant sleep information to hospital personnel; (2) support hospitals in implementing and modeling safe sleep practices; and (3) provide guidance on addressing caregiver safe sleep concerns. A process evaluation was conducted to determine progress toward four goals set out by DPH: (1) all birthing hospitals have a safe infant sleep policy; (2) all safe infant sleep policies reference the AAP 2011 recommendations; (3) all safe infant sleep policies specify the type and/or content of patient safe sleep education; and (4) all hospitals require regular staff training on safe sleep recommendations. Data were collected via structured interviews and document review of crib audit data and safe sleep policies. All 79 birthing hospitals in the state participated in the statewide campaign. Prior to the initiative, 44.3% of hospitals had a safe sleep policy in place; currently, 87.3% have a policy in place. The majority (91.4%) of hospitals have provided safe sleep training to their staff at this time. Important lessons include: (1) Engagement is vital to success; (2) A comprehensive implementation guide is critical; (3) Piloting the program provides opportunities for refinement; (4) Ongoing support addresses barriers; and (5) Senior leadership facilitates success.
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Affiliation(s)
- Terri J Miller
- Georgia Department of Public Health, 2 Peachtree Street, NW, Atlanta, GA, 30303-3186, USA.
| | - Trina C Salm Ward
- Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, 2400 E Hartford Ave, Milwaukee, WI, 53211, USA
| | - Marcie M McClellan
- College of Public Health, University of Georgia, 105 Spear Road, Athens, GA, 30602, USA
| | - Lisa Dawson
- Georgia Department of Public Health, 2 Peachtree Street, NW, Atlanta, GA, 30303-3186, USA
| | - Kate Ford
- Georgia Department of Public Health, 2 Peachtree Street, NW, Atlanta, GA, 30303-3186, USA
| | - Lauren Polatty
- Georgia Department of Public Health, 2 Peachtree Street, NW, Atlanta, GA, 30303-3186, USA
| | - Rebecca L Walcott
- College of Public Health, University of Georgia, 105 Spear Road, Athens, GA, 30602, USA
| | - Phaedra S Corso
- College of Public Health, Economic Evaluation Research Group, University of Georgia, 105 Spear Road, Athens, GA, 30602, USA
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Naugler MR, DiCarlo K. Barriers to and Interventions that Increase Nurses' and Parents' Compliance With Safe Sleep Recommendations for Preterm Infants. Nurs Womens Health 2018; 22:24-39. [PMID: 29433698 DOI: 10.1016/j.nwh.2017.12.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 08/01/2017] [Indexed: 06/08/2023]
Abstract
The purpose of this integrative review was to identify interventions that increase compliance of nurses and of parents with safe sleep recommendations for premature infants. Ten studies were included in the final sample, including three studies with a prospective descriptive design, five quality improvement initiatives with an interventional research design, one secondary analysis, and one retrospective medical chart review. Study samples included neonatal nurses and parents of premature infants in NICUs and transitional care nurseries in Massachusetts, Missouri, New York, North Carolina, Ohio, Pennsylvania, and Texas. Sample sizes ranged from 5 to 259 NICU parents and 86 to 658 neonatal nurses. The categories of interventions we identified include identifying barriers to compliance, changing hospital policy, and providing safe sleep education for nurses and parents. We conclude that hospitals should have current, evidence-based safe sleep policies with clear transition guidelines for premature infants and that consistent and comprehensive nursing and parental education related to safe sleep should include current American Academy of Pediatrics recommendations and should address potential barriers to compliance.
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Dowling DA, Barsman SG, Forsythe P, Damato EG. Caring about Preemies' Safe Sleep (CaPSS): An Educational Program to Improve Adherence to Safe Sleep Recommendations by Mothers of Preterm Infants. J Perinat Neonatal Nurs 2018; 32:366-372. [PMID: 29939882 DOI: 10.1097/jpn.0000000000000345] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Preterm infants born before 37 weeks' gestation die of sudden infant death syndrome (SIDS) at a rate more than double that of term infants. There is a need for SIDS prevention programs tailored to the specific needs of parents of high-risk infants. The purpose of this study was to pilot test an online educational module addressing SIDS risk-reduction recommendations (RRRs) for parents of preterm infants. This study was conducted in a 44-bed transitional care unit at a level IV NICU in the Midwest. A repeated-measures design was used. Two weeks before discharge, mothers completed a survey, addressing knowledge and plans for caring for their baby at home. Mothers then viewed the 5-section Caring about Preemies' Safe Sleep (CaPSS) education module and completed the postmodule evaluation. A discharge survey was completed 4 weeks postdischarge. Fifteen mothers, mean age 26.4 years, participated; 8 (53%) returned the postdischarge survey. Module evaluation rated clarity and completeness of information high. Mothers' ratings of SIDS knowledge were significantly higher after viewing the module (P = .000) and 4 weeks after discharge home (P = .012). Mothers found the use of a pacifier at sleep times to be new information and changed their plans for caring for their infant, with 28.6% of mothers always offering a pacifier before sleep after discharge compared with the 6.7% who had planned to do this before discharge. However, only 71% of infants slept in parents' room after discharge and only 41% were receiving at least some breast milk, which are not consistent with SIDS RRRs.
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Affiliation(s)
- Donna A Dowling
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio (Drs Dowling and Damato and Ms Barsman); and UH Rainbow Babies and Children's Hospital, Cleveland, Ohio (Ms Forsythe)
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Gollenberg A, Fendley K. Is it Time for a Sudden Infant Death Syndrome (SIDS) Awareness Campaign? Community Stakeholders' Perceptions of SIDS. ACTA ACUST UNITED AC 2017; 24:53-64. [PMID: 29249897 DOI: 10.1080/13575279.2016.1259155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background Sudden infant death syndrome (SIDS) remains a leading cause of infant death in the United States and in Virginia, the SIDS rate is higher than the national average. We sought to gauge the perceptions among community-identified stakeholders as to community resource needs to reduce SIDS. Methods We used snowball sampling to identify important community stakeholders to be interviewed as key informants. A semi-structured interview lasting 45 min-2 hours was delivered to determine resource needs to reduce SIDS, and whether high-risk community members were aware of SIDS risk factors among stakeholders representing a variety of disciplines. Interviews were conducted in two geographic areas with higher than average rates of infant mortality, an urban district, Winchester City, VA and a rural district, Page County, VA. Results A total of 74 interviews were completed with stakeholders in healthcare, health departments, social services, law enforcement, education/childcare, faith-based institutions, non-profit agencies and non-affiliated community members. The majority of respondents perceive that high-risk community members are not aware of factors that can lead to SIDS (50%). Participants suggested that more "education" is needed to further reduce the rates of SIDS in their communities (73%). Respondents detailed that more pervasive, strategic, and multi-channeled education is necessary to reduce cases of SIDS. Conclusion Community leaders perceive that high-risk community members are not fully aware of risk factors that can lead to SIDS. Maternal/child health stakeholders in these Virginia locales suggested more community-based education as a potential solution to SIDS.
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Affiliation(s)
- Audra Gollenberg
- Associate Professor of Public Health, Shenandoah University, College of Arts & Sciences, Public Health Program, Winchester, VA 22601
| | - Kim Fendley
- Associate Professor of Sociology, Shenandoah University, College of Arts & Sciences, Sociology Program, Winchester, VA 22601
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Abstract
BACKGROUND More than 95% of higher-order multiples are born preterm and more than 90% are low birth weight, making this group of infants especially vulnerable to sudden infant death syndrome (SIDS). Emerging evidence suggests that families with twins face challenges adhering to the American Academy of Pediatrics (AAP) recommendations to reduce SIDS risks. Adherence to the AAP recommendations in families with higher-order multiples has not been described. PURPOSE This study describes SIDS risk reduction infant care practices for higher-order multiples during the first year of life. METHODS Mothers caring for higher-order multiple-birth infants were recruited from an online support group. An online survey was used to assess infant care practices when the infants were first brought home from the hospital as well as at the time of the survey. RESULTS Ten mothers of triplets and 4 mothers of quadruplets responded. Less than 80% of the mothers practiced "back to sleep" immediately postdischarge. Supine sleep positioning decreased over time, particularly during daytime naps. Only 50% of the infants shared the parents' bedroom and approximately 30% bed-shared with their siblings. Sleep-time pacifier use was low. IMPLICATIONS FOR PRACTICE Safe sleep education must include specific questions regarding home sleeping arrangements, encouragement of breast milk feedings, supine positioning, and pacifier use at every sleep for higher-order multiple infants well before discharge in order for parents to plan a safe sleep environment at home. IMPLICATIONS FOR RESEARCH Prospective studies to identify barriers and facilitators can inform future strategies supporting adherence to safe sleep practices for higher-order multiple infants.
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Nursing Students' Knowledge and Attitudes Toward Infant Sleep Safety. TEACHING AND LEARNING IN NURSING 2017. [DOI: 10.1016/j.teln.2017.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Goodstein MH, Ostfeld BM. Improvements in Infant Sleep Position: We Can Do Better! Pediatrics 2017; 140:peds.2017-2068. [PMID: 28827378 DOI: 10.1542/peds.2017-2068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2017] [Indexed: 11/24/2022] Open
Affiliation(s)
| | - Barbara M Ostfeld
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
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Ostfeld BM, Schwartz-Soicher O, Reichman NE, Teitler JO, Hegyi T. Prematurity and Sudden Unexpected Infant Deaths in the United States. Pediatrics 2017; 140:peds.2016-3334. [PMID: 28759397 DOI: 10.1542/peds.2016-3334] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Prematurity, a strong risk factor for sudden unexpected infant death (SUID), was addressed in recommendations by the American Academy of Pediatrics in 2011 for safe sleep education in NICUs. We documented associations between gestational age (GA) and SUID subsequent to these guidelines. METHODS Using the 2012-2013 US linked infant birth and death certificate period files, we documented rates per live births of sudden infant death syndrome, ill-defined and unspecified causes, accidental suffocation and strangulation in bed, and overall SUID by GA in postneonatal, out-of-hospital, and autopsied cases; compared survivors and cases; and estimated logistic regression models of associations between GA and SUID. RESULTS SUID cases were more likely than survivors to be <37 weeks' GA (22.61% vs 10.79%; P < .0001). SUID rates were 2.68, 1.94, 1.46, 1.16, 0.73, and 0.51 per 1000 live births for 24 to 27, 28 to 31, 32 to 33, 34 to 36, 37 to 38, and 39 to 42 weeks' GA, respectively. Logistic regression models additionally indicated declines in the risk for SUID as GA increased. Prenatal smoking, inadequate prenatal care, and demographics associated with poverty were strongly associated with SUID. CONCLUSIONS Despite the 2011 American Academy of Pediatrics recommendations for increased safe sleep education in the NICUs, SUID rates were inversely associated with GA in 2012 to 2013, suggesting that risk of SUID associated with prematurity has multiple etiologies requiring continued investigation, including biological vulnerabilities and the efficacy of NICU education programs, and that strategies to reduce SUID should be multifaceted.
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Affiliation(s)
- Barbara M Ostfeld
- Department of Pediatrics, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey;
| | - Ofira Schwartz-Soicher
- Data and Statistical Services, Princeton University Library, Princeton University, Princeton, New Jersey
| | - Nancy E Reichman
- Department of Pediatrics, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey.,Institute of Health Evaluation, Management and Policy, University of Toronto, Toronto, Ontario, Canada; and
| | | | - Thomas Hegyi
- Department of Pediatrics, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
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Abstract
BACKGROUND The high prevalence of prematurity and low birth-weight places twin infants at increased risk for sudden unexpected infant death (SUID) and/or sudden infant death syndrome (SIDS). Risk for these SUID and SIDS is affected by a combination of nonmodifiable intrinsic risk factors and modifiable extrinsic stressors including infant care practices related to sleep. Although adherence to the full scope of American Academy of Pediatrics (AAP) 2011 recommendations is intended to decrease risk, these recommendations are aimed at singleton infants and may require tailoring for families with multiple infants. PURPOSE The study describes infant care practices reported by mothers of twins in the first 6 months postpartum. METHODS Mothers caring for twin infants (N = 35) were surveyed online both longitudinally (at 2, 8, 16, and 24 weeks after infant hospital discharge) and cross-sectionally. AAP recommendations (2011) guided survey content. RESULTS The degree of adherence to AAP recommendations varied over time. For example, mothers of twins reported 100% adherence to placing twins supine for sleep initially, but many reported putting babies on their stomachs for naps as twins became older. Sharing a parent's bedroom decreased over time as did frequency of crib sharing. Fewer than half of mothers offered a pacifier most or all of the time for sleep. IMPLICATIONS FOR PRACTICE Opportunities exist for development of an educational program geared specifically for postpartum parents of twins. IMPLICATIONS FOR RESEARCH Barriers affecting adherence to AAP recommendations and effectiveness of educational programs addressing needs of this unique population need further exploration.
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Macklin JR, Gittelman MA, Denny SA, Southworth H, Arnold MW. The EASE Quality Improvement Project: Improving Safe Sleep Practices in Ohio Children's Hospitals. Pediatrics 2016; 138:peds.2015-4267. [PMID: 27630074 DOI: 10.1542/peds.2015-4267] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Despite American Academy of Pediatrics (AAP) recommendations, many hospitalized infants are not observed in the appropriate safe sleep environment. Caregivers tend to model sleep patterns observed in a hospital setting. This project assessed the change in infant safe sleep practices within 6 children's hospitals after the implementation of a statewide quality improvement program. METHODS The AAP recruited hospitalists from each of the state's children's hospitals and asked them to form "safe sleep teams" within their institutions. Teams used a standardized data tool to collect information on the infant's age and sleep position/environment. They collected baseline data and then weekly for the duration of the 12-month project. Teams were required to implement at least 3 Plan-Do-Study-Act cycles. We calculated changes in safe sleep practices over time. Providers received Maintenance of Certification Part IV credit for participation. RESULTS Teams collected 5343 audits at all participating sites. At baseline, only 279 (32.6%) of 856 of the sleeping infants were observed to follow AAP recommendations, compared with 110 (58.2%) of 189 (P < .001) at the project's conclusion. The presence of empty cribs was the greatest improvement (38.1% to 67.2%) (P < .001). Removing loose blankets (77.8% to 50.0%) (P < .001) was the most common change made. Audits also showed an increase in education of families about safe sleep practices from 48.2% to 75.4% (P < .001). CONCLUSIONS Multifactorial interventions by hospitalist teams in a multi-institutional program within 1 state's children's hospitals improved observed infant safe sleep behaviors and family report of safe sleep education. These behavior changes may lead to more appropriate safe sleep practices at home.
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Affiliation(s)
| | - Michael A Gittelman
- Division of Emergency Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio; and
| | - Sarah A Denny
- Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio
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Shadman KA, Wald ER, Smith W, Coller RJ. Improving Safe Sleep Practices for Hospitalized Infants. Pediatrics 2016; 138:peds.2015-4441. [PMID: 27482058 DOI: 10.1542/peds.2015-4441] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Adherence to the American Academy of Pediatrics safe sleep practice (SSP) recommendations among hospitalized infants is unknown, but is assumed to be low. This quality improvement study aimed to increase adherence to SSPs for infants admitted to a children's hospital general care unit between October 2013 and December 2014. METHODS After development of a hospital policy and redesign of room setup processes, a multidisciplinary team developed intervention strategies based on root cause analysis and implemented changes using iterative Plan-Do-Study-Act cycles. Nurse knowledge was assessed before and after education. SSPs were measured continuously with room audits during sleeping episodes. Statistical process control and run charts identified improvements and sustainability in hospital SSPs. Caregiver home practices after discharge were assessed via structured questionnaires before and after intervention. RESULTS Nursing knowledge of SSPs increased significantly for each item (P ≤ .001) except avoidance of bed sharing. Audits were completed for 316 sleep episodes. Simultaneous adherence to all SSP recommendations improved significantly from 0% to 26.9% after intervention. Significant improvements were noted in individual practices, including maintaining a flat, empty crib, with an appropriately bundled infant. The largest gains were noted in the proportion of empty cribs (from 3.4% to 60.3% after intervention, P < .001). Improvements in caregiver home practices after discharge were not statistically significant. CONCLUSIONS Sustained improvements in hospital SSPs were achieved through this quality improvement initiative, with opportunity for continued improvement. Nurse knowledge increased during the intervention. It is uncertain whether these findings translate to changes in caregiver home practices after discharge.
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Affiliation(s)
- Kristin A Shadman
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; and
| | - Ellen R Wald
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; and
| | - Windy Smith
- American Family Children's Hospital, Madison, Wisconsin
| | - Ryan J Coller
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; and
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Geyer JE, Smith PK, Kair LR. Safe sleep for pediatric inpatients. J SPEC PEDIATR NURS 2016; 21:119-30. [PMID: 27221207 DOI: 10.1111/jspn.12146] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 03/18/2016] [Accepted: 03/21/2016] [Indexed: 12/11/2022]
Abstract
PURPOSE To improve sleep environment safety for inpatient infants. DESIGN AND METHODS This quality improvement project involved assessment of sleep environment safety for inpatient infants before and after a bundled intervention of staff education and introduction of swaddle sacks and bedside storage bins. RESULTS The proportion of infant cribs without loose objects in them increased (32-72%, p = .025), and safe sleep positioning remained stable (82% vs. 95%, p = .183). PRACTICE IMPLICATIONS Staff education, swaddle sleep sacks, and bedside storage containers were associated with improved sleep safety among pediatric inpatients at our institution and may help at other institutions.
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Affiliation(s)
- Janet E Geyer
- Nursing Practice Leader with the Department of Nursing, University of Iowa Children's Hospital, Iowa City, Iowa, USA
| | - Penny K Smith
- Nurse Clinician Specialist with the Department of Nursing, University of Iowa Children's Hospital, Iowa City, Iowa, USA
| | - Laura R Kair
- Clinical Assistant Professor of Pediatrics, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
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