1
|
Shin SH, Choi C, Shih SF, Tomlinson CA, Kimbrough T. A Hospital-Based Infant Safe Sleep Intervention and Safe Sleep Practices Among Young Women: A Prospective Longitudinal Study. Matern Child Health J 2023; 27:2113-2120. [PMID: 37306824 DOI: 10.1007/s10995-023-03716-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2023] [Indexed: 06/13/2023]
Abstract
INTRODUCTION The rates of sudden unexpected infant death (SUID) are still high in the U.S. The longitudinal effects of SUID preventive education on infant safe sleep practices are less known. The current study evaluated the effects of a comprehensive hospital-based, SUID preventive intervention on safe infant sleep practices in the first six months of life and to identify factors associated with infant sleep practices. METHODS Using a one-group pretest and multiple posttest design, the current quantitative study examined the impacts of the infant safe sleep intervention among 411 women recruited at a large, urban, university medical center. Participants were prospectively followed and completed four surveys from childbirth. Linear mixed models were used to evaluate the effects of the SUID prevention program on four sleep practice outcomes, including removing unsafe items from the sleeping environment, bed sharing, room sharing without bed sharing, and placing the infant in a supine sleep position. RESULTS Compared to the baseline, participants were less likely to use unsafe items (e.g., soft bedding) in infants' sleeping areas over time. However, we found that participants reported more frequent bed sharing at 3-month and 6-month follow-ups, compared to the baseline. CONCLUSIONS Overall, maternal education and family income were positively related to healthy infant safe sleep practices. A hospital-based preventive intervention pairing an educational initiative with home-visiting services might improve safe sleep practices to remove accidental suffocation risks from the infant sleep environment.
Collapse
Affiliation(s)
- Sunny H Shin
- Department of Psychiatry, School of Medicine, Virginia Commonwealth University, 1000 Floyd Avenue, Richmond, VA, 23284, USA.
- School of Social Work, Virginia Commonwealth University, 1000 Floyd Avenue, Richmond, VA, 23284, USA.
| | - Changyong Choi
- School of Social Work, Virginia Commonwealth University, 1000 Floyd Avenue, Richmond, VA, 23284, USA
| | - Shu-Fang Shih
- Department of Health Administration, College of Health Professions, Virginia Commonwealth University, 900 E. Leigh St., Camie A. Tomlinson, MSW, Box 980203, Richmond, VA, 23298, USA
| | - Camie A Tomlinson
- School of Social Work, Virginia Commonwealth University, 1000 Floyd Avenue, Richmond, VA, 23284, USA
| | - Tiffany Kimbrough
- Department of Pediatrics, School of Medicine, Virginia Commonwealth University, 1000 E. Broad St, Box 980264, Richmond, VA, 23298, USA
| |
Collapse
|
2
|
Strobel NA, Chamberlain C, Campbell SK, Shields L, Bainbridge RG, Adams C, Edmond KM, Marriott R, McCalman J. Family-centred interventions for Indigenous early childhood well-being by primary healthcare services. Cochrane Database Syst Rev 2022; 12:CD012463. [PMID: 36511823 PMCID: PMC9746601 DOI: 10.1002/14651858.cd012463.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Primary healthcare, particularly Indigenous-led services, are well placed to deliver services that reflect the needs of Indigenous children and their families. Important characteristics identified by families for primary health care include services that support families, accommodate sociocultural needs, recognise extended family child-rearing practices, and Indigenous ways of knowing and doing business. Indigenous family-centred care interventions have been developed and implemented within primary healthcare services to plan, implement, and support the care of children, immediate and extended family and the home environment. The delivery of family-centred interventions can be through environmental, communication, educational, counselling, and family support approaches. OBJECTIVES To evaluate the benefits and harms of family-centred interventions delivered by primary healthcare services in Canada, Australia, New Zealand, and the USA on a range of physical, psychosocial, and behavioural outcomes of Indigenous children (aged from conception to less than five years), parents, and families. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 22 September 2021. SELECTION CRITERIA We included randomised controlled trials (RCTs), cluster RCTs, quasi-RCTs, controlled before-after studies, and interrupted time series of family-centred care interventions that included Indigenous children aged less than five years from Canada, Australia, New Zealand, and the USA. Interventions were included if they met the assessment criteria for family-centred interventions and were delivered in primary health care. Comparison interventions could include usual maternal and child health care or one form of family-centred intervention versus another. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were 1. overall health and well-being, 2. psychological health and emotional behaviour of children, 3. physical health and developmental health outcomes of children, 4. family health-enhancing lifestyle or behaviour outcomes, 5. psychological health of parent/carer. 6. adverse events or harms. Our secondary outcomes were 7. parenting knowledge and awareness, 8. family evaluation of care, 9. service access and utilisation, 10. family-centredness of consultation processes, and 11. economic costs and outcomes associated with the interventions. We used GRADE to assess the certainty of the evidence for our primary outcomes. MAIN RESULTS We included nine RCTs and two cluster-RCTs that investigated the effect of family-centred care interventions delivered by primary healthcare services for Indigenous early child well-being. There were 1270 mother-child dyads and 1924 children aged less than five years recruited. Seven studies were from the USA, two from New Zealand, one from Canada, and one delivered in both Australia and New Zealand. The focus of interventions varied and included three studies focused on early childhood caries; three on childhood obesity; two on child behavioural problems; and one each on negative parenting patterns, child acute respiratory illness, and sudden unexpected death in infancy. Family-centred education was the most common type of intervention delivered. Three studies compared family-centred care to usual care and seven studies provided some 'minimal' intervention to families such as education in the form of pamphlets or newsletters. One study provided a minimal intervention during the child's first 24 months and then the family-centred care intervention for one year. No studies had low or unclear risk of bias across all domains. All studies had a high risk of bias for the blinding of participants and personnel domain. Family-centred care may improve overall health and well-being of Indigenous children and their families, but the evidence was very uncertain. The pooled effect estimate from 11 studies suggests that family-centred care improved the overall health and well-being of Indigenous children and their families compared no family-centred care (standardised mean difference (SMD) 0.14, 95% confidence interval (CI) 0.03 to 0.24; 2386 participants). We are very uncertain whether family-centred care compared to no family-centred care improves the psychological health and emotional behaviour of children as measured by the Infant Toddler Social Emotional Assessment (ITSEA) (Competence domain) (mean difference (MD) 0.04, 95% CI -0.03 to 0.11; 2 studies, 384 participants). We assessed the evidence as being very uncertain about the effect of family-centred care on physical health and developmental health outcomes of children. Pooled data from eight trials on physical health and developmental outcomes found there was little to no difference between the intervention and the control groups (SMD 0.13, 95% CI -0.00 to 0.26; 1961 participants). The evidence is also very unclear whether family-centred care improved family-enhancing lifestyle and behaviours outcomes. Nine studies measured family health-enhancing lifestyle and behaviours and pooled analysis found there was little to no difference between groups (SMD 0.16, 95% CI -0.06 to 0.39; 1969 participants; very low-certainty evidence). There was very low-certainty evidence of little to no difference for the psychological health of parents and carers when they participated in family-centred care compared to any control group (SMD 0.10, 95% CI -0.03 to 0.22; 5 studies, 975 parents/carers). Two studies stated that there were no adverse events as a result of the intervention. No additional data were provided. No studies reported from the health service providers perspective or on outcomes for family's evaluation of care or family-centredness of consultation processes. AUTHORS' CONCLUSIONS There is some evidence to suggest that family-centred care delivered by primary healthcare services improves the overall health and well-being of Indigenous children, parents, and families. However, due to lack of data, there was not enough evidence to determine whether specific outcomes such as child health and development improved as a result of family-centred interventions. Seven of the 11 studies delivered family-centred education interventions. Seven studies were from the USA and centred on two particular trials, the 'Healthy Children, Strong Families' and 'Family Spirit' trials. As the evidence is very low certainty for all outcomes, further high-quality trials are needed to provide robust evidence for the use of family-centred care interventions for Indigenous children aged less than five years.
Collapse
Affiliation(s)
- Natalie A Strobel
- Kurongkurl Katitjin, Edith Cowan University, Mount Lawley, Australia
- Medical School, The University of Western Australia, Perth, Australia
| | - Catherine Chamberlain
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Sandra K Campbell
- College of Nursing & Midwifery, Charles Darwin University, Darwin, Australia
| | - Linda Shields
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sunshine Coast, Australia
| | - Roxanne G Bainbridge
- School of Human Health and Social Sciences, Central Queensland University, Cairns, Australia
| | - Claire Adams
- Kurongkurl Katitjin, Edith Cowan University, Mount Lawley, Australia
| | - Karen M Edmond
- Department of Women and Children's Health, King's College London, London, UK
| | - Rhonda Marriott
- Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch University, Murdoch, Australia
| | - Janya McCalman
- School of Human Health and Social Sciences, Central Queensland University, Cairns, Australia
| |
Collapse
|
3
|
George M, Richards R, Watson B, Lucas A, Fitzgerald R, Taylor R, Galland B. Pacific families navigating responsiveness and children's sleep in Aotearoa New Zealand. Sleep Med X 2021; 3:100039. [PMID: 34881360 PMCID: PMC8590065 DOI: 10.1016/j.sleepx.2021.100039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 08/16/2021] [Accepted: 10/12/2021] [Indexed: 12/31/2022] Open
Abstract
The stakes for understanding sleep practices are rising as health inequalities related to sleep become more apparent. Pacific peoples in Aotearoa New Zealand face disproportionate challenges around poverty and health and sleep is one growing area of importance in addressing health inequalities. Through a qualitative study of 17 Pacific families in Aotearoa New Zealand, we provide a rare and valuable glimpse into the familial, cultural, social and economic context of sleep for Pacific families and children in New Zealand. These Pacific families uphold a core value of responsiveness to family, community, culture and faith. These values feed wellbeing in a variety of ways, especially when health is considered through Pacific, holistic frameworks. These families apply the same responsiveness to economic pressures, often taking on shiftwork. We show how responsiveness to family and culture, as well as limited economic means, permeates sleep practices within these Pacific households. These broader shaping factors must be acknowledged, considered, respected and integrated into any healthy sleep initiatives and interventions, in order to ensure benefit - and not harm - is achieved. A rare, valuable and intimate glimpse into the familial, cultural, social and economic context of sleep for Pacific families in New Zealand. Many health initiatives and interventions do not account for cultural variation and do not reach the populations that need them most. A qualitative study, integrating the Fonofale Model of health, informing culturally relevant sleep interventions for Pacific families. Pacific families value family, community, faith and culture; they are also disproportionately affected by economic hardship. Both impact sleep.
Collapse
Affiliation(s)
- Molly George
- University of Otago, PO Box 56, Dunedin, New Zealand
| | | | | | - Albany Lucas
- University of Otago, PO Box 56, Dunedin, New Zealand
| | | | | | | |
Collapse
|
4
|
Blair PS, Pease A, Bates F, Ball H, Thompson JMD, Hauck FR, Moon R, McEntire B, Shatz A, Cohen M, Salm Ward TC, Fleming P. Concerns about the promotion of a cardboard baby box as a place for infants to sleep. BMJ 2018; 363:k4243. [PMID: 30333110 DOI: 10.1136/bmj.k4243] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Peter S Blair
- Bristol Medical School, University of Bristol, St Michael's Hospital, Bristol BS2 8EG, UK
| | - Anna Pease
- Bristol Medical School, University of Bristol, St Michael's Hospital, Bristol BS2 8EG, UK
| | | | | | | | - Fern R Hauck
- University of Virginia, Charlottesville, VA, USA
| | - Rachel Moon
- University of Virginia, Charlottesville, VA, USA
| | | | - Anat Shatz
- Israeli Foundation for the Study and Prevention of Sudden Infant Death, Jerusalem, Israel
| | - Marta Cohen
- Sheffield Children's Hospital NHS Trust, Sheffield, UK
| | | | - Peter Fleming
- Bristol Medical School, University of Bristol, St Michael's Hospital, Bristol BS2 8EG, UK
| |
Collapse
|
5
|
Manhire KM, Williams SM, Tipene-Leach D, Baddock SA, Abel S, Tangiora A, Jones R, Taylor BJ. Predictors of breastfeeding duration in a predominantly Māori population in New Zealand. BMC Pediatr 2018; 18:299. [PMID: 30208860 PMCID: PMC6136165 DOI: 10.1186/s12887-018-1274-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 09/03/2018] [Indexed: 11/10/2022] Open
Abstract
Background Although breastfeeding duration in New Zealand’s indigenous Māori is shorter than in non-Māori, we know little about barriers or motivators of breastfeeding in this community. The aim of this analysis was to identify predictors for extended duration of breastfeeding amongst participants drawn from predominantly Māori communities in regional Hawke’s Bay. Methods Mother/baby dyads were recruited from two midwifery practices serving predominantly Māori women in mostly deprived areas, for a randomised controlled trial comparing the risks and benefits of an indigenous sleeping device (wahakura) and a bassinet. Questionnaires were administered at baseline (pregnancy) and at one, three and six months postnatal. Several questions relating to breastfeeding and factors associated with breastfeeding were included. The data from both groups were pooled to examine predictors of breastfeeding duration. Results Māori comprised 70.5% of the 197 participants recruited. The median time infants were fully breastfed was eight weeks and Māori women were more likely to breastfeed for a shorter duration than New Zealand European women with an odds-ratio (OR) of 0.45 (95% CI 0.24, 0.85). The key predictors for extended duration of breastfeeding were the strong support of the mother’s partner (OR = 3.64, 95% CI 1.76, 7.55) or her mother for breastfeeding (OR = 2.47, 95% CI 1.27, 4.82), longer intended duration of maternal breastfeeding (OR = 1.02, 95% CI 1.00, 1.03) and being an older mother (OR = 1.07, 95% CI 1.02, 1.12). The key predictors for shorter duration of breastfeeding were pacifier use (OR = 0.28, 95% CI 0.17, 0.46), daily cigarette smoking (OR = 0.51, 95% CI 0.37, 0.69), alcohol use (OR = 0.54, 95% CI 0.31, 0.93) and living in a more deprived area (OR 0.40, 95% CI 0.22, 0.72). Conclusions Breastfeeding duration in this group of mainly Māori women was shorter than the national average. Increasing the duration of breastfeeding by these mothers could be further facilitated by ante and postnatal education involving their own mothers and their partners in the support of breastfeeding and by addressing pacifier use, smoking and alcohol use.
Collapse
Affiliation(s)
- Kathy M Manhire
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand. .,Faculty of Education, Humanities and Health Sciences, Eastern Institute of Technology, Hawke's Bay, New Zealand.
| | - Sheila M Williams
- Department of Preventive & Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - David Tipene-Leach
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.,Faculty of Education, Humanities and Health Sciences, Eastern Institute of Technology, Hawke's Bay, New Zealand
| | - Sally A Baddock
- School of Midwifery, Otago Polytechnic, Dunedin, New Zealand
| | - Sally Abel
- Kaupapa Consulting Ltd, Napier, Napier, New Zealand
| | - Angeline Tangiora
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Raymond Jones
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Barry J Taylor
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| |
Collapse
|
6
|
Tipene-Leach D, Baddock SA, Williams SM, Tangiora A, Jones R, McElnay C, Taylor BJ. The Pēpi-Pod study: Overnight video, oximetry and thermal environment while using an in-bed sleep device for sudden unexpected death in infancy prevention. J Paediatr Child Health 2018; 54:638-646. [PMID: 29357197 DOI: 10.1111/jpc.13845] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 10/22/2017] [Accepted: 12/21/2017] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to identify the potential risks and benefits of sleeping infants in a Pēpi-Pod distributed to families with high risk of sudden unexpected death in infancy compared to a bassinet. METHODS Forty-five mostly indigenous Māori mothers who were referred by local health providers to receive a Pēpi-Pod were surveyed at recruitment, 1 and 3 months. A sleep study at 1 month included infrared video, oximetry and temperature measures. RESULTS When compared with 89 historical bassinet controls, an intention-to-treat analysis of questionnaires showed no increase in direct bed sharing but demonstrated significantly less sharing of the maternal bedroom at both interviews, with the majority of those not sleeping in the maternal bedroom, actually sleeping in the living room. The 1 month 'as-used' analysis showed poorer maternal sleep quality. The 'as-used' analysis of video data (24 Pēpi-Pod and 113 bassinet infants) also showed no increase in direct bed sharing, head covering or prone/side sleep position. Differences in oxygen saturation were not significant, but heart rate was higher in the Pēpi-Pod infants by 8.37 bpm (95% confidence interval 4.40, 12.14). Time in the thermal comfort zone was not different between groups despite Pēpi-Pod infants being situated in significantly warmer rooms. CONCLUSIONS Overall, we found that most differences in infant risk behaviours in a Pēpi-Pod compared to a bassinet were small, with confidence intervals excluding meaningful differences. We noted poorer maternal sleep quality at 1 month. Higher infant heart rates in the Pēpi-Pod group may be related to higher room temperatures. The Pēpi-Pod appears physiologically safe but is associated with lower reported maternal sleep quality.
Collapse
Affiliation(s)
- David Tipene-Leach
- Department of Women's and Children's Health, and, University of Otago, Dunedin, New Zealand.,Faculty of Education, Humanities and Health Sciences, Eastern Institute of Technology, Napier, New Zealand
| | - Sally A Baddock
- School of Midwifery, Otago Polytechnic, Dunedin, New Zealand
| | - Sheila M Williams
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Angeline Tangiora
- Department of Women's and Children's Health, and, University of Otago, Dunedin, New Zealand
| | - Raymond Jones
- Department of Women's and Children's Health, and, University of Otago, Dunedin, New Zealand
| | - Caroline McElnay
- Population Health, Hawke's Bay District Health Board, Hastings, New Zealand
| | - Barry J Taylor
- Department of Women's and Children's Health, and, University of Otago, Dunedin, New Zealand
| |
Collapse
|
7
|
Baddock SA, Tipene-Leach D, Williams SM, Tangiora A, Jones R, Mącznik AK, Taylor BJ. Physiological stability in an indigenous sleep device: a randomised controlled trial. Arch Dis Child 2018; 103:377-382. [PMID: 29030386 DOI: 10.1136/archdischild-2017-313512] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 09/15/2017] [Accepted: 09/16/2017] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare overnight oxygen saturation, heart rate and the thermal environment of infants sleeping in an indigenous sleep device (wahakura) or bassinet to identify potential risks and benefits. DESIGN Randomised controlled trial. SETTING Family homes in low socio-economic areas in New Zealand. PATIENTS 200 mainly Māori mothers and their infants. INTERVENTIONS Participants received a wahakura or bassinet from birth. MAIN OUTCOME MEASURES Overnight oximetry, heart rate and temperature at 1 month. RESULTS Intention-to-treat analysis for 83 bassinet and 84 wahakura infants showed no significant differences between groups for the mean time oxygen saturation (SpO2) was less than 94% (0.54 min, 95% CI -1.36 to 2.45) or less than 90% (0.22 min, 95% CI -0.56 to 1.00), the mean number of SpO2 dips per hour >5% (-0.19, 95% CI -3.07 to 2.69) or >10% (-0.41, 95% CI -1.63 to 0.81), mean heart rate (1.99 beats/min, 95% CI -1.02 to 4.99), or time shin temperature >36°C (risk ratio (RR): 0.63, 95% CI 0.13 to 2.99) or <34°C (RR: 0.89, 95% CI 0.61 to 1.30). A per-protocol analysis of 45 bassinet and 26 wahakura infants and an as-used analysis of 104 infants in a bassinet and 48 in a wahakura found no significant differences between groups for all outcome measures. CONCLUSIONS This indigenous sleep device is at least as safe as the currently recommended bassinet, which supports its use as a sleep environment that offers an alternative way of bed-sharing. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry: ACTRN12610000993099.
Collapse
Affiliation(s)
- Sally A Baddock
- School of Midwifery, Otago Polytechnic, Dunedin, New Zealand.,Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, New Zealand
| | - David Tipene-Leach
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, New Zealand.,Faculty of Education, Humanities and Health Science, Eastern Institute of Technology, Hawke's Bay, New Zealand
| | - Sheila M Williams
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, New Zealand
| | - Angeline Tangiora
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, New Zealand
| | - Raymond Jones
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, New Zealand
| | | | - Barry J Taylor
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, New Zealand.,Department of the Dean, Dunedin School of Medicine, University of Otago, New Zealand
| |
Collapse
|
8
|
McIntosh C, Trenholme A, Stewart J, Vogel A. Evaluation of a sudden unexpected death in infancy intervention programme aimed at improving parental awareness of risk factors and protective infant care practices. J Paediatr Child Health 2018; 54:377-382. [PMID: 29125216 DOI: 10.1111/jpc.13772] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 08/23/2017] [Accepted: 09/03/2017] [Indexed: 11/29/2022]
Abstract
AIM Sudden unexpected death in infancy (SUDI) rates for Māori and Pacific infants remain higher than for other ethnic groups in New Zealand and bed-sharing is a major risk factor when there is smoking exposure in pregnancy. Sleep space programmes of education and Pēpi-Pod baby beds require evaluation. METHODS Two hundred and forty Māori and Pacific women and infants were randomised 1:1, to the Pēpi-Pod sleep space programme, or to a control group with 'usual care'. When infants were under 2 weeks of age, baseline interviews occurred, followed up by interviews at 2 and 4 months of age to assess safe sleep knowledge, infant care practices and Pēpi-Pod use and acceptability. All participants were offered a New Zealand Standard approved portable cot. RESULTS At baseline, 25% of babies did not have a baby bed. Knowledge of smoking and bed-sharing as SUDI risks improved at follow-up in both groups. One quarter regularly bed-shared at follow-up in both groups. Intention to bed-share was a strong predictor of subsequent behaviour. Pēpi-Pods were regularly used by 46% at 2 months and 16% at 4 months follow-up. CONCLUSIONS Bed-sharing and knowledge improvement were similar irrespective of group. It is likely that the impact of the intervention was reduced because the control group received better support than 'usual care' and all participants had a baby bed. New Zealand SUDI rates have declined since sleep space programmes have been available. Sleep space programmes should be prioritised for those with modifiable SUDI risk.
Collapse
Affiliation(s)
- Christine McIntosh
- Primary Health and Community Services, Counties Manukau Health, Auckland, New Zealand.,Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Adrian Trenholme
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand.,Department of Paediatrics, Counites Manukau Health, Auckland, New Zealand
| | | | - Alison Vogel
- Department of Paediatrics, Counites Manukau Health, Auckland, New Zealand
| |
Collapse
|
9
|
Baddock SA, Tipene-Leach D, Williams SM, Tangiora A, Jones R, Iosua E, Macleod EC, Taylor BJ. Wahakura Versus Bassinet for Safe Infant Sleep: A Randomized Trial. Pediatrics 2017; 139:peds.2016-0162. [PMID: 28044049 DOI: 10.1542/peds.2016-0162] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To compare an indigenous sleep device (wahakura) for infants at high risk for sudden unexpected death with a bassinet, for measures of infant sleep position, head covering, breastfeeding, bed-sharing, and maternal sleep and fatigue. METHODS A total of 200 mainly Māori pregnant women were recruited from deprived areas of New Zealand. They were randomized to receive a bassinet or wahakura and asked to sleep the infant in this device from birth. Questionnaires at 1, 3, and 6 months and an overnight infrared video in the home at 1 month were completed. RESULTS An intention-to-treat and an "as-used" analysis of questionnaires showed no group differences at 1, 3, and 6 months in infant-adult direct bed-sharing (7% vs 12%, P = .24 at 1 month), and at the 6-month interview, the wahakura group reported twice the level of full breastfeeding (22.5% vs 10.7%, P = .04). Maternal sleep and fatigue were not significantly different between groups. Video identified no increase in head covering, prone/side sleep position, or bed-sharing in the wahakura group, either from intention-to-treat analysis, or when analyzed for actual sleep location. CONCLUSION There were no significant differences in infant risk behaviors in wahakura compared with bassinets and there were other advantages, including an increase in sustained breastfeeding. This suggests wahakura are relatively safe and can be promoted as an alternative to infant-adult bed-sharing. Policies that encourage utilization are likely to be helpful in high-risk populations.
Collapse
Affiliation(s)
- Sally A Baddock
- School of Midwifery, Otago Polytechnic, Dunedin, New Zealand; .,Departments of Women's and Children's Health, and
| | | | | | | | | | | | | | - Barry J Taylor
- Departments of Women's and Children's Health, and.,Dean's Department, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| |
Collapse
|
10
|
Moon RY, Hauck FR, Colson ER. Safe Infant Sleep Interventions: What is the Evidence for Successful Behavior Change? Curr Pediatr Rev 2016; 12:67-75. [PMID: 26496723 PMCID: PMC4997961 DOI: 10.2174/1573396311666151026110148] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 10/18/2015] [Accepted: 10/21/2015] [Indexed: 11/22/2022]
Abstract
Sudden infant death syndrome (SIDS) and other sleep-related infant deaths, such as accidental suffocation and strangulation in bed and ill-defined deaths, account for >4000 deaths annually in the USA. Evidence-based recommendations for reducing the risk of sleep-related deaths have been published, but some caregivers resist adoption of these recommendations. Multiple interventions to change infant sleep-related practices of parents and professionals have been implemented. In this review, we will discuss illustrative examples of safe infant sleep interventions and evidence of their effectiveness. Facilitators of and barriers to change, as well as the limitations of the data currently available for these interventions, will be considered.
Collapse
Affiliation(s)
- Rachel Y Moon
- Department of Pediatrics, University of Virginia, PO Box 800386, Charlottesville, VA 22908 USA.
| | | | | |
Collapse
|
11
|
Fleming PJ, Blair PS, Pease A. Sudden unexpected death in infancy: aetiology, pathophysiology, epidemiology and prevention in 2015. Arch Dis Child 2015; 100:984-8. [PMID: 25699563 DOI: 10.1136/archdischild-2014-306424] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 01/28/2015] [Indexed: 11/04/2022]
Abstract
Despite the fall in numbers of unexpected infant deaths that followed the 'Back to Sleep' campaigns in the early 1990 s in the UK and many other countries, such deaths remain one of the largest single groups of deaths in the postneonatal period in many Western countries. Changes in the ways in which unexpected infant deaths are categorised by pathologists and coroners, and increasing reluctance to use the term 'sudden infant death syndrome', make assessment of nationally and internationally collected data on incidence potentially inaccurate and confusing. In this paper, we review current understanding of the epidemiology and aetiology of unexpected deaths in infancy, and current hypotheses on the pathophysiology of the processes that may lead to death. We also review interventions that have been adopted, with variable degrees of effectiveness in efforts to reduce the numbers of deaths, and new approaches that offer the possibility of prevention in the future.
Collapse
Affiliation(s)
- Peter J Fleming
- Centre for Child and Adolescent Health, University of Bristol. St Michaels Hospital, Bristol, UK
| | - Peter S Blair
- Centre for Child and Adolescent Health, University of Bristol. St Michaels Hospital, Bristol, UK
| | - Anna Pease
- Centre for Child and Adolescent Health, University of Bristol. St Michaels Hospital, Bristol, UK
| |
Collapse
|