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Himemiya-Hakucho A, Taketani A, Nakagawa A, Sakai H, Shigemoto A, Takase I. Practices and Awareness Regarding an Infant's Sleep Environment among Japanese Caregivers: A Cross-Sectional Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:471. [PMID: 38673381 PMCID: PMC11050700 DOI: 10.3390/ijerph21040471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/02/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024]
Abstract
Preventing sudden, unexpected infant death related to sleep, especially suffocation and sudden infant death syndrome, remains challenging globally. To evaluate factors associated with an unsafe sleep environment (SE) for infants in Japan, this cross-sectional study investigated the current status of practices and awareness among caregivers about a safe SE. Two hundred and fifty-four caregivers of infants in Yamaguchi Prefecture participated. Among the caregivers, 96.0% could not thoroughly practice a safe SE, although 65.0% had knowledge about a safe SE. More unsafe SE practices were significantly associated with 8- to 11-month-old infants than with 0- to 3-month-old infants, using the same practice as for an older child than with accessing information or a familiar person than with mass media as the most useful source of information. The differences in having knowledge were not associated with their practice. Many caregivers obtained information about an infant's SE from mass media and a familiar person. They preferred education via a face-to-face method by medical experts to raise awareness about a safe SE. Thus, efforts need to be developed in Japan in which experts who directly attend to caregivers can truly educate them to ensure that caregivers are continuously aware of the importance of an SE.
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Affiliation(s)
- Ayako Himemiya-Hakucho
- Department of Legal Medicine, Yamaguchi University Graduate School of Medicine, Yamaguchi 755-8505, Japan; (A.N.); (H.S.); (A.S.); (I.T.)
| | - Ayumi Taketani
- Undergraduate Courses of Medicine, Faculty of Medicine and Health Sciences, Yamaguchi University, Yamaguchi 755-8505, Japan;
| | - Aoi Nakagawa
- Department of Legal Medicine, Yamaguchi University Graduate School of Medicine, Yamaguchi 755-8505, Japan; (A.N.); (H.S.); (A.S.); (I.T.)
| | - Hiroki Sakai
- Department of Legal Medicine, Yamaguchi University Graduate School of Medicine, Yamaguchi 755-8505, Japan; (A.N.); (H.S.); (A.S.); (I.T.)
| | - Azumi Shigemoto
- Department of Legal Medicine, Yamaguchi University Graduate School of Medicine, Yamaguchi 755-8505, Japan; (A.N.); (H.S.); (A.S.); (I.T.)
| | - Izumi Takase
- Department of Legal Medicine, Yamaguchi University Graduate School of Medicine, Yamaguchi 755-8505, Japan; (A.N.); (H.S.); (A.S.); (I.T.)
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Batra EK, Quinlan K, Palusci VJ, Needelman H, Collier A. Child Fatality Review. Pediatrics 2024; 153:e2023065481. [PMID: 38374813 DOI: 10.1542/peds.2023-065481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 02/21/2024] Open
Abstract
Understanding why children die is necessary to implement strategies to prevent future deaths and improve the health of any community. Child fatality review teams (CFRTs) have existed since the 1970s and provide a necessary framework to ensure that proper questions are asked about a child's death. CFRTs provide a vital function in a community to ensure that preventable causes of deaths are identified. Pediatricians are necessary members of CFRTs because they provide medical expertise and context around a child's death. All CFRTs should have pediatric physician representation, and results from team meetings should inform public policy at all levels of government. Pediatricians should be supported in their efforts to be present on CFRTs, and they should use data from team meetings to help advocate for implementing prevention strategies.
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Affiliation(s)
- Erich K Batra
- Departments of Pediatrics, and Family and Community Medicine, Penn State College of Medicine, Hershey, Pennsylvania
| | | | - Vincent J Palusci
- Department of Pediatrics, New York University Grossman School of Medicine, New York, New York
| | - Howard Needelman
- Department of Developmental Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Abby Collier
- National Center for Fatality Review and Prevention at MPHI, Okemos, Michigan
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3
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Mery JN, Vladescu JC, Day-Watkins J, Sidener TM, Reeve KF, Schnell LK. Training medical students to teach safe infant sleep environments using pyramidal behavioral skills training. J Appl Behav Anal 2022; 55:1239-1257. [PMID: 35854197 DOI: 10.1002/jaba.942] [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: 04/01/2021] [Accepted: 05/31/2022] [Indexed: 11/09/2022]
Abstract
Medical personnel play a critical role in caregiver safe infant sleep education. However, training outcomes in the safe infant sleep training literature have been mixed. Promising approaches that warrant further investigation are the use of behavioral skills training and pyramidal training. The current study consisted of two experiments. Experiment 1 extended Carrow et al. (2020) and Vladescu et al. (2020) by teaching medical students safe infant sleep practices using behavioral skills training. Discriminated responding was examined across trained and untrained environmental arrangements using a multiple-baseline design. All participants arranged safe sleep environments following behavioral skills training. In Experiment 2, we used pyramidal behavioral skills training to train medical students to teach others safe sleep practices. Results indicated high procedural integrity scores following training and generalization of skills.
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Salada KO, Badke CM. Missed Opportunities: Healthcare Encounters Prior to Sudden Unexpected Infant Death. Front Pediatr 2022; 10:880713. [PMID: 35592846 PMCID: PMC9110659 DOI: 10.3389/fped.2022.880713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/14/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Sudden unexpected infant death (SUID) is the leading cause of death in children 28 days to 1 year of age. The study aim was to identify opportunities for healthcare professionals to provide families with education on sleep and prevention of SUID. Methods We performed a retrospective chart review of SUID infants over 10 years (12/2010-12/2020). The study included patients 0-12 months who presented to single institution with SUID (including asphyxia, suffocation, and SIDS). Baseline descriptive characteristics, sleep patterns (location, position, co-sleeping, presence of pillows/blankets), and prior healthcare encounters (type, duration, frequency, timing) were described. Results Thirty-five infants met inclusion criteria. Twenty-three percent of families routinely practiced unsafe sleep, while 63% practiced unsafe sleep at the time of SUID. All unsafe sleep behaviors increased during the SUID event compared to routine, including inappropriate location (60%), co-sleeping (46%), and inappropriate position (37%) at the time of SUID. There were 54 total healthcare encounters (mean 1.5 per patient +/- 2.1) prior to SUID. Primary care physicians (57%) and NICU (29%) were the most frequent prior healthcare encounters, however visits spanned multiple specialties. Twenty-six percent had a healthcare encounter within 7 days of their death. Discussion We demonstrated the frequency and variability in healthcare encounters among SUID infants prior to their death. Majority of infants had prior healthcare encounters, with 26% seen by healthcare professionals within 7 days of their death. These results highlight the important role healthcare professionals across all specialties have the potential to play in educating families about safe sleep and SUID.
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Affiliation(s)
- Katherine O. Salada
- Division of Hospital Based Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Colleen M. Badke
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Division of Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
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Practicing What We Preach: An Effort to Improve Safe Sleep of Hospitalized Infants. Pediatr Qual Saf 2022; 7:e561. [PMID: 35720873 PMCID: PMC9197363 DOI: 10.1097/pq9.0000000000000561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/26/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction: To prevent sudden unexpected infant death, pediatric providers recommend the ABCs of infant sleep: Alone, on the Back, and in an empty Crib. This study’s objective was to document sleep practices of infants admitted to a large children’s hospital, examine adherence to American Academy of Pediatrics safe sleep guidelines, and develop interventions to improve guideline adherence. Methods: We conducted a pre/post quality improvement study at a single quaternary care medical center from 2015 to 2019. Infants 0 to younger than 12 months were observed in their sleeping environment pre- and post-implementation of multiple hospital-wide interventions to improve the sleep safety of hospitalized infants. Results: Only 1.3% of 221 infants observed preintervention met all ABCs of safe sleep; 10.6% of 237 infants met the ABCs of safe sleep postintervention. Significant improvements in the post-intervention cohort included sleeping in a crib (94% versus 80% preintervention; P < 0.001), avoidance of co-sleeping (3% versus 15% preintervention; P < 0.001), absence of supplies in the crib (58% versus 15% preintervention; P < 0.001), and presence of an empty crib (13% versus 2% preintervention; P < 0.001). Conclusions: Most infants hospitalized at our institution do not sleep in a safe environment. However, the implementation of a care bundle led to improvements in the sleep environment in the hospital. Further research is necessary to continue improving in-hospital safe sleep and to assess whether these practices impact the home sleep environment.
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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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7
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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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Molina AL, Harrison M, Dye C, Stoops C, Schmit EO. Improving Adherence to Safe Sleep Guidelines for Hospitalized Infants at a Children’s Hospital. Pediatr Qual Saf 2022; 7:e508. [PMID: 35071951 PMCID: PMC8782121 DOI: 10.1097/pq9.0000000000000508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/13/2021] [Indexed: 11/25/2022] Open
Abstract
Supplemental Digital Content is available in the text. Introduction: Sudden unexpected infant deaths are a major problem nationally. We had poor adherence to safe sleep recommendations locally at our institution. Given the significance of this problem, hospital administration at a tertiary children’s hospital tasked a multidisciplinary group of faculty and staff with improving sleep environments for hospitalized infants. Methods: Our safe sleep task force implemented targeted interventions using the American Academy of Pediatrics policy statement as the gold standard and based on hospital data to address areas of greatest nonadherence to recommendations. We aimed to improve weekly average adherence to 95% over 12 months. A proportions process control chart (p-chart) tracked average weekly adherence over a 52-week time frame. In addition, we performed Student’s t-testing to evaluate differences in adherence over time. Results: There was a significant improvement in overall adherence to safe sleep recommendations from baseline (M = 70.8%, SD 21.6) to end of study period (M = 94.7%, SD 10.0) [t(427) = −15.1, P ≤ 0.001]. Crib audits with 100% adherence increased from a baseline (M = 0%, SD 0) to the end of the study period M = 70.4%, SD = 46) [t(381)= −21.4, P ≤ 0.001]. This resulted in two trend shifts on the p-chart using Institute for Healthcare Improvement control chart rules. Conclusions: Targeted interventions using QI methodology led to significant increases in adherence to safe sleep guidelines. Notable improvements in behavior indicated significant changes in safe sleep culture. We also noted continued adherence in follow-up audits reflecting sustainability.
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Batra EK, Lewis M, Saravana D, Corr TE, Daymont C, Miller JR, Hackman NM, Mikula M, Ostrov BE, Fogel BN. Improving Hospital Infant Safe Sleep Compliance by Using Safety Prevention Bundle Methodology. Pediatrics 2021; 148:183392. [PMID: 34851414 DOI: 10.1542/peds.2020-033704] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Sudden unexpected infant death often results from unsafe sleep environments and is the leading cause of postneonatal mortality in the United States. Standardization of infant sleep environment education has been revealed to impact such deaths. This standardized approach is similar to safety prevention bundles typically used to monitor and improve health outcomes, such as those related to hospital-acquired conditions (HACs). We sought to use the HAC model to measure and improve adherence to safe sleep guidelines in an entire children's hospital. METHODS A hospital-wide safe sleep bundle was implemented on September 15, 2017. A safe sleep performance improvement team met monthly to review data and discuss ideas for improvement through the use of iterative plan-do-study-act cycles. Audits were performed monthly from March 2017 to October 2019 and monitored safe sleep parameters. Adherence was measured and reviewed through the use of statistical process control charts (p-charts). RESULTS Overall compliance improved from 9% to 72%. Head of bed flat increased from 62% to 93%, sleep space free of extra items increased from 52% to 81%, and caregiver education completed increased from 10% to 84%. The centerline for infant in supine position remained stable at 81%. CONCLUSIONS Using an HAC bundle safety prevention model to improve adherence to infant safe sleep guidelines is a feasible and effective method to improve the sleep environment for infants in all areas of a children's hospital.
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Affiliation(s)
- Erich K Batra
- Departments of Family and Community Medicine.,Pediatrics, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
| | - Mary Lewis
- Pediatrics, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
| | - Deepa Saravana
- Pediatrics, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
| | - Tammy E Corr
- Pediatrics, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
| | - Carrie Daymont
- Pediatrics, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
| | - Jennifer R Miller
- Pediatrics, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
| | - Nicole M Hackman
- Pediatrics, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
| | - Margaret Mikula
- Pediatrics, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania.,Samaritan Health Services, Corvallis, Oregon
| | - Barbara E Ostrov
- Department of Pediatrics, Bernard & Millie Duker Children's Hospital, Albany Medical Center, Albany, New York
| | - Benjamin N Fogel
- Pediatrics, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
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10
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Mitchell I, Wang DY, Troskie C, Loczy L, Li A, Paes B, Lanctôt K. What risk factors for sudden infant death syndrome are preterm and term medically complex infants exposed to at home? Paediatr Child Health 2021; 26:e184-e188. [PMID: 34262631 PMCID: PMC8274542 DOI: 10.1093/pch/pxaa070] [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: 11/03/2019] [Accepted: 05/07/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Risk factors for sudden infant death syndrome include premature birth, maternal smoking, prone or side sleeping position, sleeping with blankets, sharing a sleeping surface with an adult, and sleeping without an adult in the room. In this study, we compare parents' responses on sleep patterns in premature and term infants with medical complexity. METHODS Parents of children enrolled in the Canadian Respiratory Syncytial Virus Evaluation Study of Palivizumab were phoned monthly regarding their child's health status until the end of each respiratory syncytial virus season. Baseline data were obtained on patient demographics, medical history, and neonatal course. Responses on adherence to safe sleep recommendations were recorded as part of the assessment. RESULTS A total of 2,526 preterms and 670 term infants with medical complexity were enrolled. Statistically significant differences were found in maternal smoking rates between the two groups: 13.3% (preterm); 9.3% (term) infants (χ 2=8.1, df=1, P=0.004) and with respect to toys in the crib: 12.3% (term) versus 5.8% preterms (χ 2=24.5, df=1, P<0.0005). Preterm infants were also significantly more likely to be placed prone to sleep (8.8%), compared with term infants (3.3%), (χ 2=18.1, df=1, P<0.0005). CONCLUSION All the infants in this study had frequent medical contacts. There is a greater prevalence of some risk factors for sudden infant death syndrome in preterm infants compared to term infants with medical complexity. Specific educational interventions for vulnerable infants may be necessary.
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Affiliation(s)
- Ian Mitchell
- Department of Paediatrics, University of
Calgary, Calgary, Alberta
| | - Daniel Y Wang
- Medical Outcomes and Research in Economics (MORE®)
Research Group, Sunnybrook Health Sciences Centre, University of
Toronto, Toronto, Ontario
| | | | - Lisa Loczy
- Department of Paediatrics, University of
Calgary, Calgary, Alberta
| | - Abby Li
- Medical Outcomes and Research in Economics (MORE®)
Research Group, Sunnybrook Health Sciences Centre, University of
Toronto, Toronto, Ontario
| | - Bosco Paes
- Department of Paediatrics, McMaster
University, Hamilton, Ontario
| | - Krista Lanctôt
- Medical Outcomes and Research in Economics (MORE®)
Research Group, Sunnybrook Health Sciences Centre, University of
Toronto, Toronto, Ontario
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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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12
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Bechtel K, Gawel M, Vincent GA, Violano P. Impact of statewide safe sleep legislation on hospital practices and rates of sudden unexpected infant deaths. Inj Epidemiol 2020; 7:22. [PMID: 32532344 PMCID: PMC7291413 DOI: 10.1186/s40621-020-00247-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Sudden Unexpected Infant Death (SUID) is the leading cause of death in the post-neonatal period in the United States. In 2015, Connecticut (CT) passed legislation to reduce the number of SUIDs from hazardous sleep environments requiring birthing hospitals/centers provide anticipatory guidance on safe sleep to newborn caregivers before discharge. The objective of our study was to understand the barriers and facilitators for compliance with the safe sleep legislation by birthing hospitals and to determine the effect of this legislation on SUIDs associated with unsafe sleep environments. Methods We surveyed the directors and/or educators of the 27 birthing hospitals & one birthing center in CT, about the following: 1) methods of anticipatory guidance given to parents at newborn hospital discharge; 2) knowledge about the legislation; and 3) barriers and facilitators to complying with the law. We used a voluntary online, anonymous survey. In addition, we evaluated the proportion of SUID cases presented at the CT Child Fatality Review Panel as a result of unsafe sleep environments before (2011–2015) and after implementation of the legislation (2016–2018). Chi-Square and Fisher’s exact tests were used to evaluate the proportion of deaths due to Positional Asphyxia/Accident occurring before and after legislation implementation. Results All 27 birthing hospitals and the one birthing center in CT responded to the request for the method of anticipatory guidance provided to caregivers. All hospitals reported providing anticipatory guidance; the birthing center did not provide any anticipatory guidance. The materials provided by 26/27 (96%) of hospitals was consistent with the American Academy of Pediatrics (AAP) Guidelines. There was no significant change in rates of SUID in CT before (58.86/100,000) and after (55.92/100,000) the passage of the legislation (p = 0.78). However, more infants died from positional asphyxia after (20, 27.0%) than before the enactment of the law (p < 0.01). Conclusions Despite most CT hospitals providing caregivers with anticipatory guidance on safe sleep at newborn hospital discharge, SUIDs rates associated with positional asphyxia increased in CT after the passage of the legislation. The role of legislation for reducing the number of SUIDs from hazardous sleep environments should be reconsidered.
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Affiliation(s)
- Kirsten Bechtel
- Department of Pediatrics, Section of Pediatric Emergency Medicine, Yale School of Medicine, New Haven, CT, USA. .,Department of Injury Prevention, Community Outreach, and Research, Yale New Haven Hospital, New Haven, CT, USA. .,Child Fatality Review Panel, New Haven, CT, USA.
| | - Marcie Gawel
- Department of Injury Prevention, Community Outreach, and Research, Yale New Haven Hospital, New Haven, CT, USA
| | - Gregory A Vincent
- Child Fatality Review Panel, New Haven, CT, USA.,Office of the Chief Medical Examiner, New Haven, CT, USA
| | - Pina Violano
- Department of Injury Prevention, Community Outreach, and Research, Yale New Haven Hospital, New Haven, CT, USA.,Child Fatality Review Panel, New Haven, CT, USA
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13
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Kuhlmann S, Ahlers-Schmidt CR. The Use of the Child Fatality Review Committee to Contribute to a Longitudinal Quality Improvement Project on Safe Sleep. Hosp Pediatr 2018; 8:504-505. [PMID: 30026249 DOI: 10.1542/hpeds.2018-0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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