Implementation of the American Academy of Pediatrics Recommendations to Reduce Sudden Infant Death Syndrome Risk in Neonatal Intensive Care Units

Grazel, Regina; Phalen, Ann Gibbons; Polomano, Rosemary C.

doi:10.1097/anc.0b013e3181f36ea0

Cited by 44 publications

(32 citation statements)

References 26 publications

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“…Similar to other studies, 24,25 we found high levels of nurse knowledge about SSP, particularly regarding supine position. The significant improvement we observed in knowledge of recommendations for flat HOB, empty cribs, and appropriate bundling after education was also consistent with previous work.…”

Section: Discussionsupporting

confidence: 76%

Improving Safe Sleep Practices for Hospitalized Infants

et al. 2016

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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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Section: Discussionsupporting

confidence: 76%

Improving Safe Sleep Practices for Hospitalized Infants

et al. 2016

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“…2 Although preterm infants are at higher risk for SIDS/ SUIDs, with the association between prone sleep positioning and SIDS among low birth weight infants possibly even stronger than for term infants, 3 safe sleep practices (SSP) are rarely integrated into the routine clinical care of these infants. 4 The American Academy of Pediatrics Task Force on SIDS recommends that preterm infants be placed in supine sleep position by 32 weeks postmenstrual age if they are clinically stable. 2 Despite these recommendations, preterm infants are less likely than term infants to be placed supine in the hospital, as well as after discharge to home.…”

Section: Introductionmentioning

confidence: 99%

Implementation of safe sleep practices in the neonatal intensive care unit

et al. 2015

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OBJECTIVE: To increase the percentage of eligible infants engaging in safe sleep practices (SSP) in two level III neonatal intensive care units (NICUs) in the Boston, Massachusetts area. STUDY DESIGN: On the basis of eligibility criteria (⩾34 weeks or ⩾ 1800 g without acute medical conditions), all infants were eligible for two sleep practices: SSP or NICU therapeutic positioning (NTP) depending on their gestational age, weight, clinical illness and need for therapeutic interventions. Compliance with SSP was defined as: (1) supine positioning, (2) in a flat crib with no incline, (3) without positioning devices and (4) without toys, comforters or fluffy blankets. NTP comprised usual NICU care. Nursing education was comprised of a web-based learning module and in-person teaching sessions with a study team member. Doublesided crib cards (SSP one side and NTP on the other) were attached to the bedside of every infant. Pre-and postintervention audits of all infants were carried out at both study sites. We compared compliance across all time points using generalized estimating equations to account for correlated data (SAS v9.3, Cary, NC, USA). RESULT: Of 755 cases, 395 (52.3%) were assessed to be eligible for SSP. From the pre-to post-intervention period, there was a significant improvement in overall compliance with SSP (25.9 to 79.7%; P-value o0.001). Adherence to each component of SSP also improved significantly following the intervention. CONCLUSION: Safe infant sleep practices can be integrated into the routine care of preterm infants in the NICU. Modeling SSP to families far in advance of hospital discharge may improve adherence to SSP at home and reduce the risk of sleep-related morbidity and mortality in this vulnerable population of infants.

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“…One study of NICU nurses found that only 50% of nurses place preterm infants supine during the transition to an open crib, and more than 20% never place preterm infants supine or will only place them supine 1 to 2 days before discharge. 109 Moreover, very prematurely born infants studied before hospital discharge have longer sleep duration, fewer arousals from sleep, and increased central apneas while in the prone position. 88 The task force believes that neonatologists, neonatal nurses, and other health care professionals responsible for organizing the hospital discharge of infants from NICUs should be vigilant about endorsing SIDS risk-reduction recommendations from birth.…”

Section: Preterm Infants Should Be Placed Supine As Soon As Possiblementioning

confidence: 99%

SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment

Moon¹

2011

Pediatrics

217

115

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Despite a major decrease in the incidence of sudden infant death syndrome (SIDS) since the American Academy of Pediatrics (AAP) released its recommendation in 1992 that infants be placed for sleep in a nonprone position, this decline has plateaued in recent years. Concurrently, other causes of sudden unexpected infant death occurring during sleep (sleep-related deaths), including suffocation, asphyxia, and entrapment, and ill-defined or unspecified causes of death have increased in incidence, particularly since the AAP published its last statement on SIDS in 2005. It has become increasingly important to address these other causes of sleep-related infant death. Many of the modifiable and nonmodifiable risk factors for SIDS and suffocation are strikingly similar. The AAP, therefore, is expanding its recommendations from being only SIDS-focused to focusing on a safe sleep environment that can reduce the risk of all sleep-related infant deaths including SIDS. The recommendations described in this report include supine positioning, use of a firm sleep surface, breastfeeding, room-sharing without bed-sharing, routine immunization, consideration of a pacifier, and avoidance of soft bedding, overheating, and exposure to tobacco smoke, alcohol, and illicit drugs. The rationale for these recommendations is discussed in detail in this technical report. The recommendations are published in the accompanying “Policy Statement—Sudden Infant Death Syndrome and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment,” which is included in this issue (www.pediatrics.org/cgi/doi/10.1542/peds.2011-2220).

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Implementation of the American Academy of Pediatrics Recommendations to Reduce Sudden Infant Death Syndrome Risk in Neonatal Intensive Care Units

Abstract: NICU nurses are in influential positions to educate parents and model SIDS risk-reduction strategies. This study supports other published research that points to inconsistencies in nursing practice regarding implementation of methods to reduce the risk of SIDS.

Cited by 44 publications

References 26 publications

Improving Safe Sleep Practices for Hospitalized Infants

Improving Safe Sleep Practices for Hospitalized Infants

Implementation of safe sleep practices in the neonatal intensive care unit

SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment

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