Improving Infant Sleep Safety Through a Comprehensive Hospital-Based Program

Abstract

We evaluated a comprehensive hospital-based infant safe sleep education program on parental education and safe sleep behaviors in the home using a cross-sectional survey of new parents at hospital discharge (HD) and 4-month follow-up (F/U). Knowledge and practices of infant safe sleep were compared to the National Infant Sleep Position Study benchmark. There were 1092 HD and 490 F/U surveys. Supine sleep knowledge was 99.8% at HD; 94.8% of families planned to always use this position. At F/U, 97.3% retained supine knowledge, and 84.9% maintained this position exclusively ( P < .01). Knowledge of crib as safest surface was 99.8% at HD and 99.5% F/U. Use in the parents’ room fell to 91.9% (HD) and 68.2% (F/U). Compared to the National Infant Sleep Position Study, the F/U group was more likely to use supine positioning and a bassinette or crib. Reinforcing the infant sleep safety message through intensive hospital-based education improves parental compliance with sudden infant death syndrome risk reduction guidelines.

Improving Safe Sleep Practices for Hospitalized Infants

“…Examples of potentially effective strategies include structured programs that combine modeling with caregiver education videos and SSP-specific discharge instructions mirroring efforts from newborn nurseries and ICUs. 14,16,23 Despite significant improvements in nurse knowledge and many hospital practices, reported adherence of caregivers to SSP recommendations at home did not demonstrate significant changes after our implementation of SSP. Several potential explanations exist for this finding.…”

“…14,23 Previous quality improvement efforts have demonstrated improvement in adherence to individual SSP components 14 or a more limited assessment of complete adherence to SSP guidelines (eg, sleeping alone, supine, and in a crib). 16 We sought to investigate a more comprehensive assessment of adherence to all SSP recommended by the AAP.…”

“…Families may hold similar beliefs about SSP, 7, 24 creating a secondary barrier to adherence in the hospital. Parental preference has also been demonstrated to be a barrier to perfect practice of sleep recommendations 23 and may contribute to the lack of improvement in some measures. For example, our observed rates of supine sleep positioning mirror national rates of supine sleep positioning in the home, 8 suggesting to us that future Plan-Do-StudyAct cycles will need to incorporate consideration of current caregiver practices into the development of improvement activities.…”

Maternal Report of Advice Received for Infant Care

“…There is some evidence that a multimodal approach may be most promising in improving the quality and quantity of advice reported by mothers. 24 We are currently undertaking an intervention trial at 16 of the SAFE study hospitals to assess a multimodal approach to improving recommendation consistent messaging for infant care practices.…”

Parental Advice: Given Perhaps, but Not Received

“…A recent study of comprehensive safe-sleep education presented via videos, brochures, and formal and informal teaching by nurses and doctors in 2 nurseries increased retention of safe-sleep knowledge at 4 months compared with the National Infant Sleep Prevention baseline. 9 Ensuring that intensive efforts like this become the norm at hospitals, prenatal visits, and well-child visits would go a long way toward changing sleep-safety culture.…”