Transition to a Safe Home Sleep Environment for the NICU Patient

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. INTRODUCTIONAccording to the 2016 policy statement from the American Academy of Pediatrics (AAP) Task Force on Sudden Infant Death Syndrome, all infants, including preterm and low birth weight infants, in the NICU should be placed in the supine position for sleep as soon as they are

The Experiences and Perceptions of Neonatal Clinicians When Using a Responsive Bassinet

“…The American Academy of Pediatrics recommends infants be positioned supine when sleeping, which has been shown to decrease the incidence of sudden infant death syndrome. 22 It is also recommended that safe home sleep practices are used in the NICU when there are no medical contraindications and that safe sleep is modeled for parents, 23 yet many NICUs do not adhere to safe sleep recommendations. 24 , 25 Preintervention data gathered from a Level IV NICU for a recent quality improvement study showed that 87% of infants were in an unsafe sleep environment.…”

Transition to Safe Sleep at Home Needs a Consistent Approach for NICU Babies and Their Parents

“…Several standardized programs have been successful and include policies consistent with the AAP recommendations on sleep safety, education for providers and families, visible prompts, modeling of safe sleeping while in the hospital, algorithms for assessment of readiness for safe sleep readiness, and quality improvement audits during hospitalization and postdischarge. The AAP (Goodstein et al, 2021) report provides detailed recommendations for each of the clinical issues discussed, the messages for all conditions are consistent and strong. Although there are commonly used therapeutic interventions used in the treatment of NICU patients that are not consistent with home infant sleep safety, use of these therapeutic interventions should be minimized as much as is medically feasible and when necessary, should be discontinued as soon as possible (Goodstein et al).…”

“…The latest AAP report (Goodstein et al, 2021) provides an in-depth review of literature on the relationship between the clinical issues of respiratory distress, apnea, hyperbilirubinemia, gastroesophageal refl ux, and neonatal opioid withdrawal syndrome and how care techniques, specifi cally nonsupine positioning as well as swaddling and skin-to-skin care, affects infant sleep safety. As the majority of NICU patients commonly require care that is inconsistent with safe sleep recommendations, it is understandable that providers and parents can easily become confused.…”