Sudden infant death syndrome (SIDS) is the leading cause of post-neonatal mortality in the U.S. and Massachusetts. One of the major risk factors for SIDS is preterm birth (< 37 weeks). For instance, infants born at 28-32 weeks gestational age have a greater than 2-fold risk of SIDS compared to term infants. Although preterm infants are at higher risk for SIDS, safe sleep practices are rarely integrated into the routine clinical care of these infants. The American Academy of Pediatrics (AAP) defines safe sleep as supine sleeping positioning in a safety approved crib without positioning devices and free of quilts, comforters, and other soft surfaces. The AAP Task Force on SIDS recommends that preterm infants be placed supine by 32 weeks postmenstrual age if they are clinically stable. Despite these recommendations, preterm infants are less likely to be placed supine in the hospital as well as after discharge to home.
Through our analysis of Massachusetts PRAMS data (2007-2010), we demonstrated that late preterm infants were less likely to be placed in supine sleep position after hospital discharge. In addition, we showed that 14% of late preterm and term infants were co-sleeping on an adult bed.
With the findings of this study highlighting the need to standardize the infant sleep environment in hospital settings as well as parent education of safe sleep practices, we developed the NICU Safe Sleep Collaborative. The primary aim of this initiative was to increase the use of safe sleep practices (SSP) among high risk infants discharged from MA NICUs.
- To increase the percentage of eligible infants engaging in safe sleep practices in neonatal intensive care units (NICU) to 90% in 1 year;
- To increase the percentage of infants discharged infants from the NICU who engage in safe sleep practices at home to 90% in 1 year;
- To increase the percentage of infants engaging in each component of SSP (defined as: supine positioning, flat head of bed, crib empty of positioning devices and soft objects) to 90% in 1 year;
- To increase NICU nursing staff education about SIDS and unsafe sleep practices to 100% of all staff in 1 year; and
- To increase education of parents about safe sleep practices by NICU staff prior to discharge to 100% in 1 year.
The project was formally launched in July 2015. The first two years of the project saw participating level III units achieve in increase in safe sleep compliance for eligible infants from 47.7% to 81.0%. These results were published in the Journal of Perinatology.
Since 2017, the project has expanded to include several level II units, and this growth continues in 2018. In addition, project members worked on developing systems to measure outcomes and care practices after hospital discharge. The project formally wrapped up in 2019.