Sleeping Position: Change in Practice, Advice, and Opinion in the Newborn Nursery

,

Original Research

Sleeping Position: Change in Practice, Advice, and Opinion in the Newborn Nursery

J Fam Pract. 2001 May;50(5):448

By

John E. Delzell Jr, MD, MSPH

References

1. National Center for Health Statistics. Births and deaths: United States, 1995. Hyattsville, Md: US Department of Health and Human Services, Public Health Service, Center for Disease Control; 1996.

2. Willinger M, Hoffman HJ, Wu KT, et al. Factors associated with the transition to nonprone sleep positions of infants in the United States: the National Infant Sleep Position Study. JAMA 1998;280:329-35.

3. Willinger M. SIDS prevention. Pediatr Ann 1995;24:358-64.

4. American Academy of Pediatrics AAP Task Force on Infant Positioning and SIDS. Positioning and SIDS. Pediatrics 1992;89:1120-26.

5. Willinger M, Hoffman HJ, Hartford RB. Infant sleep position and risk for sudden infant death syndrome: report of meeting held January 13 and 14, 1994, National Institutes of Health, Bethesda, Md. Pediatrics 1994;93:814-19.

6. Clinton Administration announces expanded Back to Sleep campaign: Tipper Gore to lead new effort Rockville, Md, 1997. January 12, 2000. National Institute of Child Health and Human Development. February 9, 2000. Available at: www.nichd.nih.gov/sids/clinton.htm.

7. Fleming PJ, Blair PS, Bacon C, et al. Environment of infants during sleep and risk of the sudden infant death syndrome: results of 1993-5 case-control study for confidential inquiry into stillbirths and deaths in infancy. Confidential enquiry into stillbirths and deaths regional coordinators and researchers. BMJ 1996;313:191-95.

8. Mitchell EA, Tuohy PG, Brunt JM, et al. Risk factors for sudden infant death syndrome following the prevention campaign in New Zealand: a prospective study. Pediatrics 1997;100:835-40.

9. Brenner RA, Simons-Morton BG, Bhaskar B, et al. Prevalence and predictors of the prone sleep position among inner-city infants. JAMA 1998;280:341-46.

10. Willinger M, Ko C, Hoffman HJ, et al. Factors associated with caregivers’ choice of infant sleep position, 1994-1998. JAMA 2000;283:2135-42.

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12. Scheidt P, Willinger M, Hoffman H, et al. Recommended infant sleep positions for reduction of SIDS Risk. Am J Dis Children 1993;147:462.-

13. Missouri Department of Health Missouri hospital profiles 1997. Jefferson City, Mo: Missouri Department of Health, Center for Health Information Management and Epidemiology, State Center for Health Statistics; 1998.

14. Longo DR, Brownson RC, Johnson JC, et al. Hospital smoking bans and employee smoking behavior: results of a national survey. JAMA 1996;275:1252-57.

15. Grimshaw JM, Russell IT. Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet 1993;342:1317-22.

16. Cabana MD, Rand CS, Powe NR, et al. Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA 1999;282:1458-65.

17. Lesko SM, Corwin MJ, Vezina RM, et al. Changes in sleep position during infancy: a prospective longitudinal assessment. JAMA 1998;280:336-40.

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OBJECTIVE: Sudden infant death syndrome (SIDS) is a major cause of infant mortality and is associated with the prone sleeping position. Our goal was to determine changes in newborn nursery policies and practices regarding infant sleeping position between 1992 and 1999.

STUDY DESIGN: We conducted telephone interviews with the head nurses in all of the newborn nurseries in Missouri.

POPULATION: In 1992 there were 79 hospitals in Missouri with newborn nurseries; in 1999 that number had decreased to 75.

OUTCOMES MEASURED: During the interviews, we solicited nursery infant sleep position policy and practice, head nurses’ opinions about the supine sleep recommendation, and nurses’ advice to parents regarding sleep position.

RESULTS: In 1992, 32% of the nurseries used the prone position for sleep, and 58% of the head nurses interviewed disagreed with the recommendations of the American Academy of Pediatrics (AAP). By 1999, all newborn nurseries in Missouri placed infants on their backs or sides for sleep. The rate of disagreement with the AAP recommendation had decreased, with 25% of respondents indicating that they disagreed.

CONCLUSIONS: From 1992 to 1999 nurseries in Missouri have changed from predominantly using prone and lateral positioning to lateral and supine positioning for newborns. Some nurses continue to voice concern about placing infants on their backs and expressed a willingness to place babies prone. Since there is agreement between nurses’ usual infant positioning and the advice given to parents, and because both are important influences on infant positioning by parents, future campaigns to decrease SIDS should emphasize correcting nurses’ positioning behavior and advising parents to increase infant supine positioning.

Sudden infant death syndrome (SIDS) is the leading cause of postneonatal infant mortality in the United States, accounting for approximately one third of all such deaths.¹ Between 1992 and 1996 the rate of SIDS deaths in the United States declined from 1.2 per 1000 live births to 0.74 per 1000 live births, and this decline accounted for 75% of the decline in the postneonatal infant death rate.²

By 1990 a strong association between the prone sleeping position and SIDS had been established,³ and in 1992 the American Academy of Pediatrics (AAP) Task Force on Infant Positioning and SIDS recommended that all full-term infants be placed in the lateral or supine position for sleep.^4,5 The Back to Sleep campaign was launched in 1994 by the US Department of Health and Human Services and other partners to help disseminate the message that back sleeping can reduce the risk of SIDS and save lives.^2,6 Studies in other countries indicated that SIDS rates declined concurrent with decreases in the prevalence of prone sleeping.³ Between 1992 and 1995 the SIDS rate in the United States declined 30%, while the prevalence of prone sleeping decreased from 78% to 43%.¹ Since the initial AAP recommendations, additional evidence has accumulated supporting supine or side positioning^7,8 and more recently that side positioning carries a higher risk for SIDS than supine.⁷

The recommendation of a health care professional and observation of sleep position in the hospital have both been shown to be important determinants in parents’ decision making about infant sleep position.^2,9,10 Although there are several studies of sleep positioning by caregivers and of sleep position recommendations by health care providers, there is only one study of nursery nursing staff regarding infant sleep position.^2,9,11,12 The National Institute of Child Health and Human Development has conducted a survey of health professionals regarding infant sleep position since 1993, but the results have not been published.⁹ Our study was initiated to assess the infant sleep position policies and practices of newborn nurseries in Missouri and evaluate nursery staff opinions of the AAP recommendation shortly after the recommendation was released in 1992 and again in 1999.

Methods

Study Design

A nurse interviewer conducted a telephone survey of all newborn nurseries in Missouri in 1992 and 1999. The Missouri Department of Health hospital profile database was used to identify hospitals with newborn nurseries before both surveys.¹³ An experienced obstetric nurse clinician contacted each hospital newborn nursery, spoke to the head nurse or charge nurse, and invited that nurse to participate in a short survey on infant sleep position.

After agreeing to participate, respondents were asked 10 questions about the policy and practice for infant sleep positioning in the nursery, what position they advise parents to use on discharge, and their opinion of the AAP recommendation. To maintain consistency between the 1992 and 1999 surveys, the 1999 survey was modified for date references and deletion of a question about any recent changes to their sleep position policy.