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

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Original Research

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

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

References

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The opinion question was recorded as a narrative response during the interview. For data analysis, the responses were coded into 4 categories: agree, disagree, no opinion, or other Table 1. Three of the authors (J.E.D., R.L.P., P.G.S.) independently coded the opinion statements from the 1992 and 1999 surveys, and any discrepancies were resolved by consensus. The same coding criteria were used for both surveys. The data were analyzed using SAS software (SAS Institute, Cary, NC).

Our study was granted an exemption by the institutional review board at the University of Missouri–Columbia.

Results

In 1992 there were 79 hospitals with newborn nurseries in Missouri, and by 1999 this number had decreased to 75; however, the average number of nursery beds per hospital remained relatively constant with 16 in 1992 (median=12) and 15 in 1999 (median=12). For both surveys all hospitals with newborn nurseries in Missouri were contacted and agreed to participate.

In 1992, 92% of the head nurses were aware of the AAP recommendation for back or side sleeping position. By 1999, all were aware of the recommendation; however, the percentage of nurseries with an infant sleep position policy decreased from 98% to 95%.

Marked changes occurred in the infant sleep position used in these nurseries in the 7 years between surveys. In 1992, 32% of the survey respondents reported that their usual practice or policy was to use the prone position (exclusively) or stomach or side for sleep. In 1999, none of the respondents reported using the prone position as usual practice Table 2. Reported use of the supine position and of both supine and lateral position increased dramatically between 1992 and 1999 while exclusive use of side positioning decreased. Several of the nurses stated that they still place some babies on their stomach in the nursery and justified this by stating that they do not tell the parents or they watch the babies closely.

The positioning advice given to parents changed from 1992 to 1999, with more hospitals advising use of supine position exclusively or both the supine and the lateral position. In 1999, no nursery staff advised parents to place their babies prone. The position respondents stated that they used in the nursery and that they advised parents at discharge were highly correlated in 1999 but less so in 1992. The percentage agreement between the position used in the nursery and the advice given to parents in 1992 was 68% ({k}=0.52) and had increased to 75% ({k}=0.57) in 1999.

The proportion of respondents who agreed with the AAP recommendation increased between 1992 and 1999, while the proportion disagreeing decreased. Even so, in 1999 25% of the respondents stated opinions disagreeing with the recommendation.

The nurses who disagreed with the AAP recommendation in 1992 were more likely to state use of the prone position was their usual practice than respondents who agreed (68% vs 0%). In 1999 none of the respondents reported that prone position was their usual practice, and no respondent who disagreed with the recommendation used the supine position exclusively. Conversely, 36% of 1999 respondents who agreed with the recommendation placed babies exclusively on their backs (data not shown).

Discussion

This is the first published study that reports how newborn nurseries have implemented the AAP recommendations for infant sleep positioning. Our 2 surveys of head nurses in all newborn nurseries in Missouri show a significant change in nursery practice and nursing advice since the publication of the AAP statement on infant sleep positioning in 1992.

We were surprised to learn that 4 nurseries reported no infant sleep position policies or standard practice, but were encouraged by the overall decline in prone and exclusively side positioning. In 1992, 84% of Missouri nurseries were routinely placing babies prone or on their side. Both of these positions are of concern: Side positioning is the least stable, and both prone and side positioning are associated with an increased risk of SIDS.^2,7,8 In 1999, 78% of head nurses reported back or back or side positioning as their standard practice, and only 23% still used side positioning as their standard practice. Head nurses report that prone positioning is no longer a standard practice in any Missouri nursery, but some nurses indicate a willingness to make exceptions for “spitty” babies and immediately after feeding.

Nursery advice to parents about positioning has also changed. In 1992, 80% of head nurses advised parents to place their babies either on their sides or prone. In 1999, 8% still advised side; 20% recommended supine; and 72% recommended either back or side. No head nurses reported that placing babies prone for sleep was standard advice.