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      As easy as ABC: evaluation of safe sleep initiative on safe sleep compliance in a freestanding pediatric hospital

      1 , 1 , 3 , 4 , 5 , 2 , 3 , 5 , 5 , 5 , 6 ,
      Injury Epidemiology
      BioMed Central
      23rd Annual Injury Free Coalition for Kids Conference (Injury Free Coalition for Kids)
      30 November - 2 December 2018
      Pediatrics, Injury prevention, Infant mortality, Sleep safety, Sudden infant death syndrome, Intervention, Quality improvement

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          The American Academy of Pediatrics (AAP) recommends the ABCs of safe infant sleep (alone, back, clear crib) to combat the increasing rates of Sudden Unexplained Infant Death (SUID). It is unclear if these recommendations are followed for infants hospitalized in pediatric facilities after the newborn period. The objectives of this study were to assess baseline infant sleep behaviors at a tertiary care freestanding pediatric hospital and to evaluate the effectiveness of a hospital-based infant safe sleep program in improving adherence to safe sleep recommendations.


          A quality improvement program with pre- and post- analyses was performed on a convenience sample of infants < 12-months old utilizing a crib audit tool on two general pediatric inpatient units. The crib audit tool was used before and after the safe sleep program intervention. It recorded the infant’s sleep position, location during sleep, and sleep environment. Interventions included: 1) nursing education, 2) crib cards with a checklist of the ABC’s of safe sleep provided for the cribs of hospitalized infants, and 3) tracking boards to report weekly measured compliance with the ABCs. Chi square analysis was used to compare adherence to recommendations before and after program implementation.


          There were 62 cribs included pre-intervention and 90 cribs post-intervention. Overall, there was no significant change in safe sleep positioning (81% to 82%, p = 0.97). There was a significant increase in adherence to the safe sleep environment recommendation (3% to 38%, p < 0.01). Overall safe sleep, including both position and environment, referred to as ABC compliance, improved from 3% pre-intervention to 34% post-intervention ( p < 0.01). Only 18% of cribs audited displayed a crib card, demonstrating poor compliance on placement of the cards. There was no significant difference in compliance with safe sleep recommendations between infants with a crib card compared to those without (25% vs. 37%, p = 0.51).


          Significant improvements were made in sleep environments and overall safe sleep compliance after introduction of crib cards and tracking boards. Most likely the crib auditing process itself and the tracking boards had a larger impact than the crib cards.

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          Most cited references18

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          SIDS and Other Sleep-Related Infant Deaths: Evidence Base for 2016 Updated Recommendations for a Safe Infant Sleeping Environment.

          Approximately 3500 infants die annually in the United States from sleep-related infant deaths, including sudden infant death syndrome (SIDS), ill-defined deaths, and accidental suffocation and strangulation in bed. After an initial decrease in the 1990s, the overall sleep-related infant death rate has not declined in more recent years. Many of the modifiable and nonmodifiable risk factors for SIDS and other sleep-related infant deaths are strikingly similar. The American Academy of Pediatrics recommends a safe sleep environment that can reduce the risk of all sleep-related infant deaths. Recommendations for a safe sleep environment include supine positioning, use of a firm sleep surface, room-sharing without bed-sharing, and avoidance of soft bedding and overheating. Additional recommendations for SIDS risk reduction include avoidance of exposure to smoke, alcohol, and illicit drugs; breastfeeding; routine immunization; and use of a pacifier. New evidence and rationale for recommendations are presented for skin-to-skin care for newborn infants, bedside and in-bed sleepers, sleeping on couches/armchairs and in sitting devices, and use of soft bedding after 4 months of age. In addition, expanded recommendations for infant sleep location are included. The recommendations and strength of evidence for each recommendation are published in the accompanying policy statement, "SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment," which is included in this issue.
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            Trends in infant bedding use: National Infant Sleep Position study, 1993-2010.

            Use of potentially hazardous bedding, as defined by the American Academy of Pediatrics (eg, pillows, quilts, comforters, loose bedding), is a modifiable risk factor for sudden infant death syndrome and unintentional sleep-related suffocation. The proportion of US infants sleeping with these types of bedding is unknown.
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              Factors Associated With Choice of Infant Sleep Position.

              The American Academy of Pediatrics recommends infants be placed supine for sleep. Our objectives in this study were to, in a nationally representative sample, examine (1) prevalence of maternal intention regarding infant sleeping position and of actual practice and (2) factors associated with their choices.

                Author and article information

                Inj Epidemiol
                Inj Epidemiol
                Injury Epidemiology
                BioMed Central (London )
                29 May 2019
                29 May 2019
                : 6
                Issue : Suppl 1 Issue sponsor : Publication of this supplement has been supported by the Injury Free Coalition for Kids. The articles have undergone the journal's standard peer review process for supplements. The Supplement Editor declares that she has no competing interests.
                [1 ]ISNI 0000 0001 0941 6502, GRID grid.189967.8, Rollins School of Public Health, , Emory University, ; Atlanta, GA USA
                [2 ]ISNI 0000 0004 4692 4364, GRID grid.420388.5, Georgia Department of Public Health, ; Atlanta, GA USA
                [3 ]ISNI 0000 0001 0941 6502, GRID grid.189967.8, Department of Pediatrics, , Emory University School of Medicine, ; Atlanta, GA USA
                [4 ]ISNI 0000 0001 0941 6502, GRID grid.189967.8, Department of Emergency Medicine, , Emory University School of Medicine, ; Atlanta, GA USA
                [5 ]ISNI 0000 0004 0371 6071, GRID grid.428158.2, Children’s Healthcare of Atlanta, ; Atlanta, GA USA
                [6 ]Pediatric Emergency Medicine Associates, Atlanta, GA USA
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                23rd Annual Injury Free Coalition for Kids Conference
                Injury Free Coalition for Kids
                Fort Lauderdale, FL, USA
                30 November - 2 December 2018
                Custom metadata
                © The Author(s) 2019

                pediatrics,injury prevention,infant mortality,sleep safety,sudden infant death syndrome,intervention,quality improvement


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