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      A Statewide Hospital-Based Safe Infant Sleep Initiative: Measurement of Parental Knowledge and Behavior

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          Abstract

          Sleep-related infant deaths are a leading cause of infant mortality in Georgia, and these deaths are largely associated with unsafe sleep practices among caregivers. In early 2016, the Georgia Department of Public Health launched the Georgia Safe to Sleep Hospital Initiative, providing hospitals with safe infant sleep information and educational materials to be distributed to families and newborns. This study examined the knowledge and behaviors of a sample of Georgia parents after the implementation of the Hospital Initiative and identified the family characteristics and intervention components most closely associated with the knowledge and practice of safe infant sleep. The primary caretakers of all infants born in Georgia from August to October 2016 were invited to complete a web-based survey 1 month after hospital discharge. The final sample size included 420 parents of newborns, and the primary outcomes assessed included two measures of knowledge and four measures of infant sleep behaviors regarding infant sleep position and location. Most respondents demonstrated knowledge of the correct recommended sleep position (90%) and location (85%). Logistic regression revealed that receipt of information in the hospital was significantly correlated with safe sleep behaviors, and infant sleep habits tended to influence safe sleep practices. Additionally, Medicaid parents receiving bassinets from the hospital were 74% less likely to bed share (OR 0.26; 95% CI 0.007). Implementation of a statewide hospital initiative was associated with high levels of parental knowledge and behavior and may have been successful in reducing the practice of bed sharing among Medicaid parents.

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          The online version of this article (10.1007/s10900-017-0449-x) contains supplementary material, which is available to authorized users.

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          Most cited references24

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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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            Relationships among infant sleep patterns, maternal fatigue, and development of depressive symptomatology.

            Postpartum depression is a serious condition for women after childbirth. Although its etiology is unclear, one potentially important predictive variable that has received little attention is maternal sleep deprivation. The objective of this study was to examine relationships among infant sleep patterns, maternal fatigue, and the development of postpartum depression in women with no major depressive symptomatology at 1 week postpartum. As part of a population-based postpartum depression study, 505 women who had an Edinburgh Postnatal Depression Scale (EPDS) score 12) at 4 and 8 weeks were significantly more likely to report that their baby cried often, be woken up 3 times or more between 10 pm and 6 am, have received less than 6 hours of sleep in a 24-hour period over the past week, indicate that their baby did not sleep well, and think that their baby's sleep pattern did not allow them to get a reasonable amount of sleep. Consistent with these findings, mothers with an EPDS score > 12 were significantly more likely to respond that they often felt tired. These results suggest that infant sleep patterns and maternal fatigue are strongly associated with a new onset of depressive symptoms in the postpartum period, and provide support for the development of postpartum depression preventive interventions designed to reduce sleep deprivation in the early weeks postpartum.
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              Risk Factors, Protective Factors, and Current Recommendations to Reduce Sudden Infant Death Syndrome

              Sudden infant death syndrome remains the leading cause of death in infants aged 1 month to 1 year in the United States.
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                Author and article information

                Contributors
                rlwalcott@uga.edu
                Journal
                J Community Health
                J Community Health
                Journal of Community Health
                Springer US (New York )
                0094-5145
                1573-3610
                29 November 2017
                29 November 2017
                2018
                : 43
                : 3
                : 534-542
                Affiliations
                [1 ]ISNI 0000 0004 1936 738X, GRID grid.213876.9, Department of Health Policy and Management, College of Public Health, , University of Georgia, ; Athens, GA 30602 USA
                [2 ]ISNI 0000 0001 0695 7223, GRID grid.267468.9, Helen Bader School of Social Welfare, , University of Wisconsin-Milwaukee, ; Milwaukee, WI 53201 USA
                [3 ]ISNI 0000 0004 4692 4364, GRID grid.420388.5, Division of Health Protection and Safety, , Georgia Department of Public Health, ; Atlanta, GA 30303 USA
                Author information
                http://orcid.org/0000-0002-5841-3022
                Article
                449
                10.1007/s10900-017-0449-x
                5919986
                29188464
                ba30a67a-70d5-4bf9-a09b-ff8f3c83e248
                © The Author(s) 2017

                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.

                History
                Funding
                Funded by: Georgia Department of Public Health
                Categories
                Original Paper
                Custom metadata
                © Springer Science+Business Media, LLC, part of Springer Nature 2018

                Health & Social care
                safe sleep education,sudden infant death syndrome (sids),sleep position,sleep practices,infant sleep

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