Editor's Note: Dr. Claire Castellano (she/her/hers) is a resident physician in pediatrics at the Children’s Hospital of Philadelphia. In addition to her MD, Claire has a Master’s in Public Health, focusing on global epidemiology. Claire hopes to combine her interests in medical education and global health in her career as a pediatrician. -Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics
Sudden unexpected infant death (SUID) tragically remains one of the most common causes of infant mortality in the nation and in Pennsylvania. Although there are many factors associated with SUID, unsafe sleep is associated with over 70% of SUID cases, according to data from the CDC. The American Academy of Pediatrics has recommendations for safe sleep to prevent SUID.
The CDC’s Pregnancy Risk Assessment Monitoring System (PRAMS) survey collects data regarding factors related to infant morbidity and mortality, including safe sleep, from mothers nationwide during the 2–6 month postpartum period.
In 2016, the Pennsylvania Department of Health (PADOH) started a comprehensive hospital-based safe sleep initiative for newborns, focused on education to staff and parents (through posters, videos, and brochures) and behavior modeling safe sleep for infants in the hospital. For 5 years (2017–2021), 27 hospitals in Pennsylvania implemented this intervention for newborns in the well-baby nursery.
Dr. Zhen-qiang Ma and colleagues at the PADOH retrospectively analyzed 2017–2021 PRAMS data to assess the effectiveness of this intervention, and their study, “A Hospital-Based Initiative for Infant Safe Sleep Practices,” is being released early in Pediatrics this week (10.1542/peds.2024-067659).
The authors compared data from mother-infant dyads at hospitals with and without the safe sleep initiative. They inquired about 4 safe sleep practices in the 2–6 months following birth:
- Placing infant to sleep on back
- Placing infant to sleep on a separate surface
- Placing infant to sleep without soft bedding
- Roomsharing without bedsharing
Among the group exposed to the safe sleep initiative, there was a:
- 72% increase in placing infant to sleep on back
- 48% increase in placing infant to sleep on a separate surface
- 41% increase in placing infant to sleep without soft bedding
- No significant change in roomsharing without bedsharing
In addition, respondents exposed to the initiative were 38% more likely to recommend safe sleep practices to others.
Although there were additional factors, including parental smoking status, breastfeeding, race, and insurance status, affecting safe sleep that the initiative did not address, these results strongly suggest that a multidisciplinary, comprehensive approach to safe sleep in the hospital, including behavior modeling and education, is successful in promoting safe sleep practices.
In an accompanying commentary, Drs. Lori Feldman-Winter and Ann Kellams, from Cooper University Health Care and the University of Virginia respectively, reviewed the questions of PRAMS and identify areas for improvement, specifically with regard to breastfeeding and room sharing (10.1542/peds.2024-069242). They astutely note that sometimes bedsharing occurs when a mother is breastfeeding during the night and recommend the survey include questions about when bedsharing occurs and if it is intentional or unintentional. In addition, they recommend expanding PRAMS to include partner-specific questions, as data suggests partners, especially to breastfeeding parents, can play a large role in encouraging and implementing safe sleep.
Overall, multimodal hospital initiatives have great potential to influence home safe sleep practices, but more data is needed to both identify other factors that influence home practice and help iteratively improve such hospital initiatives.