Safe Sleep Practices and Sudden Infant Death Syndrome (SIDS) Risk Reduction Knowledge among New Mothers

Esther K. Chung, MD, MPH, FAAP, To Dung K. Nguyen, BS, MD, Radha Sadacharan, BA,

MPH, Lauren M. Daley, Judilyn Arena-Ondik, RN, MSN, CPN,

Carol Carofiglio, PhD, RN.

Department of Pediatrics, Jefferson Medical College and Nemours, Philadelphia, PA and the Department of Nursing, Thomas Jefferson

University, Philadelphia, PA, US

We have no relationships to disclose.

Background

• Sudden Infant Death Syndrome (SIDS) is the leading cause of infant death beyond the newborn period.

• In October 2010, Pennsylvania (PA) passed The Safe Sleep Bill, which requires that all birthing facilities provide written materials on SIDS risk reduction.

Objectives

• Determine the effectiveness of the current SIDS education at Thomas Jefferson University Hospital (TJUH) Newborn Nursery

• Assess knowledge of SIDS risk factors and perceptions of safe sleep recommendations among new mothers

Methods

• Cross-sectional, telephone survey• New mothers following hospital discharge from the

Newborn Nursery at TJUH between April 2011 and October 2012

• Surveys conducted at 2-4 weeks postpartum• Assessed knowledge of SIDS risk factors, infant

sleep practices, and perceptions of safe sleep recommendations

Results: Maternal Characteristics (N = 292)

Mean age + SD, yrs 27 + 6

Race/ethnicity, Non-white, % 75

Marital status, single, % 45

Education, % High school/GED or less Some college Post graduate

38548

Parity, multiparous, % 60

Medical assistance, % 55

Receive WIC benefits, % 68

Weeks of pregnancy at delivery + SD 39 + 1

Results: SIDS Risk Reduction Education

Prenatal education Written materials postpartum

HCP counseling postpartum

0

10

20

30

40

50

60

70

80

90

100

YesNoDon't Know

Results: Timing of SIDS Risk Reduction Education

Early pregnancyMid pregnancyLate pregnancyAfter baby bornDon't know

Results: Knowledge

Back position safest Risk of choking on back Increased SIDS risk on sofa

0

10

20

30

40

50

60

70

80

90

100

Yes/TrueNo/FalseDon't Know

Results: Sleep Practices(N = 292)

Practice Percent

Back position used by mother 93

Back position used by hospital staff 97

Bed-sharing with newborn 15

Results: SIDS Risk Reduction Education and Associated Characteristics

Prenatal Education Written Materials

Postpartum

HCP Counseling Postpartum

Age Younger mother were more likely to receive

education26 vs. 28, p = 0.018

NS NS

Race/ethnicity NS NS NS

Education More likely in those with HS education than

those with postgraduate training: 44% vs. 24%, 0 = 0.005

NS More likely in those with HS education than

those with postgraduate training: 94% vs. 78%, 0 = 0.038

Parity NS NS NS

Insurance NS NS NS

Results: Receipt of Written Materials

• Associated with a higher likelihood of knowing:– An increased SIDS risk associated with pillows in

the crib (94% vs. 90%, p = 0.01)• Not associated with the following:

– Knowing the back sleep position is the safest– Having concerns about choking when using the back position– Knowing there is an increased risk of SIDS on sofa– Knowing there is an increased risk with using bumpers or loose

blankets– Bed-sharing

Results: Prenatal Education and Healthcare Professional Counseling in Newborn Nursery

• Not associated with– Knowing the back sleep position is the safest– Concerns about choking– Knowledge of increased SIDS risk with sleeping on

sofa– Pillows, bumpers or loose blankets– Bed-sharing

Results: Non-Back Sleep Position as Safest and Associated Characteristics

All associations with p < 0.05

Non-White Race Single WIC0

2

4

6

8

10

12

14

16

YesNo

Results: Concerns about an Increased Risk of Choking with the Back Sleep Position

Non-White Race

Single HS Educ Medical Assistance

WIC0

5

10

15

20

25

30

35

YesNo

Awareness of Risk of SIDS with Sleeping on Sofa

• The following factors were not associated with knowing that there is an increased risk of SIDS associated with sleeping on a sofa– Age– Race/ethnicity– Marital status– Education– Parity– Insurance– Receipt of WIC

Results: Bed-sharing

• Older age (30 vs. 27 years, p = 0.001)• Whites race/ethnicity (21% vs. 13%, p = 0.01)• Higher education: those with postgraduate level

education more likely than those with a HS education (35% vs. 9%, p = 0.004)

• No association with– Marital status– Parity– Insurance– Receipt of WIC

Conclusions

• Enhanced efforts must be made to educate non-white race/ethnicity, single, and low-income mothers about SIDS risk reduction

• When teaching about SIDS risk reduction, increased efforts should be made to discuss safety, concerns about choking when using the back sleep position, and bed-sharing

Limitations

• Single hospital; therefore, may not be generalizable to other populations

• Based exclusively on maternal report• Unable to confirm if written materials read• Other unmeasured factors could impact

knowledge and practices (e.g., bed-sharing)