Nurses role in Sudden Infant Death Syndrome (SIDS) risk reduction:
A Selected Annotated Bibliography

These articles have been selected by Resource Center staff from PubMed, a service of the National Library of Medicine that includes over 19 million citations from MEDLINE and other life science journals for biomedical articles back to 1948. PubMed includes links to full text articles and other related resources.

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McMullen SL, Lipke B, LeMura C.
Sudden infant death syndrome prevention: a model program for NICUs.
Neonatal Netw. 2009 Jan-Feb;28(1):7-12.

Health care providers' opinions can influence how parents place their infant to sleep. Neonatal nurses can improve how they teach and model safe infant sleep practices to parents. To increase neonatal nurses' knowledge, a sudden infant death syndrome (SIDS) prevention program was implemented. Program components included a computerized teaching tool, a crib card, sleep sacks, and discharge instructions. Initial program evaluation showed that 98 percent of infants slept supine and 93 percent slept in sleep sacks in open cribs. However, nurses continued to swaddle some infants with blankets to improve thermoregulation. To increase nursing compliance in modeling safe infant sleep practices, Halo SleepSack Swaddles were provided for nurses to use in place of a blanket to regulate infant temperature. Recent data show that 100 percent of infants in open cribs are now sleeping supine wearing a Halo Swaddle or a traditional Halo SleepSack. This model program can easily be replicated to enhance neonatal nurses' knowledge about SIDS prevention.

 

National Institute of Nursing Research, National Institutes of Health, Department of Health and Human Services.
Findings from the National Institute of Nursing Research related to neonatal care: 2008 update.
Neonatal Netw. 2009 Jan-Feb;28(1):e1-4.

A new program designed to help nurses teach parents, family members, and child care providers about risks and protective practices for Sudden Infant Death Syndrome (SIDS) is now available from the National Institutes of Health. The Continuing Education Program on Sudden Infant Death Syndrome (SIDS) Risk Reduction was developed by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and the National Institute of Nursing Research (NINR), in collaboration with national nursing and infant health organizations. (Represented by Jeanette Xaichkin, RNC, MSN, The Academy of Neonatal Nursing Participated in the process.)

 

Rosen LA.
Infant sleep and feeding.
J Obstet Gynecol Neonatal Nurs. 2008 Nov-Dec;37(6):706-14.

OBJECTIVE: To conduct an integrated review of the literature on the relationship between infant sleep and feeding; hence, health care providers have accurate information to provide anticipatory guidance to parents making decisions regarding feeding and sleeping. DATA SOURCES: Computerized searches of MEDLINE and CINAHL databases, as well as references lists from published articles on infant sleep and feeding methods from 1982 to 2007. Search terms were "infant sleep" and "infant feeding." STUDY SELECTION: Literature was selected from refereed publications in the areas of nursing, medicine, psychology, sociology, and lactation. A total of 48 publications were used in this review. DATA EXTRACTION: Data were extracted using keywords pertinent to infant sleep parameters and the relationship to feeding method. A total of 161 articles were reviewed for inclusion, and only 37 met inclusion criteria. Eleven additional articles were retrieved from the references of these 37 articles. DATA SYNTHESIS: Articles that focused on early infant sleep development and sleep were utilized. Those that focused exclusively on premature or older infants or toddlers or whose primary focus was on sudden infant death syndrome were excluded. CONCLUSIONS: Infants have unique sleep patterns causing adjustment for new parents. Sleep is biopsychosocially influenced, and the interactions between parent and baby have a profound effect on the sleeping and feeding methods and patterns of the infant. When health care providers appreciate these influences and individual nuances of infant sleep, they can share information to appropriately guide and reassure the developing family.

 

Ateah CA, Hamelin KJ.
Maternal bedsharing practices, experiences, and awareness of risks.
J Obstet Gynecol Neonatal Nurs. 2008 May-Jun;37(3):274-81.

Comment in:
J Obstet Gynecol Neonatal Nurs. 2008 Nov-Dec;37(6):619-21; author reply 621.

OBJECTIVES: The objectives of this study were to determine mothers' practices and experiences of bedsharing with their infants and also to determine their knowledge of the risks. DESIGN: A self-report questionnaire was mailed to 1,122 mothers of infants. SETTING: Manitoba, Canada. Participants: The participants in this study were the mothers of infants aged 3 months whose contact information was obtained through the Manitoba Health Information Privacy Committee. MAIN OUTCOME MEASURE: Maternal-infant bedsharing practices and maternal knowledge of risks. RESULTS: There were 293 completed questionnaires received (26% return rate). Key findings suggest that although 89% of participants agreed that sleeping with one's baby has some risks associated with it, 72% reported that they bedshared with their baby on either a regular or an occasional basis. Mothers who breastfed were twice as likely to have bedshared. Approximately 13% of respondents who had bedshared reported an experience(s) with bedsharing in which they had rolled onto or partway onto their infant. CONCLUSIONS: Although the majority of participants agreed that bedsharing had risks for infants, almost three quarters of respondents reported bedsharing on a regular or an occasional basis. Reports by respondents of rolling onto or partway onto their infants support the conclusion that health care professionals should promote safe sleeping environments that include a separate sleep surface for infants.

 

Marter A, Agruss JC.
Pacifiers: an update on use and misuse.
J Spec Pediatr Nurs. 2007 Oct;12(4):278-85.

PURPOSE: The use of pacifiers is a controversial topic; this article looks at the subject from both a historical and cultural perspective, with a review of current research. CONCLUSIONS: The use of pacifiers in infants older than 1 month is currently recommended by multiple researchers to prevent sudden infant death syndrome, and is associated with other benefits for premature infants. However, pacifier use has also been associated with higher risk of otitis media. PRACTICE IMPLICATIONS: Knowledge of the most recent evidence will enable providers to communicate appropriate guidelines on pacifier use to families.

 

Burd L, Peterson M, Face GC, Face FC, Shervold D, Klug MG.
Efficacy of a SIDS risk factor education methodology at a native American and Caucasian site.
Matern Child Health J. 2007 Jul;11(4):365-71. Epub 2007 Feb 13.

OBJECTIVE: To complete a community based efficacy study of a SIDS risk reduction methodology. METHODS: We utilized two community sites for this study: 1) a Native American home visiting program for pregnant and young mothers; and 2) an obstetrics department in a community hospital. Pre and posttests were used to measure learning. The risk reduction intervention was delivered by hospital nurses or the home visiting staff and required about 20 minutes. Each of the nine risk factors was discussed. RESULTS: We completed paired pre and post testing with 341 women. The pre tests found substantial knowledge deficits about SIDS risk factors in both groups. The pre and posttest changes for the nine risk factors ranged from 5% to 74%. Participants from both groups demonstrated nearly equivalent rates of learning for all nine of the risk concepts. CONCLUSION: This study demonstrated the efficacy of this brief intervention program. The program was effective in increasing parental knowledge of the risk factors targeted by this study in both settings. The magnitude of change supports additional research with this program in other settings and with additional populations.

 

Price SK, Hillman L, Gardner P, Schenk K, Warren C.
Changing hospital newborn nursery practice: results from a statewide "Back to Sleep" nurses training program.
Matern Child Health J. 2008 May;12(3):363-71. Epub 2007 Jun 15.

OBJECTIVE: In response to findings from a statewide survey of hospital nurses, the authors designed, conducted, and evaluated a "Back to Sleep" nursing curriculum and training program in Missouri hospitals using two distinct training formats. This article evaluates the initial and follow-up outcomes for training participants and assesses the impact of training format on participant outcomes. METHODS: Participants selected training format by hospital site. In each training format, participants responded to a pre and post test questionnaire measuring knowledge, beliefs, and current infant care behaviors as well as satisfaction with the training. Three months after completion of all statewide trainings, the authors also conducted a follow-up survey. RESULTS: Nurses who participated in the training reported statistically significant improvements in knowledge and "Back to Sleep" adherent beliefs. Over 98% of participants (N=515) intended to place infants in back-only sleep positions following the training. Knowledge, attitudes, and practice intentions were significantly improved across both training formats. Additionally, follow-up survey respondents statewide (N=295) reported lasting improvements, including 63% of nurses reportedly using supine-only sleep position for infants after the first 24 h of life, compared to 28% in the original statewide survey. CONCLUSIONS: Further research is needed to determine the long-term impact of this intervention and assess its applicability beyond this initial implementation. Ultimately, the findings from the evaluation of this pilot intervention and nursing-specific "Back to Sleep" curriculum demonstrate that it has a promising effect on risk-reduction adherence in hospital settings where parent observations of safe sleep behavior first occur.

 

Esposito L, Hegyi T, Ostfeld BM.
Educating parents about the risk factors of sudden infant death syndrome: the role of neonatal intensive care unit and well baby nursery nurses.
J Perinat Neonatal Nurs. 2007 Apr-Jun;21(2):158-64.

Nurses in newborn nurseries and neonatal intensive care units are instrumental in educating parents about reducing the risk for SIDS. Nurse participation is acknowledged and encouraged in the current policy statement on SIDS Risk Reduction put forth by the American Academy of Pediatrics. Despite the decline in SIDS, it remains the leading cause of postneonatal infant mortality, and despite greater public compliance with the risk reduction guidelines there is room for improvement in how effectively and consistently they are disseminated. To facilitate nursing participation as educators, role models, and collaborators in the development of relevant hospital policies and procedures, we review the current recommendations, addressing issues that may serve as barriers to participation, describing the biological plausibility underlying risk-reducing practices, and presenting resources from which nurses may obtain teaching materials and model policies.

 

Morgan KH, Groer MW, Smith LJ.
The controversy about what constitutes safe and nurturant infant sleep environments.
J Obstet Gynecol Neonatal Nurs. 2006 Nov-Dec; 35(6):684-91.

In 1999, the U.S. Consumer Product Safety Commission stated that cribs provide the safest sleep environment for infants. Scientific data fails to support that statement and controversy continues in the scientific, medical, and parenting communities. Recent data demonstrate that cribs may represent the most unsafe sleep. This article seeks to inform health care professionals of the issues involved in the controversy and to offer guidelines for educating parents about safe and unsafe sleep practices.

 

Aris C, Stevens TP, Lemura C, Lipke B, McMullen S, Cote-Arsenault D, Consenstein L.
NICU Nurses' knowledge and discharge teaching related to infant sleep position and risk of SIDS.
Adv Neonatal Care. 2006 Oct; 6(5):281-294.

Infants requiring neonatal intensive care are often placed prone during their acute illness. After hospital discharge the American Academy of Pediatrics (AAP) recommends supine sleep position to reduce the risk of Sudden Infant Death Syndrome (SIDS). Little is known about nursing knowledge and practice regarding best sleep positions for infants as they transition from neonatal intensive care to home. Objective: To explore and describe neonatal intensive care unit (NICU) nurses' knowledge and practice in the NICU, and to determine the content of parent instruction regarding infant sleep position at discharge. Study Design: This survey was conducted in 2 phases. In Phase I, a questionnaire was designed and completed by 157 neonatal nurses currently practicing in Level III and IV NICUs in the state of New York. After content analysis of responses and item revisions, a panel of experts reviewed questionnaire items. Phase II involved completion of the final questionnaire by 95 NICU nurses in 4 additional hospitals. The combined results of Phase I and II are reported. Results: Of 514 questionnaires distributed, 252 (49%) were completed and analyzed. During NICU hospitalization, nurse respondents identified prone position as the best general sleep position for preterm infants (65%) followed by either prone or side-lying (12%). The nurses' assessment of the infants' readiness for supine sleep position at the time of NICU discharge varied. Most nurses responded that preterm infants were ready to sleep supine anytime (29%), close to discharge (13%), when maintaining their body temperature in an open crib (25%), between 34 to 36 weeks postmenstrual age (PMA) (15%), after 37 weeks PMA (13%), and when the infant's respiratory status was stable (6%). Typical sleep positions chosen for full-term infants in the NICU were supine (40%), side or supine (30%), all positions (18%), side (8%), prone or side (3%), and prone (1%). Frequently cited reasons to place full-term infants to sleep prone were: reflux (45%), upper airway anomalies (40%), respiratory distress (29%), inconsolability (29%), and to promote development (17%). At NICU discharge, 52% of nurses instructed parents to place their infants in the supine position for sleep. The most common nonsupine sleep positions recommended by nurses at discharge were either supine or side (38%), and exclusive side positioning (9%). Conclusions: Nearly 95% of respondents identified a nonsupine sleep position as optimal for hospitalized preterm infants. Further, only 52% of neonatal nurses routinely provide discharge instructions that promote supine sleep positions at home. This study suggests that nursing self-reports of discharge teaching practices are inconsistent, and in some cases in direct conflict with the national "Back to Sleep" recommendations, which emphasize that the supine position is the safest position for healthy full-term and preterm infants after hospital discharge.

 

Krueger G.
Meaning-making in the aftermath of sudden infant death syndrome.
Nurs Inq. 2006 Sep; 13(3):163-71.

The reconstruction of meaning in the aftermath of sudden infant death syndrome (SIDS) is part of the grieving process but has to date been poorly understood. Earlier theorists including Freud, Bowlby and Kubler-Ross provided a foundation for what occurs during this time using stage theories. More recent researchers, often using qualitative techniques, have provided a more complex and expanded view that enhances our knowledge of meaning reconstruction following infant loss. This overview of representative contemporary authors compares and contrasts them with the longstanding models that are being supplanted within the emerging field of thanatology. Understanding parental reactions within this new framework can help healthcare professionals in dealing with those affected by SIDS and provide a more empathic and sensitive approach to individual differences. Parents' own accounts of their post-SIDS experience are consistent with these newer theories. Comprehending how parents cope and reconstruct their lives is an important element in providing appropriate psychological support services.

 

Bullock LF, Mickey K, Green J, Heine A.
Are nurses acting as role models for the prevention of SIDS.
MCN Am J Matern Child Nurs. 2004 May-Jun; 29(3):172-7.

Purpose: To examine nurses' knowledge, attitude, and practice in positioning healthy newborns for sleep in the hospital setting. Design and Methods: A cross-sectional descriptive design was used to survey a convenience sample of practicing maternal child nurses in 58 Missouri hospitals. A 24-item investigator designed questionnaire was developed with input from SIDS Resources in Missouri. Results: A total of 528 surveys were analyzed. These nurses reported no longer placing infants in the prone position for sleep, but almost 75% of those answering the survey used either the side-lying position or a mixture of side and back positioning, even though 96% of the nurses said they were aware of the AAP Guidelines recommending "back to sleep." Forty-five percent of the nurses thought the infant would be at risk for aspiration if only placed on his/her back. Only 53% of the nurses knew their hospital's policy about newborn positioning; 80% of those who knew about the policy said it included the lateral position as being acceptable practice. Clinical Implications: Nurses are the role models for new parents regarding newborn sleep position, and are in a unique position to influence parents' decisions about how to place their infants for sleep at home. Because nurses continue to worry about aspiration when newborns are placed on their backs, it is clear that more education is needed for hospital nurses about newborn sleep position and hospital policies, as well as AAP Guidelines.

 

Stastny PF, Ichinose TY, Thayer SD, Olson RJ, Keens TG.
Infant sleep positioning by nursery staff and mothers in newborn hospital nurseries.
Nurs Res. 2004 Mar-Apr; 53(2):122-9.

Background: Although advice from healthcare professionals may influence parental infant placement choice to reduce sudden infant death syndrome risk, literature on nursery staff infant placement behaviors and the degree to which they influence maternal infant sleep positioning is limited. Objective: To assess newborn placement practices of the mother and nursery staff and their interrelationship in the hospital setting. Methods: A cross-sectional survey-based study was conducted among hospital newborn nursery staff (n = 96) and mothers of newborns (n = 579) at eight perinatal hospitals in Orange County, California. Results: Although a majority of sampled nursery staff (72%) identified the supine position as the placement that most lowers sudden infant death syndrome risk, only 30% reported most often placing infants to sleep in that position, with most staff (91%) citing fear of aspiration as the motivation for supine position avoidance. Only 34% of staff reported advising exclusive supine infant positioning to mothers. Approximately 36% of mothers reported using supine infant placement exclusively. Maternal infant placement choice varied by both the advice (p <.01) and the placement modeling (p <.01) provided by staff, with the highest proportion of usual supine infant placement found among mothers who reported receiving both. A mother's race/ethnicity also affected the reception of exclusive supine placement recommendations (p <.01). Conclusions: Exclusive supine infant placement appears to be underused by both nursery staff and mothers of newborn infants. Culturally grounded educational intervention with nursery staff regarding infant positioning and placement in the hospital setting is indicated.

 

Jeffery HE.
SIDS guidelines and the importance of nurses as role models.
Jrl of neonatal, paediatric and child health nursing, 2004 Mar, 7(1): 4-8.

Despite improved knowledge about the risk factors associated with sudden infant death syndrome (SIDS) and successful public health campaigns to inform parents and health professionals about them, the SIDS rate in Australia remains higher than in some other developed countries. Nurses share a special and close parental and infant advocacy role both in hospital and the community which can have a powerful influence on the parent's choice of infant sleeping position. Practice that incorporates safe infant sleeping position and environment, accompanied by a verbal recommendation, can potentially save lives and as such is a duty of care for all nurses. This requires nurses to be aware of current evidence and to implement and promote recommendations for reducing the risk of SIDS.

 

Colson ER, Joslin, SC.
Changing nursery practice gets inner-city infants in the supine position for sleep.
Arch Pediatr Adolesc Med. 2002 Jul; 156(7):717-20.

Objective: To determine whether an educational intervention to change nursery practice would result in more inner-city parents placing their infants in the supine position for sleep. Design: We conducted semistructured interviews at the 2-week health supervision visit with 1 convenience sample of parents before and a different convenience sample of parents after an educational intervention was conducted to change nursery practice in positioning infants for sleep. Setting: University hospital clinic located in an urban setting. Participants: Parents of 2-week-old infants at their first health supervision visit in an urban, university-affiliated clinic. All parents who were approached agreed to participate. Intervention: Nurses were instructed to place infants exclusively in the supine position in the nursery and to instruct parents to exclusively place infants in the supine sleeping position at home. Main Outcome Measures: The usual sleeping position in which parents reported placing their 2-week old infants. Results: Before the intervention, 41% of parents reported that a clinician had told them to place their infants to sleep in the supine position compared with 81% after the intervention (odds ratio [OR], 6.1; 95% confidence interval [CI], 3.1-12.3). Before the intervention, 37% of parents reported that the nursery staff placed their infants to sleep in the supine position, compared with 88% after the intervention (OR, 12.5; 95% CI, 5.7-27.7). Before the intervention, 42% of parents reported that they usually placed their infants to sleep in the supine position at home compared with 75% after the intervention (OR, 4.2; 95% CI, 2.1-7.9). Conclusion: After an educational intervention to change practice in a well-newborn nursery, many more parents reported placing their infants in the supine position for sleep, which suggests that such an intervention may have an impact on the position in which parents place their children to sleep.

 

Horstman K, van Rens-Leenaarts E.
Beyond the boundary between science and values: Re-evaluating the moral dimension of the nurse's role in cot death prevention.
Nurs Ethics. 2002 Mar; 9(2):137-54.

This article combines a philosophical critique of the idea that public health nurses are primary technicians who neutrally hand over scientifically established facts on risks to the public and an empirical analysis of the actual work of public health nurses. It is argued that the relationship between facts and values in public health is complex and that, despite the introduction of several scientifically-based standards and guidelines, public health nurses are not technicians. They do moral work and experience ethical dilemmas. To get a grip on the specific character of this moral work, we distance ourselves from the idea that there are ethical dilemmas in public health nursing for which we can provide general ethical rules and principles. Instead we suggest a contextual ethical approach, in which several different kinds of consideration may be important. To illustrate this, we analysed 15 in-depth interviews with nurses involved in the prevention of cot deaths in the Netherlands. It is shown that these nurses do not neutrally pass on the epidemiological facts on the risks of prone sleeping, warm bed-clothes and passive smoking, but they are the moral architects of this preventive practice. It is also shown that this moral work and the ethical dilemmas they experience cannot be characterized in terms of general ethical rules and principles. It becomes clear that the moral work of nurses differs according to the three main risks at stake: the balance between virtue, risk taking and responsibility depends on the specific context.

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September 2009

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