The Impact of Early SIDS Intervention on Infant Sleep Position

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The Impact of Early SIDS Intervention on Infant
Sleep Position

• Patsy Rodriguez, MD
• Faculty mentor Dr. M. Malloy

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Definition

• SIDS sudden death of an infant under 1 year of
  age that remains unexplained after a complete
  investigation, including
• An Autopsy
• Examination of death scene
• Review of any symptoms or illnesses the infant
  experienced before dying
• Any other important medical history

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SIDS Facts

• Highest risk of SIDS death occurs between 2-4
  months of age
• Occurs without warning ? no way to tell in
  advance which babies will die

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SIDS FACT

• Leading cause of death
• in infants
• 1 month-1 year of age

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SIDS deaths/year

• 1983-1992 approximately 5,000 deaths a year
  attributed to SIDS
• 2002 2,295 SIDS deaths
• 2003 1,994 SIDS deaths (Preliminary data)

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SIDS

• 1992 AAP recommends to place infants on their
  sides or backs to sleep to reduce SIDS
• 1994 NICHD, AAP, SIDS
• Alliance launch the Back To Sleep Program
  to help reduce the risk of SIDS deaths

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Risk Factors

• Prone sleep position
• African-American children are twice as likely to
  die of SIDS
• African-American infants are more likely to be
  placed prone
• Co-Bedding
• Soft Bedding
• Males
• Low income
• Younger mothers
• Less education
• Smoking

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Black vs White Prone Prevalence and SIDS Rates
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Why SIDS project?

• Low income population at high risk
• African-American children are twice as likely to
  die of SIDS
• African-American infants are more likely to be
  placed prone

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Objective

• To determine if early SIDS intervention will
  increase the likelihood of supine placement at 6
  months of age.

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• Method.
• Design Quasi-experimental educational
  intervention with telephone survey follow-up.
• Setting general pediatrics clinic.
• Participants caregivers of 2 week old infants.
• Statistical analysis. Chi square test.

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The Study Groups

• 34 care givers completed questionnaires during
  the 2 week-old well-child visit
• Two groups were chosen
• The first 17 participants were declared the no
  intervention group.
• The next 17 participants were declared the
  intervention group.

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2 wks 6 m/oNo intervention
17 10 With intervention 17 10 34 20
6 m/o Follow-up

• Performed a follow-up phone survey when the
  infant was 6 months old to determine the sleep
  position of the infant.

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No Intervention Group

• Received the routine sleep position check shown
  on the 2-week old Well Child form.

• Sleeps back/side position

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With Intervention Group

• Also received the routine sleep position check
  shown on the 2-week old Well Child form.
• Informed the caregivers of the following
  definition of SIDS, incidence of SIDS, risk
  factors, myths, and the age of highest risk for
  SIDS.
• Handed the caregivers the Back to Sleep pamphlet
• Was only done during the 2 week visit and was
  done AFTER the questionnaire was completed.

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The Intervention

• Definition sudden, unexplained death of a baby
  under 1 year of age.
• 5,000 deaths/year ? after promotion of placing
  infants on their backs to sleep, 3,000
  deaths/year.
• Do not know the cause, but know some risk factors
  to help decrease SIDS (smoking, soft bedding).

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The Intervention (continued)

• There is no increase risk of choking.
• Tummy-time is okay.
• Highest risk of SIDS death is under 6 months of
  age.

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2-Week Old QuestionnaireResults
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Sleep Position at 2 weeks old
No Intervention Group 47 Supine 53
Side With Intervention Group 59 Supine 35
Side 6 Supine Side
p0.413
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Questionnaire Gender

• No with
• Female 8 7
• Male 9 10

• Overall (No intervention and with) 44 female,
  55 male

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Questionnaire Ethnicity
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Questionnaire Co-Bedding

• Cobedding infrequent in both groups
• Most of the infants slept in their cribs.

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Questionnaire Crib Safety

• The vast majority of both groups had nothing in
  the cribs.
• Risk Factors stuffed animals, fluffy blankets,
  fluffy pillow

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Questionnaire Did mother smoke tobacco during
pregnancy?

• 4 of the 17 caregivers smoked during pregnancy in
  the no intervention group.
• None of the 17 caregivers smoked during pregnancy
  in the intervention group.

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Questionnaire Chose sleep position because of
advice from . . .

• Other nurse, previous child, nursery
• Both groups (59) Dr. plus advice from another
  source aided in the care givers decision to
  choose their infants sleep position.

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Questionnaire Most influence on chosen sleep
position . . .

• Their doctor had the most influence on their
  infants chosen sleep position.

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6 m/o Follow-Up Phone Survey
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Sleep Position at 6 m/o

• No Intervention Group
• 30 Supine, 70 Side
• With Intervention Group
• 90 Supine, 10 Side

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Sleep Position Hispanic
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Sleep Position African-American
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Sleep Position Caucasian
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Change in Sleep Position Over Time by Group

• No Intervention
• 5 Back ? Side
• 3 Side ?Back
• 2 Side ? Side
• With Intervention
• 5 Back ? Back
• 3 Side ? Back
• 1 Side ? Side
• 1 Back Side ? Back

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Results

• No infant was placed prone at 2 weeks old or 6
  m/o
• By chi-square analysis, there was no difference
  between groups for sleep position before the
  start of the intervention (p0.413).
• The care givers that received the SIDS
  intervention had the highest supine placement at
  6 m/o (p0.0076).
• Independent of race, the SIDS intervention group
  had the highest supine placement at 6 m/o
  (p0.01)

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Conclusion

• Early and frequent educational information on
  infant sleep positioning by all members of the
  health care team, but primarily the primary care
  physician, will increase the likelihood of supine
  placement at 6 months of age.

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• Physician recommendation of supine
• placement had the strongest influence in the
• caregivers choice of sleep position.

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6 m/o Did you know about SIDS before the babys
birth?

• Overall, 65 knew about SIDS before the babys
  birth, however, 35 did not know about SIDS.

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6 m/o Do you remember being informed of SIDS by
the nursery at your babys discharge?

• Overall, 65 of both groups did not remember
  being informed about SIDS at their infants
  discharge from the hospital.