Mary McClain

Risk of sudden infant death syndrome among infants with in utero exposure to cocaine

To determine whether the risk of sudden infant death syndrome (SIDS) among infants exposed to cocaine in utero may be elevated, we assessed the risk for SIDS in a large, well-described, prospective cohort of infants whose mothers had or had not used cocaine during pregnancy. Of 996 women consecutively enrolled while registering for prenatal care, 175 used cocaine during pregnancy. Only one infant of the mothers who used cocaine died of SIDS, a risk of 5.6 in 1000, compared with four infants among the 821 nonexposed infants, a risk of 4.9 in 1000. The relative risk for SIDS among infants whose mothers used cocaine during pregnancy compared with those whose mothers did not use cocaine was 1.17 (95% confidence interval 0.13, 10.43), suggesting that there is no increased risk of SIDS among infants exposed in utero to cocaine.

The Effect of Nursing Quality Improvement and Mobile Health Interventions on Infant Sleep Practices: A Randomized Clinical Trial.

Importance Inadequate adherence to recommendations known to reduce the risk of sudden unexpected infant death has contributed to a slowing in the decline of these deaths. Objective To assess the effectiveness of 2 interventions separately and combined to promote infant safe sleep practices compared with control interventions. Design, Setting, and Participants Four-group cluster randomized clinical trial of mothers of healthy term newborns who were recruited between March 2015 and May 2016 at 16 US hospitals with more than 100 births annually. Data collection ended in October 2016. Interventions All participants were beneficiaries of a nursing quality improvement campaign in infant safe sleep practices (intervention) or breastfeeding (control), and then received a 60-day mobile health program, in which mothers received frequent emails or text messages containing short videos with educational content about infant safe sleep practices (intervention) or breastfeeding (control) and queries about infant care practices. Main Outcomes and Measures The primary outcome was maternal self-reported adherence to 4 infant safe sleep practices of sleep position (supine), sleep location (room sharing without bed sharing), soft bedding use (none), and pacifier use (any); data were collected by maternal survey when the infant was aged 60 to 240 days. Results Of the 1600 mothers who were randomized to 1 of 4 groups (400 per group), 1263 completed the survey (78.9%). The mean (SD) maternal age was 28.1 years (5.8 years) and 32.8% of respondents were non-Hispanic white, 32.3% Hispanic, 27.2% non-Hispanic black, and 7.7% other race/ethnicity. The mean (SD) infant age was 11.2 weeks (4.4 weeks) and 51.2% were female. In the adjusted analyses, mothers receiving the safe sleep mobile health intervention had higher prevalence of placing their infants supine compared with mothers receiving the control mobile health intervention (89.1% vs 80.2%, respectively; adjusted risk difference, 8.9% [95% CI, 5.3%-11.7%]), room sharing without bed sharing (82.8% vs 70.4%; adjusted risk difference, 12.4% [95% CI, 9.3%-15.1%]), no soft bedding use (79.4% vs 67.6%; adjusted risk difference, 11.8% [95% CI, 8.1%-15.2%]), and any pacifier use (68.5% vs 59.8%; adjusted risk difference, 8.7% [95% CI, 3.9%-13.1%]). The independent effect of the nursing quality improvement intervention was not significant for all outcomes. Interactions between the 2 interventions were only significant for the supine sleep position. Conclusions and Relevance Among mothers of healthy term newborns, a mobile health intervention, but not a nursing quality improvement intervention, improved adherence to infant safe sleep practices compared with control interventions. Whether widespread implementation is feasible or if it reduces sudden and unexpected infant death rates remains to be studied. Trial Registration clinicaltrials.gov Identifier: NCT01713868

TodaysBaby Quality Improvement: Safe Sleep Teaching and Role Modeling in 8 US Maternity Units

A multicenter safe sleep QI campaign in 8 US maternity units to teach and role model safe sleep practices during the newborn hospital stay. BACKGROUND AND OBJECTIVES: Nursing education and role modeling can increase adherence to safe sleep practices. Eight US hospital maternity units with variable baseline approaches to education participated in a national multicenter nursing quality improvement (QI) intervention to promote safe sleep practices. The goals at participating maternity units were to (1) increase the rate of mothers who reported receiving safe sleep information from nurses to ≥90% and (2) increase the rates of infants observed sleeping supine in a safe environment to ≥90%. METHODS: A safe sleep QI toolkit, designed for and provided to all sites, included an educational curriculum and tools to use for staff and parent education. Local teams implemented safe sleep education using the tools as plan-do-study-act cycles. After each cycle, audits assessing maternal report of nursing education on safe sleep and inpatient infant sleep position and environment were performed. RESULTS: The QI interventions lasted a median of 160 days (range, 101–273). Mothers reported receiving information on 4 primary safe sleep topics 72% to 95% of the time (a 24%–57% increase over the baseline). Additionally, 93% of infants were observed in a supine sleep position, and 88% of infants were observed in a safe sleep environment (a 24% and 33% increase over baseline, respectively). These rates were sustained up to 12 months later. CONCLUSIONS: Implementation of a multisite QI intervention for safe sleep parenting education and role modeling led to increased knowledge of and compliance with safe sleep practices during postpartum hospitalization.

Risk factors for sudden Infant death syndrome among northern plains Indians

Infant mortality-specially postneonatal deaths occurring 1 to 12 months after birth-is increased in American Indians. Sudden infant death syndrome (SIDS), the major cause of postneonatal death, was up to recently the leading cause of infant deaths in American Indian populations. Risk factors for SIDS were sought by reviewing findings from a population-based case-control study of 33 infants who died of SIDS and 66 matched living control infants (the Aberdeen Area Infant Mortality Study). All participants were American Indians living in the Dakotas, Nebraska, and Iowa in the years 1992-1996. The study group included infants dying before 12 months of age but excluded those who died while still hospitalized after delivery. The mean age at death in the SIDS group was 109 days. Univariate analyses showed that parents of SIDS infants had fewer years of education and more often reported fewer than seven prenatal visits. More case mothers had smoked and taken alcohol just before and during pregnancy, and more of them engaged in binge drinking in the first trimester. There was no difference in the use of illicit drugs during pregnancy. Comparable numbers of infants in the case and control groups were put to sleep on their stomachs in the 2 weeks before death. Infants given two or more layers of clothing were at increased risk of SIDS. Those having fewer than three well-baby visits had a nearly 14-fold greater risk of SIDS. Breast-feeding was not a significant factor. On logistic regression analysis, periconceptional drinking remained associated with SIDS (adjusted odds ratio, 6.2). Infants who usually had two or more layers of clothing were also at increased risk, with an identical odds ratio. These findings suggest that controlling alcohol consumption before and during pregnancy could lessen the risk of SIDS in this American Indian population. Attention also should be given to infant clothing, and efforts should be made to promote regular public health nurse visits.

Change in the Prevalence of Prone Sleeping at Three Months of Age † 511

The Back to Sleep campaign was begun in mid-1994 to reduce the prevalence of prone infant sleeping from 40-50% to < 10%. Using data from an ongoing longitudinal study of early infant care practices, we assessed trends in prone sleeping from 6/95 - 9/97. Mother-infant pairs are recruited at birth hospitals in Massacusetts and Ohio and followed for six months. Descriptive data are collected at enrollment; information on sleep position and other infant care practices is collected by follow-up mail/phone questionnaire. From 6/95 - 12/95 mothers of 1607 three month (9-16 weeks) old infants (birthweight≥ 2500g) responded to a question asking the position their infant was placed to sleep on the previous night. From 1/97 - 9/97 mothers of 2028 three month old infants responded to this question. In each year, 80% of mothers were White, 10% Black, and 10% Hispanic. Stratified analyses were performed for prevalence of prone sleeping in 1995 and 1997. Relative risks and 95% confidence intervals (CI) presented in the Table describe the reduction in prevalence of prone sleeping from 1995 to 1997. Trends were similar for Black and Hispanic infants, so data were pooled. There was a significant reduction in the prevalence of prone sleeping across all strata. The greatest decline was observed among infants of highly educated(high = college degree), minority mothers. These associations between race, education, and prone sleeping remain after controlling for other factors through multiple logistic regression. The prevalence of prone sleeping is approaching the target of 10% among infants of highly educated mothers regardless of race/ethnicity, however, prone sleeping remains higher among infants of less educated mothers, especially minorities. These data may be useful in directing future efforts for the Back to Sleep campaign.