Stephanie Kuhlmann

Does Providing Infant Caregivers With a Wearable Blanket Increase Safe Sleep Practices? A Randomized Controlled Trial

In Sedgwick County, Kansas, the infant mortality rate has been consistently higher than that of Kansas or the United States as a whole. Nearly 20% of these deaths are attributed to sudden unexpected infant deaths (SUID). Sleep-related deaths, including sudden infant death syndrome, are part of this category. In 2011, the American Academy of Pediatrics (AAP) released revised recommendations to reduce the risk of sleeprelated deaths that focused on a safe sleep environment in addition to supine position. Several initiatives have been undertaken to improve safe sleep for infants in Sedgwick County. Community baby showers provide portable cribs and wearable blankets to equip high-risk caregivers with tools to promote safe sleep, resulting in high intentions to follow the AAP safe sleep guidelines. A hospital-based project improved safe sleep for newborns, but struggled to keep loose blankets out of the bassinet. In addition, pilot testing of the Medical Society of Sedgwick County Safe Sleep Toolkit in pediatric and obstetrical resident clinics found the majority of caregivers reported placing their infant supine to sleep in a safe location (crib, bassinet, or portable crib). However, more than 60% reported unsafe items in the crib, the most frequent of which were loose blankets. Physician promotion of safe sleep has been shown as one of the strongest indicators of whether a caregiver will use safe sleep strategies, such as supine position. In addition, social marketing strategies often incorporate functional promotional items to enhance behavioral change. Therefore, we hypothesized providing caregivers with a wearable blanket would increase safe sleep practices. The purpose of this study was to test the effectiveness of a wearable blanket versus a control item to increase safe sleep practices among parents or caregivers (henceforth “caregivers”) at a pediatric resident clinic. Materials and Methods

Implementation of a Statewide Program to Promote Safe Sleep, Breastfeeding and Tobacco Cessation to High Risk Pregnant Women

Infant mortality remains a problem in the United States with sleep-related deaths accounting for a significant portion. Known risk reduction strategies include breastfeeding, avoiding tobacco use and following the American Academy of Pediatrics’ safe sleep guidelines. The purpose of this project was to evaluate outcomes of Safe Sleep Instructor-led community baby showers, which included safe sleep promotion, breastfeeding promotion and tobacco cessation education. Certified Safe Sleep Instructors (n = 35) were trained on how to plan and host a Community Baby Shower to provide education to pregnant women of low socioeconomic status or with high risk of infant mortality. Eighteen Community Baby Showers were held across two urban and eight rural counties in Kansas. Surveys were administered pre- and post-event to assess participant knowledge, confidence and intentions to follow through with planned action related to safe sleep, breastfeeding and reducing tobacco risk. Matched data were summarized and evaluated for differences using McNemar’s and Wilcoxon Signed Rank tests. Significant increases were observed in Baby Shower participants’ (n = 845) reported plans to follow the AAP Safe Sleep guidelines (all p < 0.001), likelihood to breastfeed (p < 0.001), confidence in ability to breastfeed for more than 6 months (p < 0.001), knowledge of local breastfeeding support resources (p < 0.001), knowledge of ways to avoid second-hand smoke exposure (p < 0.001) and knowledge of local tobacco cessation services (p = 0.004). Based on the result of the pre- and post-event surveys, certified Safe Sleep Instructors were able to plan and host successful events to increase knowledge and confidence related to risk reduction strategies to reduce sleep-related infant deaths.

The Use of the Child Fatality Review Committee to Contribute to a Longitudinal Quality Improvement Project on Safe Sleep

As sudden unexpected infant death rates have plateaued in the United States over the last decade, the rate of sleep-related deaths due to accidental suffocation and strangulation in bed has revealed an upward trend.1 There has been much focus on infant safe sleep over the last few years to reduce these preventable deaths. The American Academy of Pediatrics revised its sudden infant death syndrome reduction recommendations to include safe sleep environments. These recommendations advise that infants sleep on separate sleep surfaces designed for infants to prevent accidental suffocation, strangulation, layover, or entrapment that could occur in the adult bed, chair, or couch. In addition, the sleeping surface should be free of any loose objects, such as blankets, pillows, or toys, that could obstruct an infant’s airway.2 Some of the efforts to reduce deaths have included public service campaigns,3 community programs and initiatives, safe sleep education and modeling in the hospital setting, and identifying and addressing barriers to safe sleep.4,5 The direct impact of individual …

Case 5: Abdominal Pain, Nausea, and Vomiting in a 14-year-old Boy

1. Mohinder R. Vindhyal, MD, MEd* 2. Stephanie Kuhlmann, DO* 3. Shravani Vindhyal, MD* 4. Jeff Kao, MD* 5. Ragneel Bijjula, MD* 6. K. James Kallail, PhD* 1. *KU School of Medicine, The University of Kansas Medical Center, Wichita, KS A 14-year-old boy presents with nausea, vomiting (3–4 times per day), and abdominal pain lasting 7 days. The abdominal pain is sharp and rated 6 of 10 without radiation. The patient and his mother deny fever and weight loss. He had a bowel movement 4 days before presentation and has had decreased urination for the past 3 days. His medical history includes kidney disease, and his surgical history is unremarkable. He plays basketball at school and has no history of recent travel or excessive exercise. His Patient Health Questionnaire-9 score reveals no evidence of depression, and his psychiatric history rules out an eating disorder. His temperature is 96.1°F (35.6°C), heart rate is 92 beats/min, respiratory rate is 20 breaths/min, blood pressure is 134/90 mm Hg, and oxygen saturation is 98% on room air. His weight is 117.7 lb (53.4 kg), height is 70.0 in (177.8 cm), and BMI is 16.8, which is at the 9th percentile, with no significant change from his previous visits to his primary care physician. On physical examination, he is alert and oriented with no distress but reports some abdominal discomfort. His mucous membranes are dry, with delayed capillary refill and poor skin turgor. His abdomen is distended, with diffuse tenderness …

Qualitative Assessment of Pregnant Women’s Perceptions of Infant Sleep Boxes:

Although several states have implemented programs providing boxes for infant sleep, safe sleep experts express concern regarding the paucity of safety and efficacy research on boxes. The purpose of this study was to assess pregnant women’s perceptions regarding use of baby sleep boxes. A convenience sample was recruited from a community prenatal education program. Twenty-eight women were administered a brief semistructured interview about their knowledge of baby sleep boxes, opinions about the boxes, and questions they would have. For most (n = 15, 54%), this was their first pregnancy. Participants self-identified as white (43%), black (36%), Hispanic (18%), and “other” (4%). Ten subthemes emerged related to previous knowledge of boxes (useful for families in need, historic precedent in other countries), positive attributes (portable, compact, affordable, decorative), and negative attributes (low to ground, structural integrity/design, stability, stigma). Research on safety and efficacy could reduce concerns, but issues of stigma may persist.

Collaborating with obstetrical providers to promote infant safe sleep guidelines

OBJECTIVES To partner with obstetrical providers to increase promotion of the American Academy of Pediatrics guidelines for infant safe sleep. Specifically, this study evaluates the effectiveness of the Safe Sleep Toolkit during obstetrical visits. Secondary objectives include improving provider and maternal knowledge of safe sleep. METHODS Obstetrical providers (n=11) and staff at an outpatient clinic were trained using the Safe Sleep Toolkit and encouraged to discuss infant safe sleep with pregnant women at their 28- or 36-week gestation appointment (n=111, 56 pre- and 55 post-intervention). Provider-reported time spent counseling women on safe sleep recommendations and safe sleep knowledge was measured before and after the intervention. Surveys were conducted with women assessing safe sleep knowledge, intention to follow guidelines, and whether safe sleep was discussed at the appointment. RESULTS Significantly more post-intervention women reported their provider had discussed safe sleep (78% vs 32%) (P<.001). Similarly, provider-reported discussion with women increased significantly for all safe sleep guidelines (82%-90% vs 8%-12%) (all P<.001). Maternal knowledge, especially surrounding unsafe sleep practices, improved significantly post-intervention. CONCLUSION Training obstetricians to use a toolkit to promote infant safe sleep guidelines increases the prenatal delivery of this information, and improves pregnant womens knowledge and intentions regarding safe infant sleep.