sudden unexpected infant death (suid): facts for nicu nurses christine a. aris, bsn, rn, nnp, bc...

Sudden Unexpected Infant Death (SUID):

Facts for NICU Nurses

Christine A. Aris, BSN, RN, NNP, BCSherri L. McMullen, PhD, RN, NNP, BCBethann M. Lipke, RNC, MS, CNSCatherine A. Le Mura, RN, MS, NNP, BC Larry Consenstein, MDSt. Joseph’s Hospital Health Center Syracuse, New York With contributions from The Children’s Hospital at Dartmouth© copyright 2014

Overall Purpose & Objectives

Purpose: Teach evidence-based practice of SUID risk reduction strategies in preparation for discharge

Objectives: After viewing the SUID Facts for Nurses teaching tool the learner will be able to: Define SUID & SIDS Identify 2 infant risk factors for SIDS & SUID which are

strongly associated with admission to the NICU Recognize 2 indications for positioning infants prone in

the NICU Discuss the impact that nurses have as role models in

the NICU on parent’s practice of SIDS & SUID reduction strategies after discharge

List 5 risk reduction strategies for SUID as recommended by the American Academy of Pediatrics

Parent Quote

“The hardest thing for us is that we were not given the information. You can only go by what you are provided with.”

What is a SUID?

Any infant who dies unexpectedly (Sudden Unexpected Infant Death) –

SUID SUID is a broad term that includes both

explained and unexplained deaths.

We focus on “sleep related” SUID (i.e. not focused on trauma, drowning, congenital anomalies, etc).

The Children’s Hospital at Dartmouth

SUID

EXPLAINED UNEXPLAINED

Simple Classification System

SIDS

Undetermined

Trauma

Drowning Known Diagnosis

Accidental Suffocation


What is SIDS?• SIDS is any SUID (i.e. sudden and

unexpected death) that remains unexplained after:– A complete review of the history– An autopsy– A death scene investigation

• Typically, a seemingly healthy infant is found dead after a sleep period


SIDS & explained SUID share common risk factors

Common risk factors for SIDS and explained SUID (accidental suffocation and strangulation in bed-ASSB): low socioeconomic status smoking bed-sharing overheating

Specific risk factors for SIDS: not breast feeding first 2 weeks of life prone sleep position

(Vennemann, Bajonowski, Betterfa-Bahlouol, Suerland, Jorch, Brinkmann, et al,

2007)

When does SIDS & SUID occur?

SIDS is most common in first six months of life. Peak incidence is between 2 and 4 months. More SIDS deaths occur in fall & winter months.

This has diminished since the Back to sleep campaign.

Some hypothesize that the seasonal effect was due to over bundling and over heating. With the infant on his or her back and the forehead exposed, the infant is better able to dissipate heat.

The risk is higher for premature infants.

Populations at risk SIDS occurs with varying incidence in all

cultures U.S. SIDS incidence in Blacks (113.5 per

100,000) is twice that for Whites (45.5 per 100,000)

Native American infants have higher incidence for SIDS

SIDS in other countries: Lowest rates in Asian countries Higher rates in Maori, Australian, Aboriginine

Maternal risk factors Young maternal age at first pregnancy Short inter-pregnancy interval Low educational level Poor prenatal care Cigarette smoking during,after pregnancy Drug use during pregnancy Native American and African American

ethnicity

What are the two most significant risk factors for SIDS?

Prone sleep positioning Supine sleep is safest.

• When the frequency of prone decreased from >70% to ~11.3% in 2002 in the US, SIDS had decreased by 50-60% by 2001.

• However, the prevalence of prone sleeping increased to 13% in 2004 and remains stagnant.

Smoking Avoid maternal smoking and exposure to

passive smoking.

Which infants are at greatest risk?

Neonatal Intensive Care Unit (NICU) admission The lower the gestational age the

higher the risk of SIDS The lower the birthweight the higher

the risk of SIDS A combination of these increases the

risk by more than each factor alone

How big are the risks?

Estimates vary with big risks for small babies A preterm or low birth weight (LBW) baby

sleeping supine has 2 X more likelihood for SIDS than a healthy term baby

A preterm infant is:• 85 X more likely to die of SIDS sleeping prone• 40 X more likely to die of SIDS sleeping on the side

A LBW baby is• 83 X more likely to die of SIDS sleeping prone • 36 X more likely to die of SIDS sleeping on the side

(Oyen et al. 1997; Fleming & Blair, 2003)

Small babies with big risks Babies who are “Small at birth”: preterm (<37

weeks) or LBW (< 2500 grams) A baby who is not “small at birth” is:

2.3 times more likely to die of SIDS sleeping on the side

8 times more likely to die of SIDS sleeping prone A baby who is “small at birth” is:

15 times more likely to die of SIDS sleeping side >24 times more likely to die of SIDS sleeping prone

(Blair, Ward Platt, Smith, &Fleming, 2006)

NICU Admissions

While we know that preterm infants are at higher risk for SIDS, full term infants were more than twice as likely to die of SIDS if they were admitted to a NICU.

Blair, P., Ward-Plantt, M., Fleming, P., & CESDI SUDI Research Group Institute of Child Health, UBHT Education Centre, Bristol BS2 8AE, UK. (2003). Early Human Development, 74, 57-82.

SIDS Etiology

Although there are many theories about what causes SIDS, the exact cause of SIDS is still unknown and may even be multi-factorial

Much is known about what reduces the risk

The most prevalent theory is the triple risk theory

Triple Risk Model


The Triple Risk Model: The Vulnerable Infant

What makes an infant vulnerable? Adverse intrauterine conditions (hypoxia, poor

placental blood flow or maternal smoking may alter autonomic nervous system)

Medullary region of the brainstem is important for control of respiration and autonomic function

Reflexes that fail to respond to a life threatening event

Our current hypothesis is that SIDS results when a vulnerable

infant cannot adequately defend against an asphyxiating

environment—a level of asphyxia where most infants

would not die!


An Example of SIDS Pathogenesis

Adapted from Kinney and Thach, NEJM, 2009


Common brainstem abnormalities in SIDS victims

Decreased acetylcholine and glutamate receptor binding (Kinney et al, 1995 and Panigrahy et al, 1997)

Decreased serotonergic receptor binding in the serotonergic regions (Panigrahy, A. Filiano, JJ, et al, 2000)

Decreased 5-HT1A receptor binding, increased numbers of immature 5-HT neurons (Paterson, et al, JAMA, 2006)

Decreased levels of 5-HT and TPH2, the major synthesizing enzyme for 5-HT (Duncan et al, JAMA, 2010)

Decreased GABAA receptor binding (Broadbelt et al, J Neuropathol Exp Neurol, 2011)

These metabolic defects are not present in infants dying of other causes, including chronic hypoxia


Adapted from Kinney and Thach, 2009

Arousal to hypoxia

Medullary abnormality in the brainstem impairs function


Serotonin 5-HT1A Receptor Binding decreased in SIDS

Panigraphy et al, J Neuropathol Exp Neurol, 2000

Lots of 5-HT1A receptor bindingVery little 5-HT1A receptor binding


Incidence of SIDS in the U.S. 1983-1992:

5,000-6,000 deaths per year 1994:

“Back to Sleep” campaign 2001: 2,295 deaths per year 2006: 2,326 deaths per year 2011:

SIDS is still leading cause of infant mortality beyond the neonatal period.

American Academy of Pediatrics, 2011

Incidence of SUID, SIDS and ASSB (accidental suffocation or strangulation in bed) The Children’s Hospital at Dartmouth

From 1998-2001 the number of deaths “signed

out” as ASSB and undetermined increased

dramatically

SUID

SIDS

UNK + ASSB

This does not necessarily mean

that the incidences are changing, only

that the medical examiners are

assigning the cause of death differently!

BTS

So why the uncertainty?

• Many believe this is an example of “DIAGNOSTIC SHIFT” away from SIDS to “ASPHYXIA”.

• Medical examiners are tending to call more deaths “accidental suffocation” or “undetermined”.

• Yet the causative role of asphyxia is based upon the subjective bias of the scene examiner, as there is no biomarker or standardized criteria for diagnosing lethal asphyxia at autopsy.

• Often, factors in the environment that suggest asphyxia/suffocation are well recognized SIDS risk factors.


Asphyxia and Suffocation

Asphyxia: situation in which there is a decrease in oxygen (O2) and an increase in carbon dioxide (CO2) in the body

Suffocation: a form of asphyxia Entrapment: when an infant is “trapped” in a situation

that produces asphyxia. Strangulation: when bed clothes or other material is

wrapped around the neck, blocking the airway causing asphyxia.

Accidental suffocation or strangulation in bed includes (1) suffocation by bedding, pillow, or waterbed (2) overlaying the infant while sleeping (3) wedging or entrapment of an infant between two objects and strangulation The Children’s Hospital at Dartmouth

So…Do we call it SIDS or Accidental Suffocation?

Probability of death: determined by interaction between infant vulnerability and asphyxiating environment.

There are degrees of vulnerability and the potential of the environment to be asphyxiating – i.e. continuum from (none severe).

Infant vulnerability: related to multiple intrinsic risk factors, many of which cannot be determined at the time of death.

prematurity, maternal drug use, exposure to intrauterine hypoxia, brainstem neurotransmitter dysfunction, or a critical period of development.

Asphyxiating environment: can be created by multiple extrinsic risk factors, which are evaluated by history and the death scene investigation.

soft mattress, soft bedding, pillows, bumper pads, bed sharing, kangaroo care and prone positioning.


So…Do we call it SIDS or Accidental Suffocation?

Interactions can occur anywhere along the continuum:

a normal infant could die in a severely asphyxiating environment

a very vulnerable infant could die in a non-asphyxiating environment.

A medical examiner determines cause of death, based on the death scene information.

Less deaths are being called “SIDS” and more are “undetermined” or “accidental suffocation”. In the past, all except obvious cases of accidental suffocation were called “SIDS”.

This diagnostic shift makes it difficult to track the success of public health programs such as “back to sleep” or now “safe to sleep”.

Importantly, safe sleep practices that remove the potential for asphyxia, could reduce deaths for infants that are especially vulnerable.


Asphyxia has ALWAYS been part of SIDS

Most extrinsic risk factors for SIDS are associated with potentially asphyxiating environments Prone sleeping Soft bedding, pillows, bumper pads, etc Bed sharing Over bundling

Although it is clear that in some asphyxiating environments ANY infant would die, in most of these circumstances infants usually DO NOT DIE!


So what have we learned?

• Up to 70% of SIDS infants have abnormalities in brainstem neurotransmitter systems involved in vital homeostatic functions

• This may result in: ineffective arousal, cardiorespiratory and thermal responses to stressors.


So what have we learned? Infants who subsequently die of SIDS have:

blunted arousal responses, decreased heart rate variability, and episodes of apnea, bradycardia and tachycardia days to weeks prior to death, and ineffective gasping shortly before death evidence for respiratory and autonomic instability

Animal studies have identified abnormalities resulting from controlled combinations of neurotransmitter dysfunction and risk factors: altered sleep and impaired arousal, central

chemosensitivity, and a prolonged laryngeal chemoreflex.


HIGH ALERT! Low birthweight and early gestation

infants are at the highest risk for SIDS. These infants are more likely to be placed

side-lying or prone at 2-4 months, during the peak incidence for SIDS.

Reasons parents place infants to sleep side or prone:

• Infant’s sleep preference• Advice from medical professionals• Observed care in the hospital

Actual death scene reenactment photographs

Tomorrows Child… CPSC, Detroit, Michigan 2005

Who still needs to be convinced about the facts?

African American and Native American SIDS rates have not decreased as much as the Caucasian population.

These populations may not be receiving the vital messages of placing their infants on their back to sleep, avoiding tobacco exposure and co-bedding.

Evidence shows that nurses and other health care professionals are inconsistent with teaching current recommendations for safe sleep.

Parent Quote

“If a baby is on his back I thought it was not a comfortable way to sleep. I thought he would be nice and warm on his tummy. It is not true. If that was told to me I would have never done that.”

Some nurses may think supine sleep has risks, but there are …

No significant risks of supine sleep No increase in apnea No increase in bradycardia No increase in problems related to reflux or aspiration

No difference in total sleep time or percentage of quiet sleep in prone vs. supine position

More sleep awakenings which may be protective

Patient education & safety Parents need to learn why sleep practices for

sick babies in the NICU differ from safe sleep at home….

Parents must be cautioned against continuing these practices at home

Patient safety• Effective communication is a cornerstone of patient

safety - The Joint Commission

Specific positioning to improve breathing or promote development in the NICU is no longer needed at home

Effects of prone during acute illness: • Improved Oxygenation• Improved lung mechanics• Less ventilation/perfusion mismatching• Higher lung volumes • Decreased energy expenditure

Developmental outcomes • Muscles develop by pushing when prone or

surrounded by a firm, but cushioned flexible wall• Prone and side for stress and pain

• Provides comfort and organization• Low stimuli environment• Kangaroo holding• Dark (or cycled lighting > 32 weeks)

Risks of prone increases as preterm infants mature

Characteristics that potentially increase vulnerability for SIDS (in preterm infants sleeping prone at 1-3 months adjusted age): Heart rate variability

• decreased during quiet sleep QT intervals

• prolonged during quiet sleep Awakenings

• fewer arousals, less awakenings Arousal threshold

• significantly increased stimuli required to arouse infant

(Ariagno, et al. Pediatrics 2003; Goto et al. Pediatrics 1999; Horn et al. SLEEP, 2002)

Are there exceptions to ‘Back to sleep’

Exceptions for supine sleep are rare, but include infants for whom risk of death from complications of gastro-esophageal reflux is greater than risk of SIDS:• infants with impaired protective airway

mechanisms, such as those with laryngeal clefts who have not undergone anti-reflux surgery

AAP 2011 recommendations

Parent Quote

“The main reason parents, and why I didn’t put my baby on his back to sleep is because he would choke. That is not true. He has the same reflexes as an adult or toddler to turn his head.”

More about reflux….

Because of the increased risk of SIDS risk, the North American Society for Pediatric Gastroenterology (NASPGHAN) states: prone positioning, and elevating head of crib

are no longer recommended treatments, for mild or moderate reflux in infants less than one year.

(Vandenplas, Rudolph, DiLorenzo et al, 2009)

Supine sleep positionis safest for reflux…

When positioned prone, a baby could be more likely to aspirate as gravity allows emesis to flow down into the trachea.

When supine, the emesis stays in the esophagus decreasing the risk of aspiration.

(Cote A. Back to sleep…for life, Montreal Children’s Hospital, Montreal, Canada, Copyright 2002)

Keep crib in flat position

Elevation of crib has never been proven to reduce reflux when infants sleep supine, but may cause infants to slide into a position which compromises respiration

AAP 2011 recommendations

Back to sleep: for all healthy infants, even preterm

There is little evidence to support the perception that preterm infants actually have more reflux.

Although there are less frequent episodes of reflux in prone and side position, there are no benefits that outweigh the risk of death from SIDS.

Supine sleep does not increase risk of choking and aspiration, even for infants with reflux.

In fact, in the few cases of infant death from aspiration, infants were found in the prone position.

Co-bedding multiples is not recommended

It is the position of the National Association of Neonatal Nurses (NANN) that co-bedding cannot be endorsed until further research is available.

NANN also believes that neonatal units that choose to implement co-bedding should do so after developing a clinical evaluation protocol to be used in collecting data on the risks and benefits of practice.

Co-bedding multiples potentially increases the risks

Many multiples are:Premature IUGR LBWRe-breathing

+ Hyperthermia_________________________________________

Multiple risks for SIDS

(Hayward, K. MCN 2003;28(4):260-263)

Recent hospital deaths reported in the US

(1999 to 2013; 9 cases in past 3 years)

All were healthy prior to their deaths and were successfully breastfed

All were bed sharing 6 received sedating drugs (stated or probable—death

within 24 hours of delivery) 10 reported parental fatigue 3 mothers were obese or had “large breasts” 2 involved bed sharing with multiple adults 6 deaths involved pillows 2 of the mothers smoked

Thach,B. Journal of Perinatology, in press, Nov 2013 The Children’s Hospital at Dartmouth

Public health measures to prevent SIDS and Suffocation

• Have been largely focused on eliminating potentially asphyxiating environments

• Effectiveness does not require a mechanism• For example, we really don’t know why

sleeping on the back reduces the risk for SIDS

• Does suggest that something is different about being prone that results in a series of events culminating in death.


Campaign changed from “Back to Sleep” to “Safe to Sleep”

Focus shifted to safe sleep environment, building on the success of “Back to sleep”

When the death scene is carefully scrutinized, asphyxia contributes to the cause of death in the majority (86%) of SUIDS

Potentially, asphyxia generating conditions in the sleep environment can increase the risk for SIDS by 3x Improving the sleep environment can protect against SIDS and suffocation, entrapment, and other accidental deaths


“Safe to Sleep” campaign Consistent with, reinforced, and expanded the

previous recommendations

Easier for parents and providers by providing specific answers about reflux, crib bumpers, pacifiers, etc.

Detailed, evidence-based answers to encourage parent compliance.

More emphasis on the role of the health care provider in modeling safe sleep in the hospital.

Focused on ways to reduce the risk of all sleep-related infant deaths, including SIDS, suffocation, and other accidental deaths.


There are TWO documents Policy statement: Summary of recommendations

Technical Report: background literature review and

data analyses (electronic version only)

Some topics are only covered in this report:

Swaddling, toxins and toxic gases and hearing

screens


Summary of 2011 AAP Focus for Safe Infant Sleep

SIDS incidence remains at a plateau Room sharing is safest, no bed sharing Always place infants back to sleep until

one year, no side sleeping Avoid exposure to smoke Firm bed surface, no soft objects Place infants to sleep on back in the NICU

as soon as medically stable, by 32 weeks before they are discharged

Use the back sleep position every time!

• Babies who usually sleep on their backs, but who are then placed on their stomachs are at very high risk for SIDS

• Infants placed either side or prone for sleep are two times more likely to die of SIDS

• When infants usually sleep on the back, their risk increases 8.2 times when they are placed prone.

• The risk increases 6.9 times when placed in an unaccustomed side sleep position.

(Li, 2003)

Firm sleep surface!

A firm crib mattress, covered by a fitted sheet is recommended

Crib, bassinette, or portable crib that conforms to safety standards

• Consumer Product Safety Commission and ASTM International

• Make sure product has not been recalled, or missing hardware

(AAP 2011 recommendations)

Separate but close: Share the room not the bed Infants should never bed share or sleep

with adults or other children. One should never sleep on a couch or

armchair with infant. Placing cribs or bassinets in parents’

bedroom has been shown to reduce SIDS Infants should never sleep on adult beds

because of risk of entrapment and suffocation


Bed-Sharing Risks…. Bed sharing:

Increased from 5.5 to 12.8% between 1993-2000• 3 times in U.S. Asian population• 4 times in U.S. African Americans

Promoted by breast feeding advocates

Bed sharing risks are associated with: Maternal cigarette smoke Recent maternal alcohol consumption. Covering by quilt or comforter. Parental tiredness. Sleeping with other children.

Breastfeeding & Safe Sleep

• Breast feeding is associated with a reduced risk of SIDS

• Safe practice- infants may be brought to bed to breastfeed or comfort and returned to their own crib when parents are ready to sleep

• However, this not recommended for parents that are excessively tired or using medications or substances that may impair alertness.


Pacifiers to reduce SIDS The mechanism is unknown, however

pacifier use is strongly associated with reducing the risk for SIDS.

Protection lasts during sleep, even if pacifier falls out of the infant’s mouth.


AAP infant sleep policy use of pacifiers (2011)

Mechanism is unclear, but studies show protective effect of pacifiers

• Do not reinsert once the infant falls asleep.• Don’t force baby to take it, try to offer

pacifier when infant is a little older• Do not attach to clothing or stuffed toys, or

hang around neck • Clean pacifier and replace often• For breast fed infants, wait 3-4 weeks before

introducing

Avoid overheating!

Dress appropriate for environment No more than one layer than adult

would wear to comfortably sleep Blanket sleep sacks, correctly sized Avoid over bundling or covering face

and head Signs of overheating: infant’s chest

feeling hot to touch or sweating(AAP 2011 recommendations)

Back to Sleep, but prone for play!

Too much supine positioning can cause: Positional deformities Diaper rash, eczema, cradle cap Mild delay in developmental milestones

not significant by 18 months gross motor skills, upper body tone

Ways to reduce potential harmful effects: “Tummy Time” while awake and observed Avoid excess time in infant seats Change position in crib so infant will orient

toward activity outside of room (e.g. door)

Home monitors and commercial sleep devices

Home monitors have not been found to reduce the incidence of SIDS

Avoid commercial devices marketed to reduce SIDS by maintaining sleep position or prevent re-breathing

• None are sufficiently tested for safety or effectively reducing SIDS or suffocation


Car seats, swings, boppies and infant seats are not for sleeping

When returning home from travel and infant is asleep in the car seat, transfer the infant to a crib.

Boppie pillows are sometimes used to help support the infant during breastfeeding. Infants should not be placed on boppies for sleep.

Swings are appropriate for play, but when it is time for sleep transfer the infant to a crib.

Car seats, swings and infant seats should never be placed on elevated surfaces, including counters, beds, and cribs.


Swaddling and Sleep Sacks The risks of swaddling are uncertain and therefore

the AAP did not make any firm recommendations

Swaddling not done correctly clearly increases the risk for strangulation

We recommend that after “safe sleep” is implemented, swaddling be replaced by sleep sacks for normal nursing care.

We are further recommending sleep sacks rather than swaddling for home care.


What you do will make a difference!

Parents copy at home what is demonstrated in the hospital Stable preterm infants should be placed supine

for sleep by 32 weeks. Demonstrate proper practice

No stuffed animals in crib No blankets over crib Avoid over bundling, quilts and comforters Tummy time when awake and observed

Nurse as Educator

The Joint Commission • Delineates nursing standards for patient

education• Expects evidence that patients and significant

others understand what they have been taught

State Nurse Practice Acts (NPAs)• Nursing scope of practice includes teaching!• Nurses are expected to provide instruction to

maintain optimal levels of wellness, prevent disease, manage illness, and develop skills to give supportive care to family members.

(Bastable 2003 Nurse as Educator- Principles of Teaching and Learning for Nursing Practice)

Nurse’s discharge instructions will save lives

Discourage parents from placing their baby to sleep in the prone or side lying position

Teach parents to place their baby on his or her back to sleep for the first year. Parents should require anyone who cares for their baby to do likewise However, once the child can roll over, there is no need

to keep flipping him or her over onto their back Teach parents about risk reduction measures

protect infant from any smoke exposure no soft bedding or co-bedding avoid overdressing/overheating

Seeing is Believing!

Parents need to see their baby sleeping safely on his or her back before discharge

Best practice in the NICU before going home!

Supine sleep position

Wearable blanket or swaddle below nipple line

Firm mattress

No loose bedding or soft toys in crib

Flat crib position

Be careful not to do anything in the ICN that you don’t want parents doing at home

Convert “Back to Sleep” to “Safe Sleep” campaign to reduce ALL sleep-related deaths

Provide public education for all who care for infants (parents, child care providers, grandparents, foster parents, babysitters and expectant families), including strategies for:

Overcoming barriers to behavior change

Increasing breastfeeding while decreasing unsafe sleep

Eliminating tobacco smoke exposure

Continue to have a special focus on cultures and ethnic groups with the highest incidence of SIDS and accidental suffocation.

Introduce recommendations before pregnancy and ideally in secondary school curricula to both males and females. The Children’s Hospital at Dartmouth

Stick to the factsStay current!

Be a safe sleep champion Remember: parents place infants in

positions recommended and modeled by medical and nursing professionals

Provide educational materials

We endorse use of this national poster in your institution to promote safe sleep for parents

http://www.cpsc.gov/en/Safety-Education/Neighborhood-Safety-Network/Posters/Bare-is-Best/


Nursing research findings…. 514 surveys were sent to NICU nurses in 9 institutions

and 252 (49%) responded. Only half instructed parents to place infants on the back to sleep as illustrated in the chart below:

52%38%

1% 9%

Always place infant to sleep on back

Back or side for sleep

Whatever position the infant is most comfortableinSide with positioning r olls

Discharge Instructions Given to Parents

(Aris et al. Advances in Neonatal Care 2006)

More evidence of “unsafe” hospital safe sleep practice

1080 surveys sent to nurses in 19 institutions in 2 Mid Atlantic states; 430 (40%) responded.

85% identified AAP SIDS reduction strategies Regardless of nursing and neonatal experience, or

education level: 50% position preterm infants supine when weaned to an open crib, 15% wait one to only a few days before discharge, and 6% never do so.

45.5% use positioning aids/rolls in infants cribs Common reasons for side and prone positioning

Fear of aspiration (29%) Infant comfort (28%) Infant safety (20%)

(Grazel, Phalen. Gibbons, & Polomano, 2010)

Nurses hold the key to saving lives!

Nursing is key to getting accurate information to parents. Use evidence based practice, not opinion or traditional practice.

Nurses are essential role models for parents.

Nurses are in a powerful position to make a difference.

Parent Quote

“ I talked to a lot of doctors and asked them why they don’t tell parents about SIDS. They say they don’t want to scare mothers. They don’t want them to think their baby is going to die from SIDS. I say, I would rather be scared for a year than to be sad for the rest of my life because my baby died.”

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hospital discharge in healthy preterm infants. Journal of Perinatology, 18 (3), 168-172.2. American Academy of Pediatrics, Task Force on Sudden Infant Death Syndrome (2005).The changing

concept of sudden infant death syndrome: Diagnostic coding shifts,controversies regarding the sleeping environment, and new variables to consider in reducing risk. Pediatrics, 116(5), 1245-1255.

3. American Academy of Pediatrics, Task Force on Infant Sleep Position and Sudden Infant Death Syndrome. (2000). Changing Concepts of Sudden Infant Death Syndrome: Implications for Infant Sleeping Environment and Sleep Position. Pediatrics, 105 (3), 650-656.

4. American Academy of Pediatrics (2011). SIDS and other sleep-related infant deaths: Expansion of recommendations for a safe sleeping environment. Pediatrics, e000. Retrieved from http://pediatrics.aappublications.org/content/early/2011/10/12/peds.2011-2285

5. Ariagno, R.L., Mirmiran, M., Adams, M.M., Saporito, A.G., Dubin, A.M., & Baldwin, R.B. (2003). Effect of position on sleep, heart rate variability, and QT interval in preterm infants at 1 and 3 months’ corrected age. Pediatrics, 111 (3), 622-625.

6. Aris, C., Stevens, T., Le Mura, C. Lipke, B., McMullen, S., Cote-Arsenault, D., Consenstein, L (2006). NICU nurses knowledge and discharge teaching related to infant sleep position and risk of SIDS. Advances in Neonatal Care, 6, 281-294.

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REFERENCES10. Blair, P., Ward-Plantt, M., Fleming, P., & CESDI SUDI Research Group Institute of Child Health, UBHT

Education Centre, Bristol BS2 8AE, UK. (2003). Sleeping position amongst preterm infants after discharge: are we getting the message across? Early Human Development, 74, 57-82.

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12. Blair, P.S, Ward Platt, M., Smith, I.J., Fleming, P.J., (2006). Sudden infant death syndrome and sleeping position in pre-term and low birth weight infants: an opportunity for targeted intervention. Arch Dis Child, 91, 101-106 doi:10.1136/adc.2004.070391.

13. Center for Disease Control (2006). Notice to readers: Release of sudden unexplained infant death investigation reporting form. Retrieved May 7, 2008 from www.cdc.gov/mmwr/preview/mmwrhtml/mm5508a7.htm.

14. Center for Disease Control SUID line graph. Retrieved from the CDC website on 5/14/13 @ ( http://www.cdc.gov/sids/images/SUIDlinegraph.gif

15. Dimitriou, G., Greenough, A., Pink, L., McGhee, A., Hickey, A., & Rafferty, G.F. (2002). Effect of posture on oxygenation and respiratory muscle strength in convalescent infants. Archives of Disease in Childhood, 86(3), F147-F150.

16. Fleming, P.J., & Blair, P.S. (2003). Sudden unexpected deaths after discharge from the neonatal intensive care unit. Seminars in Neonatology, 8, 159-167 Gibson, E., Dembofsky, C.A., Rubin, S., & Greenspan, J.S. (2000). Infant sleep position practices 2 years into the “back to sleep” campaign. Clinical Pediatrics, 39 (5), 285-289.

17. Gleeson, M. (2003). Development of Infant Mucosal Immunity in Relation to Vulnerability to Infections, from SIDS International Conference Booklet in Edmonton, Alberta, Canada, July 2-6, 67-117-118.

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5508a7.htm

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