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Implementation of the American Academy of Pediatrics Recommendations to Reduce Sudden Infant Death Syndrome Risk in Neonatal Intensive Care Units: An Evaluation of Nursing Knowledge and Practice

Grazel, Regina MSN, RN, BC, APN-C; Phalen, Ann Gibbons PhD, APRN, NNP-BC; Polomano, Rosemary C. PhD, RN, FAAN

Section Editor(s): Dowling, Donna

doi: 10.1097/ANC.0b013e3181f36ea0
Original Research

There is a direct relationship between nonsupine sleeping and sudden infant death syndrome (SIDS). Premature infants are at greater risk for SIDS and are often cared for in nonsupine positions during the course of hospitalization. Healthy premature infants should be placed supine for sleep before discharge from the neonatal intensive care unit (NICU), and parents receive specific instruction about infant sleep position and other risk factors for SIDS. Most published literature addressing nursing practices for SIDS reduction reflects practices with the healthy newborn population.

PURPOSE: To examine and describe NICU nurses' knowledge of SIDS risk-reduction measures, modeling of safe infant sleep interventions prior to discharge, and inclusion of SIDS risk reduction in parent education.

SUBJECTS: Convenience sample of nurses practicing in level II and III NICUs located in 2 Middle Atlantic States.

DESIGN AND METHODS: A prospective survey design was used for the study. The 14-item questionnaire was developed by a team of neonatal clinical experts and distributed via site coordinators to nurses in 19 NICUs.

PRINCIPAL RESULTS: A total of 1080 surveys were distributed and 430 (40%) NICU nurses completed the survey. The majority of nurses (85%) identified the American Academy of Pediatrics SIDS risk-reduction strategies for safe sleep. The investigators found that age, years of nursing and neonatal nursing experience, and educational preparation did not significantly contribute to the practice of “supine-only” position for sleep for infants in NICUs. The study revealed that nurses frequently position healthy preterm infants supine for sleep when weaned to an open crib (50%). Others wait one to a few days before discharge (15%) and some never position supine for sleep (6%). Stuffed toys are removed from cribs 90.5% of the time. For term infants without major medical complications, 45.5% of surveyed nurses continued to use positioning aids/rolls in infants' cribs. The most common reasons nurses cited to position preterm infants side-lying or prone in a crib were fear of aspiration (29%), infant comfort (28%), and infant safety (20%). NICU nurses educated parents about SIDS and reduction strategies, using various media. At discharge, 73% of the nurses verbally communicated with parents, 53% provided printed literature, and 14% used audiovisual aids with parents.

CONCLUSIONS: NICU nurses are in influential positions to educate parents and model SIDS risk-reduction strategies. This study supports other published research that points to inconsistencies in nursing practice regarding implementation of methods to reduce the risk of SIDS.

Center for Education, Development and Research, Our Lady of Lourdes Medical Center, Camden, New Jersey (Ms Grazel); Jefferson School of Nursing, Thomas Jefferson University, Philadelphia, Pennsylvania (Dr Phalen); and Division of Biobehavioral Health Sciences, School of Nursing, Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia (Dr Polomano).

Correspondence: Regina Grazel, MSN, RN, BC, APN-C, Our Lady of Lourdes Medical Center, 1600 Haddon Ave, Camden, NJ 08103; (

This work was a collaborative effort of the Delaware Valley Association of Neonatal Nurses. The research was conducted at 17 institutions listed in the “Acknowledgments” section. No grant funding was obtained.

© 2010 National Association of Neonatal Nurses