title: 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.
abstract: 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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  Convenience sample of nurses practicing in level II and III NICUs located in 2 Middle Atlantic States.
  
  
  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.
  
  
  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.
authors.affiliation: Center for Education, Development and Research, Our Lady of Lourdes Medical Center, Camden, New Jersey 08103, USA. grazelr@lourdesnet.org
authors.forename: Regina
authors.initials: R
authors.lastname: Grazel
authors.forename: Ann Gibbons
authors.initials: AG
authors.lastname: Phalen
authors.forename: Rosemary C
authors.initials: RC
authors.lastname: Polomano
mesh_terms: D001512:Bedding and Linens; D007722:Health Knowledge, Attitudes, Practice; D006284:Health Plan Implementation; D006801:Humans; D007224:Infant Care / Q000458:organization & administration*; D007231:Infant, Newborn; D007234:Infant, Premature; D008873:Mid-Atlantic Region; D017283:Neonatal Nursing / Q000458:organization & administration*; D024802:Nurse's Role; D011446:Prospective Studies; D012955:Societies, Medical; D013398:Sudden Infant Death / Q000517:prevention & control*; D016683:Supine Position