Infants are at less risk for sleep-related death if they are in safe sleep environments at the hospital and at home
About a half million – or 10% to 15% of U.S. newborns -- are admitted to Neonatal Intensive Care Units every year for special medical care. Many are preterm and low birth weight infants, who are 2 to 3 times more likely than healthy term infants to die suddenly and unexpectedly.
The American Academy of Pediatrics, recognizing the vulnerability of infants to sleep-related death, calls for intensive care units to transition infants as soon as medically possible into a safe sleep environment before they are discharged from the hospital. The AAP provides guidance for healthcare professionals within a clinical report, “Transition to a Safe Home Sleep Environment for the NICU Patient,” as well as a technical report that provides the rationale and protocols for neonatal intensive care units. Both reports will be published in the July 2021 Pediatrics and published online June 21.
“For decades now, we have known that it is safest for infants to sleep on their backs, alone and on a firm mattress with no extra bedding or pillows,” said Michael Goodstein, MD, FAAP, lead writer of both reports, created by the Committee on Fetus and Newborn and Task Force on Sudden Infant Death Syndrome.
“In the hospital, some infants who are sick or preterm may initially need to be positioned on their stomachs or sides for medical reasons, but they should be switched to a safer sleeping position long before they go home. This decreases the risk of sudden infant death and models a safe sleep environment for new parents.”
In the United States, sudden unexpected infant death (SUID), including sudden infant death syndrome (SIDS), is the leading cause of death for infants between 1 month and 1 year of age. In up to 95% of these cases, there are one or more environmental risk factors identified, according to research.
Studies have shown that neonatal intensive care unit providers do not consistently support infant sleep safety recommendations. Challenges include resolving therapeutic positioning practices for the infant that are consistent with sleep safety at home.
The AAP recommends:
The clinical report also discusses the use of bed positioners, swaddling and thermoregulation regarding sleep-related death, as well as the benefits of human milk and breastfeeding.
Experts have recommended placing infants on their backs to sleep since 1992 and a Back to Sleep Campaign in 1994 resulted in U.S. SIDS rates decreasing by 53% in 1999.
“We know so much more now about how to prevent tragic deaths due to suffocation or other sleep-related causes,” said Rachel Y. Moon, MD, FAAP, chair of the AAP Task Force on SIDS.
“We urge consistent messages to families on how to keep infants safe during sleep, beginning from birth or ideally, even before.”
To request an interview, contact AAP Public Affairs.
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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.