P0584 - Evaluating Safe Sleep Practices in an Academic Children's Hospital

Background:
The American Academy of Pediatrics (AAP) has published recommendations for safe sleep environments for infants to decrease infant sleep-related death. A paper by Shadman, entitled “Improving Safe Sleep Practices for Hospitalized Infants” demonstrated that these recommendations are poorly adhered to in the hospital setting despite being part of the AAP’s recommendations. There is currently limited data on this topic, with few articles that are truly exploring safe sleep in the inpatient setting and evaluating what current practices are.

Objective:
To evaluate the adherence of the AAP’s recommendations for safe sleep in hospitalized infants at an academic institution.

Methods:
Crib audits were performed on the general sleep environments of infants 0-12 months born or admitted to the general pediatrics inpatient, cardiac stepdown and nursery. The audits were performed using a Qualtrics survey. Information tracked included: awake/sleeping, location, position, head of bed position, presence of any additional items in the crib, and bundling. Any infant that had a medical reason for requiring different position was excluded.

Results:
A total of 442 audits across the three services were collected. Of the 442 audits, 182 were in the general pediatrics inpatient unit, 186 in the nursery, and 74 infants in the cardiac stepdown unit. When evaluating the overall sleep environment, 27.82% of cribs were noted to be flat and empty, the ideal sleep environment, with the nursery having the highest percentage at 61.29% and the cardiac stepdown unit at the lowest at 1.35% and inpatient at 4.39%, (p<0.0001, chart 1). Additional items were found in 70.81% of the total crib audits with extra blankets at the most common at 33.38%, followed by diaper supplies at 19.35%. There was also a sub-group analysis performed for sleeping infants less than or equal to 4 months given their increased risk of sleep-related deaths. There was a total of 308 of these infants, with 115 on the general pediatrics inpatient unit, 155 infants in the nursery and 38 in the cardiac unit (chart 2). The majority (68.82%) of infants were located in cribs/bassinets, with 4.54% noted to be co-sleeping. 74.67% of these infants were noted to be on his/her back and 78.88% bundled appropriately with receiving blanket/sleep sack/clothing or just diapers. 22.16% of patients were found to have “perfect sleep” defined as having empty, flat environments with appropriate bundling- with the nursery at the highest at 49.38%, cardiac stepdown at the lowest at 3.12% and inpatient at 6.06% (p< 0.0001).

Conclusion:
The AAP guidelines on safe sleep are critically important to apply to hospital settings, where keeping infants safe is vitally important. This study highlights the lack of adherence to the recommendations and also the need for further interventions.