The Status of Iowa Sleep-Related Infant Mortality: An Evaluation of Safe Sleep Education Delivery, Policy, and Practice in Birthing Hospitals
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Authors
Harris, Meghan L.
Issue Date
2014-12
Type
Thesis
Language
en_US
Keywords
Infants--Mortality--Iowa , Sleep--Education--Iowa , Birthing centers--Iowa , Sudden infant Death Syndrome--Prevention--Iowa
Alternative Title
Abstract
Problem: Sleep-related infant mortality, including sudden infant death syndrome, asphyxia, and
undetermined or unknown causes, is the third leading cause of death nationally and in Iowa
(Harris, 2014; Malloy & Ramirez, 2013). Evidence exists for increasing rates of bed sharing, a
major risk factor for sleep-related mortality (Kemp et al., 2000). Preventive messaging is most
widely and effectively delivered by health professionals at time of birth (Shaefer, Herman,
Frank, Adkins, & Tehaar, 2010). The intent of this study was to provide a characterization of
infant, maternal, and environmental factors contributing to sleep-related infant mortality and a
comprehensive review of safe sleep education policy and practices in Iowa birthing hospitals.
Procedures: An experimental, cross-sectional study design was used to analyze infant mortality
data reported by the Iowa Office of the State Medical Examiner to the Child Death Reporting
system from 2004-2012. Analyses included mortality trends for sleep-related mortality parsed
by Sudden Infant Death (SIDS), asphyxia, and undetermined or unknown cause, descriptive
statistics for maternal and infant demographic factors, and correlations for environmental factors
potentially contributing to sleep-related death. An adjacent effort with Iowa birthing hospitals
involved use of a web-based survey to assess policies, parent education programs, clinical
practice, and training related to safe infant sleep or SIDS. The survey was directed toward
obstetric unit coordinators with content drawn from previous efforts to ascertain clinical practice.
Findings: Sleep-related mortality in Iowa has been steadily increasing since 2004. Subcategorical
examination of this trend revealed rises in SIDS and undetermined or unknown cases,
but a stable rate of deaths due to asphyxia. These infants (n=384) were more often males
(58.6%), lived an average age of 102 days, were living with multiple children at time of death,
and had a young mother. An alarming 42% of infants were bed sharing at time of death, with
only 43% placed on their back to sleep prior to the event. Significant racial disparities were
present. Non-white infants were more likely to have died while bed sharing compared to white
infants, Pearson χ2(1, n=151)=6.7, p=0.01, and non-white infants were also more likely to
usually sleep someplace other than a crib, Pearson χ2(2, n=151)=5.05, p=0.025.
The hospital survey (N=42) revealed that three-quarters have policies addressing SIDS or safe
sleep education. Of those with policies, topics covered included sleep positioning, surface, bed
sharing, and the infant’s sleep environment. Respondents indicated nearly uniform
demonstration of supine sleep, though some cited fear of aspiration, as a reason supine sleep
might not be used. Less than half of hospitals require clinical staff to complete safe sleep
education training. Unit coordinators rated their SIDS or safe infant sleep programs an average
strength of 7.66 out of 10.
Conclusions: Sleep-related mortality incidence in Iowa is increasing and state-specific risk
factors exist. Racial disparities in sleep environment practice are of particular concern. Hospital
policy addressing safe infant sleep is not universal. Consistent demonstration of supine sleep
may be inhibited by concerns over aspiration. Training opportunities could be improved as
access to programs external to the hospital setting and online are not fully utilized.
Recommendations: Greater awareness of the risk factors associated with sleep-related infant
mortality is needed among parents and caregivers of infants. Expansion or strengthening of
existing hospital-based education programs may improve protective parental actions. The Health
Belief Model may be an important tool in examining why parents are not be universally adhering
to guidance against bed sharing.
Description
142 pages
Citation
Publisher
Drake University