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Pediatrics. 2013 Apr;131(4):e1264-70. doi: 10.1542/peds.2012-1857. Epub 2013 Mar 4.

Integrating "Back to Sleep" recommendations into neonatal ICU practice.

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  • 1Division of Neonatal-Perinatal Medicine, The University of Texas at Houston Medical School, 6431 Fannin St, Houston, TX 77030, USA.



The American Academy of Pediatrics stresses that NICUs should endorse and model the sudden infant deaths syndrome risk-reduction recommendations significantly before anticipated discharge of the infant. Medical personnel are critical role models for parents, and the way they position infants in the hospital strongly influences parental practices at home. The aims of this project were to increase the percentage of infants following safe sleep practices in the NICU before discharge and to determine if improving compliance with these practices would influence parent behavior at home.


An algorithm detailing when to start safe sleep practices, a "Back to Sleep" crib card, educational programs for nurses and parents, a crib audit tool, and postdischarge telephone reminders were developed as quality improvement intervention strategies.


NICU compliance with supine positioning increased from 39% to 83% (P < .001), provision of a firm sleeping surface increased from 5% to 96% (P < .001), and the removal of soft objects from the bed improved from 45% to 75% (P = .001). Through the use of a postdischarge telephone survey, parental compliance with safe sleep practices was noted to improve from 23% to 82% (P < .001).


Multifactorial interventions improved compliance with safe sleep practices in the NICU and at home.

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