Citation

Kuhlmann S, Ahlers-Schmidt CR. Hosp. Pediatr. 2018; 8(8): 504-505.

Affiliation

Kansas University School of Medicine-Wichita, Wichita, Kansas cschmidt3@kumc.edu.

Copyright

(Copyright © 2018, American Academy of Pediatrics Section on Hospital Medicine)

DOI

10.1542/hpeds.2018-0097

PMID

30026249

Abstract

As sudden unexpected infant death rates have plateaued in the United States over the last decade, the rate of sleep-related deaths due to accidental suffocation and strangulation in bed has revealed an upward trend. There has been much focus on infant safe sleep over the last few years to reduce these preventable deaths. The American Academy of Pediatrics revised its sudden infant death syndrome reduction recommendations to include safe sleep environments. These recommendations advise that infants sleep on separate sleep surfaces designed for infants to prevent accidental suffocation, strangulation, layover, or entrapment that could occur in the adult bed, chair, or couch. In addition, the sleeping surface should be free of any loose objects, such as blankets, pillows, or toys, that could obstruct an infant’s airway. Some of the efforts to reduce deaths have included public service campaigns, community programs and initiatives, safe sleep education and modeling in the hospital setting, and identifying and addressing barriers to safe sleep. The direct impact of individual interventions on the overall infant mortality rate, measured as infant deaths per 1000 live births, is difficult to determine.

State Child Fatality Review (CFR) teams and Fetal and Infant Mortality Review (FIMR) teams are public health strategies used to understand child and infant deaths at the local level through a multidisciplinary team review. A systematic process is used to collect and analyze data from multiple sources, identify systems-related factors and risks, and make recommendations to improve systematic care, address resource gaps in the community, and reduce preventable deaths.

Krugman and Cumpsty-Fowler have taken a novel approach using infant sleep-related death rates from the local CFR team to target systematic change within their hospital (Medstar Franklin Square Center, Baltimore, MD). Their longitudinal quality-improvement project was focused on creating a culture of safe sleep with consistent messaging and modeling within their institution, and they used sleep-related deaths of infants discharged from their nursery as the primary outcome measure. By collaborating with the local CFR, the hospital was able to receive feedback when infants who had been born at their hospital and discharged from their nursery died of unsafe sleep environments. The infant deaths were considered sentinel events, and each death was reviewed by using root cause analysis. Through the reviews, the hospital was able to identify process changes that needed to be made to the existing infant safe sleep program. Outcome data revealed a reduction in sleep-related death rates of infants

Language: en