Safe Sleep Practices and Sudden Infant Death Syndrome (SIDS) Risk Reduction Knowledge among New Mothers Esther K. Chung, MD, MPH, FAAP, To Dung K. Nguyen, BS, MD, Radha Sadacharan, BA, MPH, Lauren M. Daley, Judilyn Arena-Ondik, RN, MSN, CPN, Carol Carofiglio, PhD, RN. Department of Pediatrics, Jefferson Medical College and Nemours, Philadelphia, PA and the Department of Nursing, Thomas Jefferson University, Philadelphia, PA, US

We have no relationships to disclose.

Background Sudden Infant Death Syndrome (SIDS) is the leading cause of infant death beyond the newborn period. In October 2010, Pennsylvania (PA) passed The Safe Sleep Bill, which requires that all birthing facilities provide written materials on SIDS risk reduction.

Objectives Determine the effectiveness of the current SIDS education at Thomas Jefferson University Hospital (TJUH) Newborn Nursery Assess knowledge of SIDS risk factors and perceptions of safe sleep recommendations among new mothers

Methods Cross-sectional, telephone survey New mothers following hospital discharge from the Newborn Nursery at TJUH between April 2011 and October 2012 Surveys conducted at 2-4 weeks postpartum Assessed knowledge of SIDS risk factors, infant sleep practices, and perceptions of safe sleep recommendations

Results: Maternal Characteristics (N = 292) Mean age + SD, yrs Race/ethnicity, Non-white, %75 Marital status, single, %45 Education, % High school/GED or less Some college Post graduate Parity, multiparous, %60 Medical assistance, %55 Receive WIC benefits, %68 Weeks of pregnancy at delivery + SD39 + 1

Results: SIDS Risk Reduction Education

Results: Timing of SIDS Risk Reduction Education

Results: Knowledge

Results: Sleep Practices (N = 292) PracticePercent Back position used by mother93 Back position used by hospital staff97 Bed-sharing with newborn15

Results: SIDS Risk Reduction Education and Associated Characteristics Prenatal EducationWritten Materials Postpartum HCP Counseling Postpartum Age Younger mother were more likely to receive education 26 vs. 28, p = NS Race/ethnicity NS Education More likely in those with HS education than those with postgraduate training: 44% vs. 24%, 0 = NSMore likely in those with HS education than those with postgraduate training: 94% vs. 78%, 0 = Parity NS Insurance NS

Results: Receipt of Written Materials Associated with a higher likelihood of knowing: – An increased SIDS risk associated with pillows in the crib (94% vs. 90%, p = 0.01) Not associated with the following: – Knowing the back sleep position is the safest – Having concerns about choking when using the back position – Knowing there is an increased risk of SIDS on sofa – Knowing there is an increased risk with using bumpers or loose blankets – Bed-sharing

Results: Prenatal Education and Healthcare Professional Counseling in Newborn Nursery Not associated with – Knowing the back sleep position is the safest – Concerns about choking – Knowledge of increased SIDS risk with sleeping on sofa – Pillows, bumpers or loose blankets – Bed-sharing

Results: Non-Back Sleep Position as Safest and Associated Characteristics All associations with p < 0.05

Results: Concerns about an Increased Risk of Choking with the Back Sleep Position

Awareness of Risk of SIDS with Sleeping on Sofa The following factors were not associated with knowing that there is an increased risk of SIDS associated with sleeping on a sofa – Age – Race/ethnicity – Marital status – Education – Parity – Insurance – Receipt of WIC

Results: Bed-sharing Older age (30 vs. 27 years, p = 0.001) Whites race/ethnicity (21% vs. 13%, p = 0.01) Higher education: those with postgraduate level education more likely than those with a HS education (35% vs. 9%, p = 0.004) No association with – Marital status – Parity – Insurance – Receipt of WIC

Conclusions Enhanced efforts must be made to educate non-white race/ethnicity, single, and low- income mothers about SIDS risk reduction When teaching about SIDS risk reduction, increased efforts should be made to discuss safety, concerns about choking when using the back sleep position, and bed-sharing

Limitations Single hospital; therefore, may not be generalizable to other populations Based exclusively on maternal report Unable to confirm if written materials read Other unmeasured factors could impact knowledge and practices (e.g., bed-sharing)