P2A151: Evaluating Safe Sleep Practices in a Pediatric Cardiac Stepdown Unit

Background: While the “Back to Sleep” public health campaign has made great strides in decreasing rates of Sudden Infant Death Syndrome (SIDS), many babies still sleep in unsafe environments both in the hospital setting and at home, and sleep-related deaths still occur. Adherence to the American Academy of Pediatrics (AAP) infant safe sleep guidelines [1] throughout our hospital was poor, therefore our institution created a multidisciplinary “Safe Sleep Taskforce” to reduce the number of infants sleeping in unsafe environments while admitted to the hospital. One particular area of interest in regard to current safe sleep practices was the cardiac stepdown unit, as limited data is available in the literature about this population. Infants with congenital cardiac disease often remain hospitalized for a prolonged period of time and many require non-oral feedings. Flat sleep position does not increase the risk of aspiration [1] and there is no evidence to suggest infants receiving NG feedings are at increased risk of aspiration if placed supine, hence this population should still follow safe sleep guidelines.

Methods: An audit tool was created to record an infant’s sleeping environment during their admission to the Cardiac Stepdown Unit. The tool assessed sleep location, position, and environment and the infants audited were eligible for safe sleep (medically stable and preparing for discharge).

Results: Baseline data was collected from January 2020 to September 2020. During this time, 91 audits were completed and of these, 47 infants were found to be sleeping during the time of audit. 85% of infants were in a proper location (crib or bassinet), however there was 1 cosleeping event noted and 3 infants noted to be sleeping in inclined swings. Of the 47 infants who were sleeping, only 21 were noted to be appropriately on their back (45%). Strikingly, 46 of 47 infants had their bed in an inclined position (98%) despite only 40% having aspiration precautions charted. In addition, only 3 cribs were noted to be empty (6%) while the majority noted to have extra blankets, linens, diaper supplies, or toys present. Overall, only 1 of 47 (2%) of sleeping infants were noted to have “perfect sleep” defined as sleeping on their backs in an empty crib, appropriately bundled, with head of bed flat.

Conclusion: There was little data in the literature regarding adherence to safe sleep in a Cardiac Stepdown Unit and our research shows that there is baseline poor adherence to safe sleep practices. This patient population and their caregivers would benefit from education regarding modeling safe sleep while in the hospital. In particular, the majority of infants were noted to have head of bed elevated which is against AAP guidelines. Future work with focus on provider education to improve adherence.