Infant sleep position and SIDS: a hospital-based interventional study.

CONTEXT: Avoidance of the prone sleeping position is considered an important factor contributing to the decline in the incidence of sudden infant death syndrome (SIDS).
OBJECTIVES: To determine infant sleep positioning practices and SIDS awareness before and after a hospital-based Back to Sleep campaign.
DESIGN: A questionnaire-based, descriptive, and cross-sectional before-after trial.
SETTING: The pediatric outpatient department of an inner-city hospital in Brooklyn, New York.
SUBJECTS: Two consecutive samples of 250 mothers of healthy infants younger than 6 months old born in and attending the outpatient clinics of the hospital before and after the intervention. INTERVENTION AND MAIN OUTCOME MEASURES: Specific policies promoting Back to Sleep were established in our newborn nursery and outpatient department. Reduction in prone infant sleep positioning was the primary outcome measure. Increased parental SIDS awareness was a secondary outcome.
RESULTS: The proportion of infants sleeping prone was reduced significantly (from 27% to 18%) after the intervention (P < .005). Among the mothers who chose the prone sleeping position for their infants, 49.6% worried about choking. Older mothers (> 22 years) responded to the intervention by a 45.6% reduction in prone placement (P < .005) as opposed to a 11.4% reduction among younger mothers (< 22 years) (P = ns). Other factors contributing to reduced prone positioning included marriage (adjusted odds ratio [OR] 0.57; 95% confidence interval [CI] 0.93, 0.34) and breast feeding (adjusted OR 0.66; 95% CI 1.1, 0.4). SIDS awareness was 79.6% and 82.4% in the preintervention and postintervention groups, respectively (P = ns).
CONCLUSIONS: The Back to Sleep campaign was effective in our hospital setting. Our data indicate the need for special targeting of young, unmarried, and non-breast-feeding mothers. Fear of choking remains an important deterrent to proper infant sleep positioning.