Back to Sleep Campaign- When to start

[LuvMyNeonates]

So, this may already be on here, but I need help and suggestions. Our NICU is just now starting the Back to Sleep Campaign. Our policy is that once the neonate is 1500g or over, they need to be supine, with arms out, and bed flat. The only problem is, we are having more bradys due to emesis (when they are on their back and flat), and more temp. instability due to their arms out. All of our nurses feel this is too early, for a lot of our babies are not even PO feeding yet at this point. What is the policy at everyone's hospitals concerning the Back to Sleep Campaign and when do you start with it?

[FlutterbyNurse]

Thanks for the inquiry. Our NICU recently adopted a back to sleep policy as well. However, we chose to do it closer to discharge. Our policy is to allow elevated sleep positions until they are in an open crib and stable. Then we start the back to sleep protocol which sounds similar to yours, however, we still do allow elevation during gavage feeds and for 20 minutes after a feeding (gavage or nipple). Our patients do not even meet criteria to come out of an isolette until they are at least 1600 grams though.

We try to model what we expect parents to do at home which is always put baby back to sleep and hold them for at least 20 minutes after a feeding to help prevent reflux.

Hope this helps!!

[NICU_babyRN, BSN, RN]

At 34 weeks all of our infants have to start BtoS. We don't allow gel pillows once infants don't have a protected airway unless there is a need for it (hydrocephalus). Many nurses are having issues with this and it's very frustrating. Night shift is specially bad about putting infant on their tummies ALLLLL THE FREAKIN' TIME!!!! Once in open crib, even if less than 34 weeks we also promote BtoS.

If NG feeding or hx of reflux, we tilt the bed after feedings.

[sweet0176]

Once they hit 34 weeks and they are in a cot or crib, we start transitioning them to back to sleep. Once they hit 35 weeks, they have to be on their backs with bed flat and all the other good stuff. That being said, these are only for the stable kids that are transitioning to going home.

[iyqyqr]

We have a scoring sheet for Back to sleep. We give points for them meeting different criteria and when they total 10, they are put on BTS. If a baby has major reflux or airway issues then our neos write an order to disregard BTS for this pt. This method has worked well for us for about 3-4 years now.

[LuvMyNeonates]

Thank you all soo much. We have a meeting this week regarding this and all of us nurses are trying to get across to the pediatrician pushing this that we need to revise the criteria.

[acenab4jc]

What criteria does your scoring chart contain?