SIDS prevention and Back to Sleep education for NICU parents

[scrabblern, RN]

Hi everyone,

I will be doing education on SIDS to both parents and nurses of NICU patients...in our unit we tend to swaddle babies 'till almost the very end. Back to sleep is taught once by our OT prior to discharge. I did a little bit of article digging on this and found that there's been a lot of research on this... It seems that many hospitals across the nation have a similar issue. Nurses are aware that babies are supposed to be in "Back to Sleep" at least a week prior to discharge but that doesn't happen in practice. Also parents whose babies have been in NICUs for extended periods of time and have slept prone for most of they stay tend to place their babies prone at home too.

I was curious to find out how and when is Back to Sleep introduced to parents in your units? Also is there any product that your unit uses to promote Back to Sleep, such as HALO SleepSacks? If you do use the product, please describe when do you put the baby in it and how is it laundered... Do you tend to lose it in laundry much, are nurses satisfied with it, etc?

Thank you!

[NicuGal, MSN, RN]

We start at about 33-34 weeks for the smaller kids, they start going on their backs with the HOB flat unless otherwise ordered. We place them in sacks when we bundle them. Bigger kids, unless sick or crazed because they are NPO, go on their backs also. A week before discharge is too close to going home....kids don't transition that fast, well at least most of them lol

We use HALO's, but have found if they are not zipped and the velcro redone before they go to laundry the zippers don't work after a while. We also had our first batch get basically melted together because they were dried too hot. We send them down with the regular laundry. They do lose the softness to them with the first wash due to the high temps that they use and the detergent.

We start teaching about back to sleep right away. We do explain to parents that we may have their infant on their belly, but that is because of XYZ and once they are better they will go on their back, just like home. We have handouts we put in their folders.

[umcRN, BSN, RN]

We also start teaching back to sleep right away (Level IIIc). Obviously it's not practiced right away but we emphasize to parents why sleeping prone is helpful in the present situation and that it is safe because we have monitors - but parents won't have monitors at home. If a baby is off respiratory support and at goal po/ng feeds, unless contraindicated for some other reason (small chin, severe reflux, other airway/gi abnormalities) they are on their back to sleep. We will swaddle though usually up to 1 mo corrected age, we don't use sleep sacks/halo's on our unit.

[NICURN29]

We use HALO sleep sacks for babies once they are 48 hours out of the isolette. We start modeling safe sleep at 33-34 weeks.

[scrabblern, RN]

At what point does your unit take babies out of the isolette, and why do you wait 'till you take them out? We've just had a thermoregulation policy change, making most of our babies stay in a lot longer...

[scrabblern, RN]

@NicuGal: How long have you been doing HOB flat at 33-34 weeks in your unit? Do you find that the babies spit up more with HOB flat at that age, since lots of them still need gavage... Most of the nurses where I work keep babies with HOB up until the feeding tube is out. I'm now realizing that this too may be tied into the issue of demoing safe sleep...

[NicuGal, MSN, RN]

If we have a kid with reflux or reflux symptoms, then we get an order for HOB up. Some kids do just fine, it is play it by ear. We take them out of the isolette when they are tolerating the majority of their feeds PO/breast. We also will use the sleep sacks in the isolette if they are in a low bed, if they can be bundled, they can go in a sleep sack. We are finding that there a lot of kids who tolerate being on their back better than we thought.

We have been doing this for almost 6 months now. It is getting better. The biggest thing is making sure people are using appropriate bedding, not the big fluffy blankets the parents bring in...one blanket, no rolls, a burp rag under head, that is all we put in there. The parents love the sacks...it keeps the wires contained out of the bottom and the kids don't get unwrapped and slide all over :)

[Bortaz, MSN, RN]

\ said:

If we have a kid with reflux or reflux symptoms, then we get an order for HOB up. Some kids do just fine, it is play it by ear. We take them out of the isolette when they are tolerating the majority of their feeds PO/breast. We also will use the sleep sacks in the isolette if they are in a low bed, if they can be bundled, they can go in a sleep sack. We are finding that there a lot of kids who tolerate being on their back better than we thought.

We have been doing this for almost 6 months now. It is getting better. The biggest thing is making sure people are using appropriate bedding, not the big fluffy blankets the parents bring in...one blanket, no rolls, a burp rag under head, that is all we put in there. The parents love the sacks...it keeps the wires contained out of the bottom and the kids don't get unwrapped and slide all over ?

What are these sleep sacks you're talking about?

[karnicurnc, MSN, APRN, CNS]

We start weaning from the incubator at 32 weeks adjusted until the bed temp is 26. Then infant is dressed in shirt, sleeper (if available) Halo Sleepsack and hat and put in open crib with HOB flat. If infant stays warm, then he/she can continue to work on PO feeding, weaning on NC, etc. If infant gets cold, then he/she goes back into the incubator and can try it again in a day or so. If a sleepsack is not available then the infant is swaddled in a blanket with up to 2 placed on top. Closer to discharge we try to transition to swaddling at the armpit level. Our sleepsacks have also gotten lost and melted by the laundry people. I have no idea what they do with them down there! We have moved away from placing blankets over the head of the crib and I am always educating nurses about modeling safe sleep for parents.