SIDS and Your NICU Baby

Here's an article that was interesting to me, from the journal Pediatrics  (2011). It's about having babies sleep on their backs (supine) earlier in their NICU stay, for SIDS prevention after discharge.

Preterm Infants Should Be Placed Supine as Soon as Possible

Infants born prematurely have an increased risk of SIDS and the association between prone sleep position and SIDS among low birth weight infants is equal to, or perhaps even stronger than, the association among those born at term. Therefore, preterm infants should be placed supine for sleep as soon as their clinical status has stabilized. The task force supports the recommendations of the AAP Committee on Fetus and Newborn, which state that hospitalized preterm infants should be placed in the supine position for sleep by 32 weeks' postmenstrual age to allow them to become accustomed to sleeping in that position before hospital discharge. Unfortunately, preterm and very low birth weight infants continue to be more likely to be placed prone for sleep after hospital discharge. Preterm infants are placed prone initially to improve respiratory mechanics; although respiratory parameters are no different in the supine or prone positions in preterm infants who are close to discharge, both infants and their caregivers likely become accustomed to using the prone position, which makes it more difficult to change. One study of NICU nurses found that only 50% of nurses place preterm infants supine during the transition to an open crib, and more than 20% never place preterm infants supine or will only place them supine 1 to 2 days before discharge. Moreover, very prematurely born infants studied before hospital discharge have longer sleep duration, fewer arousals from sleep, and increased central apneas while in the prone position. The task force believes that neonatologists, neonatal nurses, and other health care professionals responsible for organizing the hospital discharge of infants from NICUs should be vigilant about endorsing SIDS risk-reduction recommendations from birth. They should model the recommendations as soon as the infant is medically stable and significantly before the infant's anticipated discharge. In addition, NICUs are encouraged to develop and implement policies to ensure that supine sleeping and other safe sleep practices are modeled for parents before discharge from the hospital.


NICU practice is changing. I want you to understand that nurses do this NOT out of ignorance or neglect, but out of a long history of placing babies on their tummies in the NICU, because they are safely protected by the heart rate & apnea monitors while they are in the NICU. Many times babies digest their milk better on their tummies, or settle better for longer periods of much-needed sleep. I think we've had long-held beliefs that these little ones need extra comfort, and if giving them a little time on their tummies makes them sleep well, then it seems OK. But as new recommendations come out, our practices are changing, and more of you will see your babies on their backs to sleep earlier in their NICU stay, which is a good thing.

preemie baby sleeping swaddled in hospital blanket   

My recommendation to you is this:

if your hospital staff are some of those 50% who are not placing your baby supine ("back to sleep") when it seems they should be, mention it to them, ask them why.

Some certainly will have legitimate reasons, not covered by this study, such as head shape considerations, equipment technicalities, feeding tolerance issues, your baby's particular diagnosis, etc.

But if it's just the routine at that NICU and you'd like them to follow the recommendations, request that your baby be placed supine as is recommended by the journal Pediatrics .

And remember this important bit of information - the babies are not at greater risk of SIDS while they are in the NICU, it's after they go home. So even if you see your baby on his tummy while in the NICU, the point is that you still need to place your baby on his back once you get home in order to minimize the SIDS risk.

By the way, if you have time on your hands, the entire article has excellent information on all sorts of sleeping recommendations, although it's a bit heavy & intimidating. If you're already feeling stressed out, read it later when you're ready to think about home sleeping ideas.

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