Related Experiment Video
Updated: Apr 7, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Implementation of safe sleep practices in the neonatal intensive care unit
S S Hwang1,2,3, A O'Sullivan3, E Fitzgerald3
1Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA.
Insights
Implementing safe infant sleep practices (SSP) in neonatal intensive care units (NICUs) significantly improved adherence among eligible preterm infants. This intervention can reduce sleep-related risks for vulnerable newborns.
Area of Science:
- Neonatal care
- Pediatric sleep medicine
- Public health interventions
Background:
- Neonatal intensive care units (NICUs) care for vulnerable preterm infants.
- Safe sleep practices (SSP) are crucial for reducing infant morbidity and mortality.
- Implementing evidence-based practices in NICU settings is essential for infant well-being.
Purpose of the Study:
- To enhance the adoption of safe sleep practices (SSP) among eligible infants in two level III NICUs.
- To evaluate the effectiveness of an educational intervention on SSP compliance.
Main Methods:
- A pre- and post-intervention study was conducted in two Boston-area NICUs.
- Infants were assessed for eligibility based on gestational age, weight, and medical condition.
- Compliance with SSP components (supine position, clear crib, no positioning aids) was audited following nursing education and bedside aids.
Main Results:
- Of 755 infants, 395 (52.3%) were eligible for SSP.
- Overall SSP compliance increased significantly from 25.9% to 79.7% (P<0.001) post-intervention.
- Adherence to individual SSP components also showed significant improvement.
Conclusions:
- Safe infant sleep practices (SSP) are successfully integrated into routine NICU care for preterm infants.
- Early modeling of SSP to families may improve home adherence and reduce sleep-related risks.
- This intervention supports improved outcomes for high-risk infant populations.
Objective:
To increase the percentage of eligible infants engaging in safe sleep practices (SSP) in two level III neonatal intensive care units (NICUs) in the Boston, Massachusetts area.
Study Design:
On the basis of eligibility criteria (⩾34 weeks or ⩾1800 g without acute medical conditions), all infants were eligible for two sleep practices: SSP or NICU therapeutic positioning (NTP) depending on their gestational age, weight, clinical illness and need for therapeutic interventions. Compliance with SSP was defined as: (1) supine positioning, (2) in a flat crib with no incline, (3) without positioning devices and (4) without toys, comforters or fluffy blankets. NTP comprised usual NICU care. Nursing education was comprised of a web-based learning module and in-person teaching sessions with a study team member. Double-sided crib cards (SSP one side and NTP on the other) were attached to the bedside of every infant. Pre- and postintervention audits of all infants were carried out at both study sites. We compared compliance across all time points using generalized estimating equations to account for correlated data (SAS v9.3, Cary, NC, USA).
Result:
Of 755 cases, 395 (52.3%) were assessed to be eligible for SSP. From the pre- to post-intervention period, there was a significant improvement in overall compliance with SSP (25.9 to 79.7%; P-value<0.001). Adherence to each component of SSP also improved significantly following the intervention.
Conclusion:
Safe infant sleep practices can be integrated into the routine care of preterm infants in the NICU. Modeling SSP to families far in advance of hospital discharge may improve adherence to SSP at home and reduce the risk of sleep-related morbidity and mortality in this vulnerable population of infants.
Related Concept Videos
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:15Nursing Implementation
The five steps to implementing effective nursing care include reassessing the patient, reviewing and revising the existing nursing care plan, organizing the resources and care delivery, anticipating and preventing complications, and implementing nursing interventions.
01:26Standard Precaution
Hand hygiene is the most crucial means to prevent the transmission of disease. Employers are legally required to provide their workers with personal protective equipment (PPE) to minimize exposure or contact with...
01:17Endotracheal Intubation II: Nursing Management
1. Nursing Care of Patients Before Intubation
Before the endotracheal intubation procedure, nurses play an essential role in ensuring the process goes smoothly. The nurses must be familiar with intubation...