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Published on: August 25, 2014
Home care practices for preterm and term infants after hospital discharge in Massachusetts, 2007 to 2010
1Boston Children's Hospital, Division of Newborn Medicine, Boston, MA, USA.
Insights
Late preterm infants are less likely to sleep in the recommended supine position. Safe sleep education for mothers of preterm infants needs improvement, as many infants share adult beds.
Area of Science:
- Neonatal care
- Pediatric sleep safety
- Public health
Background:
- Preterm infants (born before 37 weeks) have unique care needs.
- Safe infant sleep practices are crucial for reducing risks like Sudden Infant Death Syndrome (SIDS).
- Understanding home care practices for preterm infants is essential for targeted interventions.
Purpose of the Study:
- To compare the prevalence of key home care practices between very to moderately preterm (VPT), late preterm (LPT), and term infants.
- To analyze differences in infant sleep position, crib use, and bed-sharing across gestational age groups.
- To examine the association between preterm birth and breastfeeding and infant sleep practices.
Main Methods:
- Utilized data from the 2007-2010 Massachusetts Pregnancy Risk Assessment Monitoring System.
- Categorized infants into VPT (23-33 weeks), LPT (34-36 weeks), and term (37-42 weeks) based on gestational age.
- Employed multivariate models to assess sleep practices and breastfeeding in relation to preterm status, controlling for maternal sociodemographics.
Main Results:
- Supine sleep position was less common in VPT and LPT infants compared to term infants (64.4% and 71.5% vs. 77.1%).
- Adjusted models showed LPT infants had a lower likelihood of supine sleep compared to term infants (aPR=0.86).
- Breastfeeding rates did not differ significantly across groups; however, a notable percentage of all infants (16-18%) did not sleep in cribs, and 14% co-slept in adult beds.
Conclusions:
- Late preterm infants demonstrate a lower adherence to supine sleep positioning post-discharge compared to term infants.
- A significant proportion of both preterm and term infants engage in unsafe sleep practices, including bed-sharing.
- Hospitals should enhance safe sleep education, with a particular focus on mothers of late preterm infants.
Objective:
The objective of this study was to compare the prevalence of home care practices in very to moderately preterm (VPT), late preterm (LPT) and term infants born in Massachusetts.
Study Design:
Using 2007 to 2010 Massachusetts Pregnancy Risk Assessment Monitoring System data, births were categorized by gestational age (VPT: 23 to 33 weeks; LPT: 34 to 36 weeks; term: 37 to 42 weeks). Home care practices included breastfeeding initiation and continuation, and infant sleep practices (supine sleep position, sleeping in a crib, cosleeping in an adult bed). We developed multivariate models to examine the association of infant sleep practices and breastfeeding with preterm status, controlling for maternal sociodemographic characteristics.
Results:
Supine sleep position was more prevalent among term infants compared with VPT and LPT infants (77.1%, 71.5%, 64.4%; P=0.02). In the adjusted model, LPT infants were less likely to be placed in supine sleep position compared with term infants (adjusted prevalence ratio=0.86; 95% confidence interval: 0.75 to 0.97). Breastfeeding initiation and continuation did not differ among preterm and term groups. Nearly 16% of VPT and 18% of LPT and term infants were not sleeping in cribs and 14% of LPT and term infants were cosleeping on an adult bed.
Conclusion:
Compared with term infants, LPT infants were less likely to be placed in supine sleep position after hospital discharge. A significant percent of preterm and term infants were cosleeping on an adult bed. Hospitals may consider improving their safe sleep education, particularly to mothers of LPT infants.
