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Updated: Oct 18, 2025

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Increasing Safe Sleep Practices in the Neonatal Intensive Care Unit

Eveline Treiber Paul1

  • 1Medical University of South Carolina, Charleston.

Advances in Neonatal Care : Official Journal of the National Association of Neonatal Nurses
|October 1, 2021
PubMed

Insights

Implementing safe sleep practices (SSPs) in the neonatal intensive care unit (NICU) significantly increased infant safety. A quality improvement initiative boosted SSP adherence from 13% to 81%, creating safer sleep environments for vulnerable infants.

Area of Science:

  • Neonatal care
  • Quality improvement in healthcare
  • Pediatric patient safety

Background:

  • The American Academy of Pediatrics (AAP) recommends safe sleep practices (SSPs) in neonatal intensive care units (NICUs).
  • Preintervention data showed 87% of eligible infants in a NICU were in unsafe sleep environments.
  • A need for a quality improvement (QI) initiative to enhance SSPs was identified.

Purpose of the Study:

  • To increase the percentage of eligible infants placed in safe sleep environments by registered nurses in a NICU.
  • To implement and evaluate an evidence-based safe sleep bundle.

Main Methods:

  • A QI initiative was implemented in a level IV NICU.
  • An evidence-based safe sleep bundle was developed and introduced.
  • Bi-weekly crib audits were conducted for 5 months to collect data.

Main Results:

  • The percentage of infants in safe sleep environments increased significantly.
  • Safe sleep practices (SSPs) adherence rose by 68%, from 13% preintervention to 81% postintervention (P < .001).
  • Statistically significant improvements were observed in adherence to all components of SSPs.

Conclusions:

  • Safe sleep practices (SSPs) should be universally endorsed and modeled in all NICUs.
  • Hospital-based implementation of SSPs may improve caregiver compliance at home.
  • QI initiatives are effective in improving infant safe sleep environments.
Abstract

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