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Prevalence and predictors of the prone sleep position among inner-city infants
R A Brenner1, B G Simons-Morton, B Bhaskar
1Division of Epidemiology, Statistics, and Prevention Research, National Institute of Child Health and Human Development, Bethesda, MD 20892, USA. BrennerR@nih.gov
Insights
Forty percent of infants in a low-income cohort slept in the prone position, increasing sudden infant death syndrome (SIDS) risk. Poverty, race, and parental intent were key predictors, highlighting the need for targeted infant sleep education.
Area of Science:
- Pediatrics
- Public Health
- Neonatology
Background:
- The prone sleep position is a known risk factor for sudden infant death syndrome (SIDS).
- Limited research exists on factors influencing infant sleep position choices, particularly in vulnerable populations.
Purpose of the Study:
- To characterize infant sleep positions in a cohort of predominantly low-income, inner-city mothers.
- To identify predictors associated with placing infants in the prone sleep position within this demographic.
Main Methods:
- A prospective birth cohort study involving 394 mother-infant dyads.
- Data collected via interviews conducted shortly after delivery and again at 3 to 7 months postpartum.
- Infant sleep position assessed at the 3- to 7-month follow-up interview.
Main Results:
- At 3-7 months, 40% of infants (157/394) were placed in the prone sleep position.
- Significant predictors of prone sleep included poverty (OR 1.81), Black race (OR 2.06), grandmother presence (OR 1.83), and maternal intent (OR 2.28).
- Maternal observation of prone sleeping in the hospital strongly predicted home sleep position (93% intent).
Conclusions:
- A significant proportion of infants in this low-income population were placed in the prone sleep position.
- Educational interventions should target initial parental intentions and reinforce safe sleep practices.
- Hospitals should prioritize placing newborns in the supine position during the postpartum stay.
Context:
The prone sleep position is associated with an increased risk of sudden infant death syndrome (SIDS), but few studies have assessed factors associated with the choice of infant sleep position.
Objectives:
To describe infant sleep position in a cohort of infants born to predominantly low-income, inner-city mothers and to identify predictors of the prone sleep position in this population.
Design:
Prospective birth cohort study.
Patients And Setting:
Three hundred ninety-four mother-infant dyads, systematically selected from 3 District of Columbia hospitals between August 1995 and September 1996. Mothers were interviewed shortly after delivery and again at 3 to 7 months postpartum.
Main Outcome Measures:
Position in which infants were placed for sleep on the night prior to the 3- to 7-month interview.
Results:
At 3 to 7 months of age, 157 infants (40%) were placed for sleep in the prone position. Independent predictors of prone sleep position included poverty (odds ratio [OR], 1.81; 95% confidence interval [CI], 1.10-2.99), black race (OR, 2.06; 95% CI, 1.05-4.04), presence of infant's grandmother in the home (OR, 1.83; 95% CI, 1.11-3.00), and intent, as measured shortly after delivery, to place the infant in the prone position (OR, 2.28; 95% CI, 1.44-3.60). Importantly, of the 43 mothers who observed their infants in the prone sleep position while in the hospital, 40 (93%) intended to place their infants prone at home.
Conclusions:
A substantial proportion of infants in this predominantly low-income population were placed in the prone sleep position. Educational efforts should address both initial intentions and reinforcement of the correct sleep position, once initiated. Hospitals should ensure that healthy newborn infants are placed in the supine sleep position during the postpartum hospital stay.