Gwen Kimball, D.N.P., R.N., C.P.O.N. Safe Infant Sleep Nurse Coordinator

1. Greater Los Angeles Chapter Society of Pediatric Nurses October 20, 2017 Sudden Infant Death Syndrome and Safe Infant Sleep Gwen Kimball, D.N.P., R.N., C.P.O.N. Safe Infant Sleep Nurse Coordinator Children’s Hospital Los Angeles Christina Thiele SIDS Parent Facilitator, Grief Healing Peer Parent Support Group, Los Angeles No Conflicts of Interest to Disclose

2. “And this woman's son died in the night ...” 1 Kings 3: 19 (950 B.C.) Antoon Claeissens, The Judgment of Solomon, ~1600.

3. Sudden Infant Death Syndrome The sudden unexpected death of an infant, under one-year of age, with onset of the fatal episode apparently occurring during sleep, that remains unexplained after a thorough investigation, including performance of a complete autopsy, and review of the circumstances of death and the clinical history. Krous, H.F., J.B. Beckwith, R.W. Byard, T.O. Rognum, T. Bajanowski, T, Corey, E. Cutz, R. Hanzlick, T.G. Keens, and E.A. Mitchell. Pediatrics, 114: 234-238, 2004.

4. Sudden Infant Death Syndrome In this presentation, the following terms are considered synonymous: • SIDS • SUID • SUDI • Undetermined They all mean the same thing; that the infant’s death is unexpected and unexplained. Cutz, E. JAMA Pediatr., 170: 315-316, 2016.

6. 14 13 Gunteroth, W.G., and P.S. Spier. Pediatrics, 110: 110;e64, 2002.

7. Infant Deaths by Race/Ethnicity Carrie Florez California 2002-2003 Birth & 2003 Death Statistical Master Files & SUID Database, 2003. California Department of Health Services, MCAH/OFP, September 2005.

8. Infant Deaths by Gestational Age Ostfeld, B.M., et al. Pediatrics, 140: e20163334, 2017.

9. SIDS Autopsy Findings • No identifiable cause of death. • No signs of severe illness. • No signs of significant stress. • Diagnosis of exclusion

10. Kinney, H.C., and B.T. Thach. N. Eng. J. Med., 361: 795-805, 2009.

11.  brainstem serotonin: Autonomic Dysfunction Disrupting Cardiorespiratory Control Infant Vulnerability Hannah Kinney SIDS Development Environment Filiano, J.J., and H.C. Kinney. Biol. Neonate, 65: 194-197, 1994.

12. The majority of SIDS victims have ≥1 Risk Factor 244 SIDS victims from New Jersey, 1996-2000. Ostfeld, B.M., et al. Pediatrics, 125: 447-453, 2010.

13. The majority of SIDS victims have ≥1 Risk Factor Modifiable Risk Factors per Case Trachtenberg, F.L., et al. Pediatrics, 129: 630-638, 2012.

14. = Causes / Risk Factors • Most infants with risk factors will not die from SIDS. • Some infants without risk factors will die from SIDS. • However, infants with risk factors are at increased risk of dying from SIDS.

15. NICHD Video: Safe Sleep for Your Baby https://www.nichd.nih.gov/sts/news/videos/Pages/default.aspx

16. Safe Infant Sleep Recommendations • Back to sleep for every sleep. • Use a firm mattress. • Breastfeed. • Roomsharing, but not bedsharing. • Keep soft objects out of the crib. • Consider offering a pacifier during sleep. • Avoid cigarette smoke exposure. • Avoid alcohol and illicit drug exposure. • Avoid overheating and head covering. AAP Policy Statement. Pediatrics, 138: e20162938, 2016.

17. Safe Infant Sleep Recommendations • Obtain regular prenatal care. • Immunize according to recommended schedule. • Avoid commercial devices claiming to prevent SIDS. • Do not use home cardiorespiratory monitors to prevent SIDS. • Supervised Tummy Time while awake. • No swaddling prone or after 2-3 months of age. AAP Policy Statement. Pediatrics, 138: e20162938, 2016.

19. Does CHLA Practice Safe Infant Sleep? Or, are we this? Are we this?

20. Why Did CHLA Not Practice Safe Infant Sleep? • No normal newborn deliveries. • Infants are sick, and acute care for the medical problem is the priority. • Medical illness may modify safe infant sleep recommendations. • At discharge, education about the acute illness takes precedence over safe infant sleep education.

21. AB 757 California law requires that hospitals caring for infants: • Practice safe infant sleep for inpatients. • Provide parents information and education on: • Medical aspects of SIDS. • Measures to reduce the risk of SIDS (Safe Infant Sleep). California Health and Safety Code Sections 1254.6 and 1596.847 (1997)

22. Established a Safe Infant Sleep Hospital Policy

23. Nurse Education Activities on Safe Infant Sleep

24. Posters Placed in Each Infant’s Hospital Room

25. Video Required Viewing by All Parents of Infant Inpatients

27. Criteria for Safe Infant Sleep for Acutely Ill Infants • If the infant is asleep: • Nothing in the crib: except pacifier; nest or positioning pillows for infants who can not move • Crib flat or only slightly inclined • Supine sleep position; infants >4-months who were placed supine, but rolled to prone can still be categorized as safe. • Not swaddled over 3-months of age. • No head covering or overbundling. • No sleeping on a chair or couch. • No bedsharing.

28. Crib Audits of Inpatient Infants September 1, 2017 (n=23) Infants on 6-East, 6-West, 5-East, 5-West, 4-East, 4-West, and BMT

29. Crib Audits of Inpatient Infants September 1, 2017 (n=23) Infants on 6-East, 6-West, 5-East, 5-West, 4-East, 4-West, and BMT

30. Crib Audits of Inpatient Infants June, 2017 --- October, 2017 Infants on 6-East, 6-West, 5-East, 5-West, 4-East, 4-West, and BMT

31. Sudden Infant Death Syndrome • Most common cause of infant death between age 1-month and 1-year. • Cause remains unknown. • Can not be predicted in infants prior to death. • Reduction in SIDS in populations through public health intervention. • But SIDS has not been eliminated!

32. Benjamin Edwards “Baby Ben” January 14, 2001 – July 18, 2001