Evaluation of a Multisite Safe Infant Sleep Education and Crib Distribution Program

Rates of sleep-related infant deaths have plateaued in the past few decades despite ongoing infant sleep practice recommendations to reduce risk of sleep-related infant deaths by the American Academy of Pediatrics. The state department of public health trained facilitators at 28 sites across the state to facilitate a group safe sleep educational program. A prospective, matched pre- and post-test cohort design with follow-up was used to evaluate changes in self-reported knowledge, intentions, and practices. The final sample included 615 matched pre- and post-test surveys, and 66 matched follow-up surveys. The proportion of correct responses on all knowledge and intended practice items increased significantly from pre- to post-test. When asked where their babies would have slept if they had not received the portable crib, 66.1% of participants planned to use a recommended sleep location (e.g., crib or bassinet). At post-test, 62.3% planned to change something about their infant’s sleep based on what they learned. At follow-up, knowledge was maintained for all but two items and practices and for half of practice items. The results suggest that participating in the education program was associated with increased knowledge and intended adherence, but that these changes were not maintained at follow-up. These results are in line with the research literature that finds a difference in intentions and actual practices after the baby is born.

604 The Relationship between Birth Order and Sleep Patterns in 6-Month-Olds

Introduction The influence of birth order has been investigated in many areas of child development, but few studies have examined its relationship with infant sleep; those that have yield contradictory findings. Moreover, nocturnal parental practices may differ depending on the number of children, but these characteristics are rarely studied. This study aimed to compare nocturnal parental practices and sleep patterns of first-born to non-first-born 6-month-olds. Methods The mothers of fifty-two 6-month-olds completed a 14-day sleep diary to record their infant’s sleep. The following variables were averaged: total nocturnal sleep duration (in minutes), longest consecutive sleep duration (without interruption; in minutes) and number of nocturnal awakenings. Independent t-tests were used to compare each sleep variable between first-borns (n = 21) and non-first-borns (2nd, 3rd or 4th born, n = 31). Chi-square tests were used to compare parental sleep practices (breastfeeding frequency and infant sleep location) between first-borns and non-first-borns. Results First-borns had a longer consecutive nocturnal sleep duration (417.83 ± 142.42 vs. 310.08 ± 118.23; p < .01) and fewer nocturnal awakenings (1.69 ± 1.07 vs. 2.57 ± 1.09; p < .01) than non-first-borns. However, first-born and non-first-born infants did not differ in terms of total nocturnal sleep duration (p > .05). Breastfeeding frequency and sleep location differed as a function of birth order: 57.9% of first-born infants were exclusively breastfed, compared to 89.7% of non-firstborn infants (χ2 (1, N = 52) = 6.56; p < .05). Furthermore, 20.0% of first-borns slept in the parents’ room, compared to 56.7% of non-first-borns (χ2 (1, N = 50) = 6.62; p < .05). Conclusion First-born infants had longer periods of consecutive sleep and fewer nocturnal awakenings than non-first-borns; however, birth order was not associated with maternal reports of total nocturnal sleep duration. These results suggest that non-first-borns have more fragmented sleep. Moreover, sleep-related practices also differed between mothers of first-born and non-first-born infants. A study conducted in a larger sample and using objective sleep measures could clarify whether these different sleep patterns reflect specific nocturnal parental sleep-related practices, or if the presence of other children in the home play a role in infant sleep consolidation. Support (if any) SSHRC, FRQS

Field assessment of a safe sleep instrument using smartphone technology

Introduction:Sudden unexpected infant death is the leading cause of infant mortality with black: white infant mortality remaining at 2:1 for the last decade. Smartphone technology provides a convenient and accessible tool for injury prevention anticipatory guidance among at-risk communities.Materials and Methods:A convenience sample of pregnant teen mothers who own a smartphone. During a 1-month postnatal home visit, a safe sleep environment survey was administered, infant sleep practices were observed, and mothers trained to take and submit standard infants’ sleep environment photographs. Photographs were independently assessed for inter-rater reliability (IRR) across five sleep safety domains (primary outcome): sleep location, surface, position, presence of soft items, and hazards near the sleep area. Expert and novice coders IRR was measured using Cohen’s kappa coefficient (K). Sleep safety correlation between photographs and observation, and parent report and observation was determined.Results:Sixteen (57.1%) mothers completed the home visit. Most parents reported infants sleeping supine (78.5) in parents’ bedroom (85.9%). Photographs demonstrated sleep position, soft items without the baby present, and hanging toys had perfect agreement across all three coder pairs. Safe sleep experts’ IRR demonstrated perfect agreement for sleep location, position, and soft items. While 83.8% of parents were observed putting their infants down to sleep on their back, 78.5% of parents reported doing the same and 82.4% of the photographs demonstrated supine infant sleep position.Conclusion:Using photographs, coders can reliably categorize some key infant sleep safety aspects, and photograph sleep safety is comparable to parent report and direct observation.

Sleep habits and sleep characteristics at 1 year-old in the ELFE birth cohort study

Infant sleep plays a critical role in his/her normal development. Sleep problems, including sleep onset difficulties (SOD) and night waking (NW), ranges from 20% to 30% in infants and young children and are partially persistent over time up to adulthood. French young children seem to have longer sleep durations and less sleep troubles than their counterparts worldwide. We here aimed at describing infants sleep characteristics (duration/24h (TST), NW, and SOD) and associated sleep habits in infants aged 1 year old from the French nationwide birth cohort ELFE. This study included 11,571 infants with information on both sleep characteristics and sleep habits (parental presence when falling asleep, eating to fall asleep, sucking pacifier or finger to sleep and the location where the infant falls asleep and ends his/her sleep). Associations were studied using multinomial logistic regressions adjusted for familial and infant characteristics. Mean TST was 13hrs36 including 2hrs54 of naps, 20% of the infants had TST ≤12hrs/24h. About 46% did not present SOD or NW, while 16% had frequent SOD and 22% had NW > 1 night over 2. Parental presence, feeding to fall asleep and infants sleep location were more frequent in infants having short sleep duration (≤12h/24h), NW and SOD. Non-nutritive sucking was associated with NW, SOD and TST>14h/24h. This work provides new information regarding infant sleep location and non-nutritive sucking that should be accounted for when considering sleep behaviors. In addition, most of identified sleep habits associated with poor sleep characteristics are accessible to prevention. Key messages French infants present better sleep characteristics than their counterparts. Most sleep habits associated with poor sleep are accessible to prevention.

The Impact of Feeding Method and Infant Sleep Location on Mother/Infant Sleep, Maternal Depression, and Mothers’ Well-Being

Previous studies have found that exclusively breastfeeding (EBF) mothers get more sleep and report higher levels of well-being than mothers who are not EBF. We do not know whether infant sleep location influences these findings. The present analyses are from the Survey of Mothers’ Sleep and Fatigue, an online survey of 6,410 mothers from 59 countries. Feeding method and sleep location do interact and are related to babies’ and mothers’ sleep and measures of mothers’ well-being. EBF/bedsharing mothers reported more sleep, better physical health, and less depression, anger, and anxiety than non-EBF or nonbedsharing mothers. Conversely, bedsharing/non-EBF mothers had some of the worst outcomes. Bedsharing was related to positive outcomes for EBF mothers. Our findings are consistent with recommendations that non-EBF mothers avoid bedsharing.

Intensity of exposure to pulmonary tuberculosis determines risk of tuberculosis infection and disease

Household contacts of pulmonary tuberculosis (TB) patients are at increased risk of TB infection and disease. However, their risk in relation to the intensity of exposure remains unknown.We studied smear-positive TB cases and their household contacts in Vitória, Brazil. We collected clinical, demographic and radiographic information from TB cases, and obtained tuberculin skin test (TST) and QuantiFERON-TB Gold (QFT) results from household contacts. We measured intensity of exposure using a proximity score and sleep location in relation to the TB index case and defined infection by TST ≥10 mm or QFT ≥0.35 UI·mL−1. We ascertained secondary TB cases by reviewing local and nationwide case registries.We included 160 TB index cases and 894 household contacts. 464 (65%) had TB infection and 23 (2.6%) developed TB disease. Risk of TB infection and disease increased with more intense exposures. In an adjusted analysis, the proximity score was associated with TB disease (OR 1.61, 95% CI 1.25–2.08; p<0.000); however, its diagnostic performance was only moderate.Intensity of exposure increased risk of TB infection and disease among household contacts; however, its diagnostic performance was still suboptimal. A biomarker to target preventive therapy is urgently needed in this at-risk population.