[1690.3] Supine Sleep Positioning in Preterm and Term Infants after Hospital Discharge in 36 States, 2000-2011

Sunah Hwang, Ruben Smith, Wanda Barfield, Vincent Smith, Marie McCormick. Newborn Medicine, Boston Children's Hospital, Boston, MA; Pediatrics, Harvard Medical School, Boston, MA; Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA; Neonatology, Beth Israel Deaconness Medical Center, Boston, MA; Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA.

BACKGROUND: Supine sleep positioning (SSP) has been shown to reduce the risk of sudden infant death syndrome (SIDS). Preterm infants (<37 weeks) are at higher risk for SIDS. Recent multi-state population-based estimates of infant sleep positioning after hospital discharge are lacking for the preterm population.
OBJECTIVE: Compare the prevalence of supine sleep positioning after hospital discharge for preterm and term infants in the United States.
DESIGN/METHODS: We analyzed 2000-2011 data from the CDC PRAMS. Chi-square tests were used to measure differences in maternal and infant characteristics and SSP after hospital discharge by the following gestational age (GA) categories: <28, 28 0/7-33 6/7, 34 0/7-36 6/7, 37 0/7-42 6/7 weeks. We calculated adjusted prevalence ratios (APR) to evaluate the likelihood of SSP for each GA category compared to term infants, controlling for maternal age, race/ethnicity, education, insurance status before pregnancy, previous live birth, method of delivery, and maternal length of hospital stay. Weighted prevalence estimates were used for all analyses.
RESULTS: There was significant variation by state in the prevalence of SSP in the United States for the entire cohort (N=374,461); in Alabama, only 49.5% of all infants were placed in supine sleep position compared to the highest prevalence of 81.4% in Wisconsin. In the bivariate analysis, there were significant differences in the prevalence of SSP by GA for all years included: <28: 59.2%, 28 0/7-33 6/7: 62.2%, 34 0/7-36 6/7: 62.6%, 37 0/7-42 6/7 weeks: 66.7% (p<0.001). While all GA groups experienced a significant increase in SSP from 2000 to 2010, infants born <28 weeks had the largest increase from 39.6% to 68.0%. In the adjusted analyses, there was no significant difference in SSP for infants born <28 and 28 0/7-33 6/7 weeks compared to term infants (APR:0.98, CI: 0.94-1.02; APR:0.99, CI: 0.97-1.00). However, late preterm infants (34 0/7-36 6/7) were less likely to be placed in SSP compared to term infants (APR:0.96, CI:0.95-0.98).
CONCLUSIONS: In this population-based study, we demonstrated significant variation in the prevalence of SSP in the United States. Although the prevalence of SSP is improving for all GA groups, it is still far from optimal and thus continued efforts need to be directed toward all infants. Late preterm infants and certain states may require additional attention given their decreased likelihood to engage in SSP.


Session: Platform Session: Perinatal Epidemiology (2:45 PM - 4:45 PM)
Date/Time: Saturday, May 3, 2014 - 3:15 PM
Room: West 109 - Vancouver Convention Centre
Course Code: 1690


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