Temple study shows baby boxes & sleep education reduced bed-sharing in 1st week of infancy
(Philadelphia, PA) – Bed-sharing, the unsafe practice in which parents sleep in the same bed as their babies, is associated with sleep-related deaths in infants, including sudden infant death syndrome (SIDS) and accidental suffocation and strangulation in bed. However, a research team at Temple University Hospital (TUH) has now found that face-to-face postpartum education about safe infant sleep, combined with the distribution of a baby box, which is a cardboard bassinet, reduced the rates of bed-sharing during babies' first 8 days of life. The research was presented May 6 at the Pediatric Academic Societies Meeting in San Francisco.
To promote a safe sleeping environment for babies, the American Academy of Pediatrics (AAP) recommends room-sharing without bed-sharing, a firm mattress, breastfeeding, baby sleeping on the back and avoidance of exposure to smoking, alcohol and other drugs.
"In an effort to address the common high-risk behaviors associated with infant mortality, we created the Sleep Awareness Family Education at Temple, or SAFE-T, program," says Megan Heere, MD, Assistant Professor of Pediatrics at the Lewis Katz School of Medicine at Temple University and Medical Director of the Well Baby Nursery at TUH. "The program seeks to use education and baby boxes to curb those high risk behaviors."
TUH is located in North Philadelphia, an area that has one of the highest infant mortality rates in the United States with many babies born into poverty and to young mothers who do not have adequate resources to care for a newborn.
In order to determine if TUH's SAFE-T program was effective in reducing the rates of bed-sharing, the Temple research team performed a prospective, controlled, interrupted time series study utilizing mothers and infants who were discharged together between January 1, 2015 and November 15, 2016. Within 72 hours after discharge the mother was contacted by phone for a standard post-discharge interview to assess sleep environment for the babies, including where their baby sleeps. Baby box was added as a response option after May 3, 2016, the date that Temple began providing baby boxes free of charge to all mothers who delivered at TUH.
The study was divided into two groups. The control group, whose data was collected between January 1, 2015 and February 7, 2016, received standard nursing discharge instructions which included instructions on safe infant sleep. Data for the intervention group was collected between February 8, 2016 and November 15, 2016. The intervention group received education that included AAP safe infant sleep recommendations delivered in person by a select group of registered nurses, under the direction of a pediatrician. Each mother was also given a summary of the teaching points on a laminated door hanger. The intervention group also received a baby box, complete with a foam mattress, cotton fitted sheet and baby supplies. Each mother also watched a 3-minute instructional video on the use of the baby box as a bassinet.
Temple contacted 5,187 mothers for a post-discharge interview between January 1, 2015 and November 15, 2016. A total of 2,763 mothers completed the interview, with a response rate of 54% for the control group and 52% for the intervention group.
The research team found that:
- Face-to-face sleep education and providing a baby box with a firm mattress and fitted sheet reduced the rate of bed-sharing by 25% in the first eight days of life.
- For exclusively breastfed infants, a population at increased risk of bed-sharing, bed-sharing was reduced by 50%.
- Of the mothers who received the baby box, a majority said they used the box as a sleeping place for their infants.
- Of the mothers who received the baby box, 12% said they used the box as the primary or usual sleeping space for their infants.
- Of the mothers who exclusively breastfed and also used the box as a sleeping space, 59% said the box made breastfeeding easier.
"We are pleased with the results of this first-of-its-kind study," adds Dr. Heere, who was also lead investigator. "Future studies are needed to determine if the effect of this intervention is sustainable through the first 6 to 12 months of life, and if this intervention can significantly reduce the incidence of sleep-related death in large populations over time."
"The SAFE-T program is a total team effort with a high level of collaboration between Temple nurses and physicians, and it's inspiring to see the impact that this program is having on the well-being of our patients and their families," says Jennifer Rodriguez, BSN, RN, Director of Nursing Services at TUH.
Initial funding for the baby boxes was provided in part by the W.K. Kellogg Foundation and Kohl's Cares for Kids, in addition to Temple University Hospital. Also, physicians, nurses, staff and friends of Temple University Hospital, as well as Temple University alumni have been making donations to support the program.
The baby boxes are manufactured by the Baby Box Co.
Editor's Note: Neither Dr. Megan Heere, Jennifer Rodriguez nor any members of their immediate families has any financial interest in the Baby Box Co.
About Temple Health
Temple University Health System (TUHS) is a $1.6 billion academic health system dedicated to providing access to quality patient care and supporting excellence in medical education and research. The Health System consists of Temple University Hospital (TUH), ranked among the "Best Hospitals" in the region by U.S. News & World Report; TUH-Episcopal Campus; TUH-Northeastern Campus; Fox Chase Cancer Center, an NCI-designated comprehensive cancer center; Jeanes Hospital, a community-based hospital offering medical, surgical and emergency services; Temple Transport Team, a ground and air-ambulance company; and Temple Physicians, Inc., a network of community-based specialty and primary-care physician practices. TUHS is affiliated with the Lewis Katz School of Medicine at Temple University.
The Lewis Katz School of Medicine (LKSOM), established in 1901, is one of the nation's leading medical schools. Each year, the School of Medicine educates approximately 840 medical students and 140 graduate students. Based on its level of funding from the National Institutes of Health, the Katz School of Medicine is the second-highest ranked medical school in Philadelphia and the third-highest in the Commonwealth of Pennsylvania. According to U.S. News & World Report, LKSOM is among the top 10 most applied-to medical schools in the nation.
Temple Health refers to the health, education and research activities carried out by the affiliates of Temple University Health System (TUHS) and by the Katz School of Medicine. TUHS neither provides nor controls the provision of health care. All health care is provided by its member organizations or independent health care providers affiliated with TUHS member organizations. Each TUHS member organization is owned and operated pursuant to its governing documents.