what are recommendations of the back to sleep campaign
Effectiveness of the 'Dorsum-to-Slumber' campaigns among healthcare professionals in the by 20 years: a systematic review
Abstruse
Objectives From the late 1980s 'Dorsum-to-Sleep' (BTS) campaigns were run in most adult countries to increase awareness of the supine position'due south protective effect against sleep-related baby deaths. In one case the media awareness-raising activity associated with these campaigns ended, healthcare professionals' role became crucial. The goal of this paper is to determine if healthcare professionals' knowledge and parent communication consistent with show-based infant sleep recommendations have inverse over the by twenty years.
Setting All studies investigating healthcare professionals' noesis and/or advice to parents were included in a systematic review. The search was performed in PubMed and in MEDLINE, and 21 studies were identified.
Results The correctness of healthcare professionals' knowledge and parent communication about the supine sleeping position increased over the past twenty years. Withal, the percentage of those enlightened that parents should avoid putting their babies to sleep in a decumbent position is decreasing over time: from about 97% in the 1990s to about 90% at the end of the 2000s.
Conclusions The effectiveness of the BTS campaigns in publicising the benefits of the supine position is confirmed by this paper. More than and more healthcare professionals know that information technology is the best position to reduce the take chances of slumber-related deaths and they recommend information technology exclusively. All the same, the subtract in the knowledge about non-prone positions suggests that the campaigns may non take focused enough on the dangers of the prone position.
- Back to Sleep
- SIDS
- systematic review
- sleep position
- parent advice
- recommendations
This is an Open Access commodity distributed in accordance with the Creative Eatables Attribution Non Commercial (CC Past-NC four.0) license, which permits others to distribute, remix, accommodate, build upon this work not-commercially, and license their derivative works on dissimilar terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/iv.0/
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- Back to Sleep
- SIDS
- systematic review
- slumber position
- parent advice
- recommendations
Strengths and limitations of this report
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This study generates the get-go comprehensive analysis of the effect of the 'Dorsum-to-Sleep' campaigns on healthcare professionals' cognition and parent advice about infants sleeping positions.
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All the results are based on published information.
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The number of studies is relatively minor, as this field has not all the same been extensively explored. This implies that the results of the newspaper may be less accurate, although it may as well limit the potential impact of any publication bias on the assay.
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While the trend was largely constructed on the basis of US studies, the most recent data vest but to other countries, and this may imply issues in terms of comparability.
Introduction
Slumber-related baby deaths (also known as 'cot deaths' or 'crib deaths') are nevertheless an of import crusade of death of good for you born infants in adult countries.1 ,2 Well-nigh of these deaths are diagnosed as Sudden Babe Expiry Syndrome (SIDS), while a minority involve accidental asphyxia.three SIDS may exist defined every bit 'the sudden unexpected expiry of an infant <1 year of historic period, with onset of the fatal episode apparently occurring during sleep, which remains unexplained after a thorough investigation, including performance of a complete autopsy and review of the circumstances of death and the clinical history'.4 The incidence of SIDS rises to a acme between ages ane and iv months and then decreases. Almost 90% of SIDS deaths happen in the first 6 months of life; nearly 2-thirds of the cases happen at night; most cases happen in wintertime; and boys are more likely to die than girls (ratio threescore:xl).5 More recently, epidemiologists have started using the broader term Sudden Unexpected Death in Infancy (SUDI) which includes SIDS and other sleep-related deaths.6 In what follows, we apply SUDI or 'sleep-related infant deaths' to refer to this broader categorisation, but retain the term SIDS when reporting on research which itself used that term.
Since the 1980s there have been many campaigns and interventions in developed countries aimed at reducing the incidence of sleep-related infant deaths.7 Earlier the start campaigns, sleeping position was the strongest risk factor for which information technology was possible to intervene to reduce the take a chance of SUDI. The supine position is the safest position. Compared with the supine, the decumbent position has 2.iii–13.1 times the risk of death from SIDS, and the lateral position 2.0 times the risk (95% CI ane.2 to 3.4).viii–12 Overall, the dangers of the prone and lateral positions tin can be considered very similar, especially if nosotros business relationship for the population-owing chance.12 ,xiii In 1985, Davies discovered that in Hong Kong, where the common habit was to put infants to sleep in a supine position, SIDS was very rare.14 On the opposite in the U.s., where the SIDS rate was much higher, most infants were placed in their bed prone until 1992.15 Information technology was believed that the prone position granted benefits (such as a lower likelihood of aspiration and a lower gastro-oesophageal reflux).15 ,16 Following Davies's findings, many epidemiological studies in the 1980s and 1990s showed a lower incidence of SIDS in those infants who slept supine. Guntheroth and Spiers17 pooled the prove collected upwardly to 1992, whence in countries such every bit holland, the U.k., Commonwealth of australia and New Zealand public wellness campaign recommendations regarding avoidance of the decumbent position began to be given to parents between 1987 and 1991. In 1992 the American University of Pediatrics (AAP) published recommendations for reducing the risk of SIDS, strongly discouraging all those in charge of newborns from putting them to sleep prone.fifteen In 2005 an updated version of the AAP guidelines recommended exclusively the supine sleeping position, a recommendation which was confirmed in 2011.eighteen ,nineteen The campaigns run in developed countries, which we shall call 'Dorsum-to-Slumber' (BTS) campaigns, aimed to raise awareness of the supine position's effect in reducing the risk of SIDS. Owing to the action of these campaigns, the major risk factor for SIDS is nowadays considered to be smoking (both during pregnancy and in the baby'due south environment).19
The objective of this paper is to evaluate if healthcare professionals' noesis and advice to parents about infant sleeping positions have changed over the past twenty years and to what extent they are aligned with public wellness recommendations. In social club to reach this, we will systematically review the findings of studies investigating the knowledge that healthcare professionals accept about sleeping positions and the advice given by healthcare professionals to parents. Both knowledge and parent advice volition be analysed. Since most studies have been conducted in the USA, special attention will be given to this case.
Methods
Studies were sought in the PubMed and MEDLINE databases, using groups of keywords including 'SIDS', 'knowledge', 'recommendation(south)', 'advice', 'back to sleep', 'prophylactic sleep', 'healthcare professionals', 'doctors', 'nurses', 'physicians', 'paediatricians', 'supine position', 'not-decumbent position', 'prone position', 'prevention' and 'reducing'. Eligibility was assessed without reference to results, authors or journals, and when the required data could not be extracted, the original authors were contacted. Experts in the field were consulted to identify other relevant studies. To ensure accuracy, the two authors independently assessed eligibility of all the studies considered. One time the studies of interest were identified, both authors extracted data independently and the results were compared. No differences were found betwixt the two reviewers' outcomes. When it was necessary to pool together the results of several surveys carried out the same year, calculations of almanac percentages were made using accented frequencies.
A study was included if it investigated healthcare professionals' noesis and/or parent advice near baby sleeping positions and, as we focused on the 20-year period mail service-BTS campaigns (which ends approximately in 2012), if it was published before 2013. All studies meeting these criteria were considered, regardless of the reference time of their survey(s) and of their publication year. Data regarding both the supine position lonely and the non-prone positions were extracted. The eligible studies involved the family unit/general physicians, paediatricians, obstetrician-gynaecologists, other physicians, midwives, head nurses, neonatal intensive care unit nurses, nursery nurses and other nurses. All were published in international peer-reviewed journals in English language. A search of the databases was besides performed in French, Italian and Spanish, just no eligible written report published in these languages was institute. Figure 1 provides a catamenia chart illustrating the selection of studies. The search was offset undertaken in Jan 2012 and updated in February 2013.
From each study we retrieved, where possible, absolute frequencies and the respective percentages relating to: (1) awareness of supine position being all-time (2) recommending supine position (iii) sensation of non-prone position lowering risk and (4) recommending non-prone position. It was causeless that the post-obit definitions described the same concept: 'healthcare professionals aware of the latest AAP recommendations for back and side sleeping position', 'healthcare professionals aware that term infants should be placed on their back to sleep', 'healthcare professionals enlightened that the supine position is a protective factor against SIDS' and 'healthcare professionals aware that the supine position is associated with the lowest chance of SIDS'. Some studies gave details about supine and non-supine positions, while others broke them downward for all possible positions. With the latter it was possible to infer both the supine and the not-decumbent information, while with the former items (3) and (4) above could non be retrieved. We only extracted figures that nosotros were sure actually measured the outcomes nosotros sought. Nosotros excluded other statistics, such as the proportion of newborns actually put to sleep in the supine position in the hospitals where surveys were conducted, as we were unsure that these reflected the personal noesis or opinions of the respondents.
Nosotros summarised how these four percentages take inverse over the past 20 years. The results of each written report were attributed to the year(southward) when the respective survey(s) were conducted, without considering the year of publication of the study. If the yr of a survey was non available (2 cases), nosotros hypothesised a 2-year lag between the year when the survey was carried out and the date when the study was accepted for publication. If more than one study related to the aforementioned yr, their average was taken and weighted according to their sample sizes. If a written report presented data referring to periods both before and later on a grooming course, only those preceding the training form were considered. Data collected over periods of more than than 1 year were assumed to exist valid for all relevant years. We performed weighted regressions where the yearly weights were determined by the number of healthcare professionals surveyed in society to prove trends. Given the limited and somehow heterogeneous nature of the studies that were considered, we only present the results of the regression in the figures for an illustrative purpose and we prefer not to focus our give-and-take on the interpretation of the regressions' results.
Results
Of the 21 selected studies, the earliest was in 1992 and the most recent in 2009. These 21 studies described 25 different surveys and 24 unlike published papers (table 1). The data for the survey without sample size information were excluded from the analysis. However, that survey belonged to a written report consisting of ii surveys, and so the overall number of considered studies did not modify. Nearly of the surveys (nineteen) were carried out in the United states, three in Commonwealth of australia, one in Italy and one in Turkey. For this reason, the results are presented with reference to the USA, but the data relating to not-United states surveys will as well be included in the graphs. The average sample size of the studies included was 512 respondents (minimum=27, maximum=5861) and the average response rate was 68.four% (minimum=23.5%, maximum=100%). In order to give clear and exhaustive information to readers, in table 1 we also nowadays response rate and survey mode of all surveys. All the same, these details are not discussed in the paper.
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Table 1
Main characteristics of all the surveys of interest (some studies involve more one survey, NA, not available)
Healthcare professionals' knowledge on rubber sleep
The pct of healthcare professionals who are aware that the supine position is the best for reducing the chance of SIDS has increased in the USA over the past 20 years, while the percent of healthcare professionals who are enlightened that whatever not-prone position would be amend than the prone position seems to have been decreasing over the past twenty years (figure two). The results of not-The states studies seem to be comparable to those of the U.s., peculiarly apropos cognition of the dangers of the prone position.
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Figure 2
Percentage of healthcare professionals aware that the supine (or any non-prone) sleeping position is the most effective in reducing the risk of SIDS (for USA, Australia, and Other countries). SIDS, Sudden Infant Death Syndrome.
The respondents in the studies reviewed came from a multifariousness of healthcare professions. A minor subset of the studies presented in table i (three US studies and 1 non-US written report) besides included data specific to detail groups. In all cases, paediatricians' knowledge of the risks of dissimilar sleep positions was more than that of other healthcare professionals (table 2).
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Table 2
Comparison between dissimilar healthcare professionals in terms of knowledge that the supine position is the safest for reducing the chance of SIDS
Healthcare professionals' advice to parents on safe sleep
In figure 3 we discover an increasing trend in the pct of healthcare professionals recommending both exclusively the supine position and a not-prone one. In the case of the non-prone position, this result contradicts the trend in reported knowledge described in figure 2, although we have no data on parent advice about the non-decumbent position for the years after 2005, when awareness of the particular dangers of the prone position is at its lowest. Figure 3 too suggests that the Australian results seem to be better than the American ones, while those belonging to other countries, which are also the nearly contempo, reveal that in their case, advice to parents from healthcare professionals is less beneficial to infants than in the USA. In the just report that compared the parent advice of dissimilar types of healthcare professionals, 74% of paediatricians only but 62% of other healthcare professionals would recommend the supine position.35
Give-and-take
Current sleep-related infant death rates are much lower than those registered before the BTS campaigns started to be implemented. In tabular array three we bear witness how SIDS rates changed over the past 20 years. For some countries, SIDS rates were derived by combing official statistics from dissimilar sources.
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Table 3
SIDS charge per unit in 1987 (per one thousand good for you born infants), the year when the BTS campaigns began, and the most contempo SIDS rate (with reference twelvemonth) for the 12 well-nigh populated developed countries
In 2005, Raydo and Reu-Donlon56 focused on the importance of healthcare professionals for transmitting the correct recommendations to parents and reviewed the available literature regarding professionals' attitudes and behavior about infant sleep positioning. This study generates the first comprehensive analysis of the effect of the BTS campaigns on healthcare professionals' knowledge and advice to parents well-nigh infants sleeping positions. All the results are based on published information.
Healthcare professionals' noesis on safe slumber
The percentages of healthcare professionals aware that the supine position is best for reducing the risk of SUDI and recommending parents of newborns to use the supine position exclusively accept been increasing over the past 20 years in parallel with the increasing number and extent of BTS campaigns, mainly focused in getting the message that 'back is best' through to the population. This suggests that the BTS message reached healthcare professionals as well equally parents of newborns. A surprising upshot of this analysis was that the percentage of healthcare professionals assertive that any non-decumbent position implied a lower risk of SUDI has decreased over the past xx years. This could exist interpreted as suggesting that the BTS campaigns full-bodied all their energies in publicising the benefits of the supine position without sufficiently stressing the dangers of the decumbent position. As a consequence, while sensation that the supine position is the best for reducing the chance of SUDI increased over time fewer people could be enlightened of the dangers of the decumbent position.
If we briefly look at the differences betwixt professional figures, paediatricians' cognition on this topic seems to be more than that of others. This information may be useful for policymakers of countries where paediatricians are expected to play an active and daily function in delivering the bulletin for reducing the run a risk of SUDI to parents. In other countries, though, the benefits could be express, as different professionals may exist in charge of delivering communication to parents. In the UK, for example, women whose pregnancies follow a normal evolution will probably never meet paediatricians or obstetrician-gynaecologists. Instead, they would have regular contacts with midwifes, wellness visitors and, most likely, general practitioners. When knowledge is considered, not-US studies prove results similar to the USA ones, if not amend. In 1987 Commonwealth of australia had the highest SIDS rate for any large country (tabular array two) but its SIDS charge per unit has since converged with those of other countries, and is at present lower than that of the USA. Our results show that in relation to both awareness and parent advice, Australia has been performing better than the The states, suggesting that there may exist an association between the quality of the information possessed by healthcare professionals and the reduction in the SIDS rate.
Healthcare professionals' advice to parents on condom sleep
In one case the campaigns are over healthcare professionals are the most important conduit through whom the message is transmitted to parents. It could exist argued that, every bit far as parents of newborns are concerned, what healthcare professionals recommend is more important than what they merits to know. Past 2004, almost 100% of healthcare professionals were recommending a not-prone position.
The advising of parents is a complex topic. In the by, it emerged has that some healthcare professionals perceive the official guidelines as potentially harmful for newborns. This is the instance, for example, of those professionals who do non recommend the supine position for fright of regurgitation and aspiration.57 All the same, when giving advice to parents, healthcare professionals accept to (or should) comply with the public health recommendations of their country, regardless of their knowledge, opinions and beliefs. This is not necessarily true when knowledge is considered, equally each professional tin undergo further training or further reading from the literature as he/she deems it necessary. The fact that the percentages of those recommending both exclusively the supine position and a non-prone one have increased over the past xx years is reassuring. In the second case, particularly, this contradicts what was observed for the trend in knowledge, suggesting that healthcare professionals actually leave aside their personal opinions, fears and beliefs when giving parents communication.
Although the touch on of the BTS campaigns cannot be established with this kind of information, it seems legitimate to suppose that these campaigns played an important role in the awareness-raising process. The last two non-United states studies included in this review are from Italian republic and Turkey: in Italian republic the get-go national BTS campaign was carried out only in 2008, and in Turkey information technology was non possible to make up one's mind whether a national BTS campaign was ever implemented. While this does non hateful that healthcare professionals in these countries did not do good from BTS campaigns carried out in other countries (and reinforced by publications in the scientific literature), information technology shows a limited level of attention given by local policymakers to this result over the by 20 years. This might explain why their performance in terms of communication to parents seemed to be below that of the U.s. and Australia.
The assay reported in this paper has limitations: the number of studies is relatively small, equally this field has not yet been extensively explored. This implies that the results of the newspaper may be less authentic, although it may also limit the potential impact of any publication bias on the assay. While the tendency was largely synthetic on the basis of US studies, the well-nigh recent data are from other countries, and this may imply that at that place may be problems in terms of comparability. Information technology is too possible that nosotros could have plant more studies to include in the analysis if nosotros had extended the search to more databases other than PubMed and MEDLINE.
The reliability of the trend lines may be influenced by the estimates that were made where the twelvemonth of the surveys was unknown and by the hypothesis that, in case of surveys carried out over more ane year, their data was assumed to relate to all relevant years. The quality of the data in the studies reviewed may vary according to the mode of the survey (face-to-face, telephone, mail service, etc). Unfortunately, there are insufficient studies for us to be able to stratify on the basis of survey mode and some studies did not betoken how the survey was conducted (tabular array 1).
Determination
The BTS campaigns and the advice given past authorities such as the AAP accept been effective in helping raising awareness among healthcare professionals of the relative risks of sleep-related infant deaths or SUDI associated with dissimilar infant sleeping positions. Noesis of the effect of slumber position on the run a risk of SUDI has been acquired in phases. Awareness that the prone position was unsafe has been over 90% since 1992, and awareness that the supine position is associated with the lowest risk of SIDS rose between 2000 and 2010 from about l% to almost eighty%. Recent studies, notwithstanding, prove that the supine position is much better than either the prone or the lateral position, and there is still some way to go to heighten sensation of this. Evidence in favour of the supine position has continued to accumulate, and the latest evidence suggests that SIDS risks from the lateral and the prone positions are similar.10 ,12 ,13 ,19
Virtually recommended interventions to reduce the risk of SUDI, notably that concerning the sleep position, are to exist implemented in the home (Job Force on SIDS, 2011). Parents therefore need access to the best and most up to engagement information. Nowadays it cannot be expected that they would try to assemble information technology through only one source. On the reverse, they might expect for this information through several sources (eg, friends, books, the internet, etc). Notwithstanding, the healthcare professionals they bargain with are still likely to be one of their main sources of data (if not the main source). Thus, once the media sensation-raising action associated with nigh BTS campaigns ended, healthcare professionals' role becomes crucial. Specifically, the findings presented in table ii seem to suggest that there is a stronger need for more education on safe slumber for not-paediatricians rather than for paediatricians.
The percentage of healthcare professionals aware that whatever non-prone position would be better than the decumbent position has been decreasing over the past xx years, which may reflect changes in knowledge of the relative risks of the prone and lateral positions due to recent research. The per centum of healthcare professionals recommending parents of newborns' to use the supine sleeping position lonely, or, at to the lowest degree, a non-decumbent sleeping position, has been increasing. Nosotros propose that this should correspond the focus of future studies or public wellness policy on this topic, as such communication is, in the terminate, what will influence parents' option in putting their babies to slumber. The pct of healthcare professionals recommending the supine position exclusively seems to be effectually 80%. Farther efforts are needed to increment it in order to reduce the adventure of sleep-related infant deaths among the population, especially considering the opposition to the supine recommendation that however exists both among healthcare professionals and parents.57
Further attempt is needed to sympathize the human relationship between healthcare professionals' awareness of the risks of different sleeping positions and their decisions to recommend certain sleeping positions over others. Moreover, information technology is important to gather more than recent data from the USA, in club to develop a better understanding on how the trend has evolved in the by few years. This might too offer useful insights in club to provide more effective healthcare professional education and advice to parents aimed at reducing the risk of sleep-related baby deaths.
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