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objectives: Examine the 1) prevalence of worries among US mothers of infants; 2) association between worries and American Academy of Pediatrics recommended infant care practices (breastfeeding, supine sleep, roomsharing without bedsharing); 3) association of maternal and household characteristics with worries. Methods: We analyzed a nationally representative sample of 3165 mothers who were surveyed regarding safe sleep and breastfeeding when infants were 2 to 6 months of age in 2011-2014. We examined the prevalence of 8 maternal worries (housing, job, income, neighborhood, family relationships, health, baby's health, family member health). We used multi-variable logistic regression to examine associations of A) both overall number of worries and individual worries with each infant care practice; and B ) maternal and household characteristics with worries. results: Twenty-six percent of mothers reported 0 worries, 26% reported 1-2 worries, 23% reported 3-4 worries, and 25% reported 5-8 worries. Compared to those with 0 worries. mothers with 5-8 worries had increased odds of bedsharing (adjusted odds ratio = 1.60 [1.19-2.14J) and non-supine sleep (aOR = 1.37 [1.07-1.74]). Specific worries associated with increased odds of bedsharing included: housing (aOR = 1.39 [1.09-1.78]), income (aOR = 1.35 [1.09-1.67]), neighborhood (aOR = 1.37 [1.05-1.78]), family relationships (aOR = 1.43 [1.10-1.86]), and health of a family member (aOR = 1.24 [1.06-1.46]). Maternal worries were not associated with infant feeding practices. Conclusions: We found a high prevalence of worries regarding basic needs, family relationships, and health among US mothers. Greater total worries and several individual worries were associated with higher odds of bedsharing. The "cognitive load" of maternal worries may impact adherence to safe sleep practices and requires further investigation. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the study was to explore how individuals in the United States of America applied BFR/KAATSU devices and administered BFR/KAATSU training. In addition, the study sought to examine safety topics related to BFR/KAATSU training. Methods: The study was completed using survey research. Subjects were recruited through Facebook, email, and word of mouth. The survey was developed, piloted, and finally deployed March 22, 2021-April 21, 2021. Results: In total, 148 consented to the research; 108 completed the survey, and of those 108, 70 indicated current use with BFR/KAATSU equipment. Professions represented included athletic training, personal training, physical therapy, and strength and conditioning. Among those currently using BFR/KAATSU training (n = 70), the following results were found. The most common devices used were inflatable devices (n = 43, 61.4%). Education completed prior to device administration was formal (n = 39, 55.7%) and/or self-directed (n = 37, 52.9%). Barriers were faced by 29 (41.4%) when trying to enact training. Techniques and parameters varied during application. Screening processes were used (n = 50, 71.4%) prior to training. The devices were used to determine restrictive pressure (n = 31, 44.3%), and a supine position was used most when determining initial restrictive pressure (n = 33, 47.1%). For subsequent restrictive pressure measurements, respondents repeated the same method used initially (n = 38, 54.3%). Workload was often defined as the length of time under tension/load (n = 22, 31.4%) and exercise was directly supervised (n = 52, 74.3%). Adverse effects included bruising, lightheadedness, and cramping (n = 15, 21.4%). The devices have also been applied on those with pathology (n = 16, 22.9%). Conclusion: Those using blood flow restriction/KAATSU devices came from several professions and used an assortment of devices for BFR/KAATSU training. Individuals applied devices using a variety of parameters on populations for which efficacy has and has not been well defined. [ABSTRACT FROM AUTHOR]

Background: Epinephrine is the first-line therapy for patients with anaphylaxis, and intramuscular (IM) delivery is shown to be superior to subcutaneous (SC) delivery. There currently is no consensus on the ideal body position for epinephrine autoinjector (EAI) administration. Objective: We designed this study to investigate whether SC tissue depth (SCTD) is affected by body position (e.g., standing, sitting, supine), which can potentially impact delivery of EAI into the IM space. Methods: Volunteer adults (ages ≥ 18 years) from a military medical treatment facility in the United States were recruited to participate in this study. SCTD of the vastus lateralis was measured via ultrasound at standing, sitting, and supine body positions. Subjects' age, sex, and body mass index (BMI) were collected. Statistical analysis was performed to compare average SCTD between body positions, sex, and BMI. Results: An analysis of variance of 51 participants (33 men and 18 women) did not reveal statistically significant difference in SCTD among standing, sitting, and supine body positions. It did show a significantly greater SCTD in women than in men (2.72 6 1.36 cm versus 1.10 6 0.38 cm; p<0.001). There was no significant association observed between BMI and SCTD in this study. Conclusion: Body position did not seem to significantly change the distance between skin and thigh muscle in adults. This would suggest that there might not be an ideal body position for EAI administration. Therefore, in case of anaphylaxis, prompt administration of epinephrine is recommended at any position. [ABSTRACT FROM AUTHOR]

Although higher education and healthier practices are positively associated, the explanatory mechanisms for this association remain unclear. The purpose of this study was to better understand mechanisms underlying this association by examining maternal adherence to 2 health-promoting infant care practices: supine placement and breastfeeding. We analyzed nationally representative data from the Study of Attitudes and Factors Effecting Infant Care, which surveyed US mothers after infant birth and 2 months thereafter. Using the Theory of Planned Behavior as a framework, we used structural equation models to elucidate mediational pathways from maternal education to supine infant placement or any breastfeeding. Data from 3297 mothers demonstrated 77.0% of infants usually were placed supine, and 57.8% received any breastfeeding. The overall direct effect of maternal educational level on supine placement and any breastfeeding was odds ratio (OR) 1.31 (95% confidence interval [CI] 1.11–1.54) and OR 2.82 (95% CI 2.35–3.37), respectively. In pathway analyses, the strongest associations with both supine position and breastfeeding were seen with positive attitudes (supine: aOR 18.96, 95% CI 9.00–39.92; breastfeeding: aOR 3.86, 95% CI 2.19–6.82) and positive social norms (supine: aOR 6.69, 95% CI 4.52–9.89; breastfeeding: aOR 5.17, 95% CI 4.28–6.23). Mothers with more education had higher odds of both positive attitudes and positive norms for the 2 practices. The associations linking educational attainment with health practices are intricate, with multiple mediating pathways. Attitudes and social norms are powerful forces that mediate the association between maternal educational attainment and both infant supine positioning and breastfeeding, and may be important mediators for other health behaviors. [ABSTRACT FROM AUTHOR]

Objectives: To understand tension mothers experience when attempting to follow American Academy of Pediatrics safe sleep guidelines and enhancing infant and parental sleep., Methods: Surveys and focus groups were conducted from November 2022 and March 2023 with United States-based English-speaking mothers of infants <6 months of age recruited via social media and who reported a nonrecommended sleep position and/or location ≥2 times the prior week., Results: Twenty-five mothers participated in focus groups and surveys. A total of 80% reported holding or rocking their infant to sleep; 76% fed their infant to sleep. Almost all were aware of the ABCs (Alone, Back, Crib) of safe sleep and intended to follow them before delivery. Many felt that ABCs were unrealistic and placed their infants in nonrecommended locations or positions because they perceived them as more comfortable and helping their infant fall and stay asleep. Mothers were more likely to use nonrecommended practices when they were awake or sleeping nearby and believed they could closely monitor their infant. Some questioned whether ABCs were the only way to achieve safe sleep. Some prioritized other safety concerns (eg, fall prevention) over sudden infant death syndrome or sudden unexpected infant death prevention. Mothers expressed confidence about getting their baby to sleep in general but were less confident that they could do this while following guidelines., Conclusions: Despite awareness of the ABCs, mothers regularly engaged in nonrecommended practices with the goal of improving their own and their infant's sleep. Interventions focused on improving infant and parental sleep while maintaining sleep safety are needed., (Copyright © 2024 by the American Academy of Pediatrics.)

Background: Recent studies have shown a high prevalence of obstructive sleep apnea in myasthenia gravis compared to the normal population. The aim of this study was to elucidate clinical and polysomnographic differences between clinically stable Korean MG patients with and without OSA.Methods: A total of 18 consecutively stable MG patients were included in this prospective study. We compared MG patients with OSA (n = 7) and without OSA (n = 11) with respect to the baseline characteristics and overnight polysomnography (PSG) parameters. Demographic parameters, prescribed medication status, thymectomy status, myasthenia gravis foundation of America score, and antibody status were obtained from their medical records. We performed the Korean version of Pittsburg sleep quality index to assess the subjective quality of sleep. Statistical analyses were performed using SPSS version 18.0 with Wilcoxon rank sum test, chi-square test, Fisher's exact test, and Spearman correlation test.Results: Among the clinical parameters, MG patients with OSA showed a higher proportion of male sex (p = 0.016) and increased body mass index (p = 0.033). The PSG showed an 11-fold higher supine apnea-hyponea index (AHI) in MG patients with OSA. AHI was further analyzed with supine and non-supine position. MG patients with OSA had a higher supine AHI (19.5 ± 15.8) compared to those without OSA (1.9 ± 1.2, P = 0.008). Most of MG patients with OSA (85.7%) showed more than two times higher supine AHI than non-supine AHI.Conclusions: This study showed that the occurrence of OSA in patients with MG is associated with male sex and obesity, which is in accordance with the normal population. Moreover, PSG data showed a high prevalence of supine dominant OSA in MG patients with OSA. [ABSTRACT FROM AUTHOR]

Background: Ultrasonography (USG) is a cheap, easily available and painless modality for the diagnosis of carpal tunnel syndrome. However, the main sonographic criteria of cross sectional area (CSA) and flattening ratio (FR) of median nerve show a wide normal variation which warrants establishment of normal range of variability in the dimensions of median nerve in different populations. Objective: The main aim of this study was to calculate the mean cross sectional area (CSA) and flattening ratio (FR) of median nerve at wrist in asymptomatic adults. Materials and methods: This prospective observational study included asymptomatic adults visiting our tertiary care hospital for unrelated heath conditions with no symptoms to suggest carpal tunnel syndrome. Ultrasound examination of both wrists was carried out by high frequency linear array transducer with frequency of 10MHz with the arm in supine neutral position on LOGIQ P5 (GE Healthcare, Chicago, Illinois, USA) ultrasound machine. The cross-sectional area (CSA) and flattening ratio (FR) of the median nerve was measured at the level of carpal tunnel inlet and mean values with standard deviation were calculated. Results: Three hundred seventy six (376) wrists of 188 subjects were examined. 36 wrists were excluded owing to presence of anatomic variations of the median nerve in them. 340 wrists of 170 patients were included in the study. Mean cross sectional area of median nerve was 9.2 mm² (±1.2). Mean value of flattening ratio was 2.4 (±0.6). Mean CSA (9.26 ±1.2 mm² ) and FR (2.41 ±0.6) of males was not significantly different from mean CSA (9.16 ±1.2 mm² ) and FR (2.4±0.55) of females. However, mean CSA of right wrist (9.4 ±1.2 mm2 ) was significantly different from mean CSA of left wrist (9.10 ±1.1 mm² ). Conclusion: We found a higher mean cross sectional area (CSA) of 9.2 mm2 of median nerve in our population. There was a significant difference in the cross sectional area of median nerve between right and left wrists. However, we did not find statistically significant difference in the CSA and FR between the males and females. Establishment of normative data for the dimensions of median nerve is essential for different populations given the wide range of variations in the dimensions of median nerve. [ABSTRACT FROM AUTHOR]

AIM The purpose of this study was to evaluate nursing educators’ attitudes and knowledge regarding current American Academy of Pediatrics recommendations for a safe infant sleeping environment. METHOD This was a cross-sectional prospective survey of all nursing programs with associate degrees or higher in the United States. Instructors teaching pediatric and obstetric didactic or clinical material at an Accreditation Commission for Education in Nursing-approved nursing school could participate. RESULTS Of 396 educators surveyed, 70 percent identified all sudden infant death syndrome risk factors. Correct responses for individual safe sleep recommendations ranged from 99 percent for correct room temperature to 53 percent for pacifier use; 9 percent said it was safest for infants to sleep in a position other than on the back. CONCLUSION Nursing educators need ongoing training on infant sleep safety to maintain mastery of the information that students need for competency in the workforce involving infant care. [ABSTRACT FROM AUTHOR]

The article discusses some important issues for health care and public health professionals to consider with regards to national and state trends in sudden unexpected infant death. Topics discussed include postneonatal mortality rates in the U.S. from 2002 to 2010, variation in national policies, and protective factors for infant mortality.

The cardio-ankle vascular index (CAVI) represents a promising index of arterial stiffness. However, neither the CAVI measure nor its measurement device, the VaSera, have undergone general testing in a North American clinical setting. To begin the process of collecting normal values in the United States, we studied 20 male and 28 female volunteers without reported cardiovascular or renal disease and no history of smoking. Their CAVIs, ankle-brachial indices (ABIs), and four-limb blood pressures were measured in three positions: supine, 7° Trendelenburg, and 7° reverse Trendelenburg. In addition, the ABI function was validated against an established ABI measurement technique. Position was found to affect CAVI and other hemodynamic parameters, indicating that CAVI is not robust to slight positional variations. No differences were found in the blood pressure between arms or legs (interbrachial or interankle), supporting recent findings from meta-analyses and studies but contradicting other work. This study represents an early step in bringing the VaSera device and its CAVI measurement into clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: Clinical pharmacology QT/QTc studies can be smaller if they more efficiently use the data generated.Objective: The aim was to use large sets of electrocardiograms (ECGs) deposited at the US Food and Drug Administration to investigate the implications of heart rate measurement on the accuracy of QTc data.Methods: Using the data of 80 thorough QT studies, we investigated whether placing study subjects in supine positions during short-term time points stabilizes heart rate (part I, based on 73 studies with 747,912 measured ECGs in 6786 healthy subjects) and whether heart rate measurements different from RR intervals captured simultaneously with QT intervals decrease QTc variability (part II, based on seven studies with 897,570 ECG measurements in 751 healthy subjects).Results: In the part I data, when subjects were placed in supine undisturbed positions, heart rate instability (max-min of repeatedly measured heart rates within the same study time point) exceeding 5 beats per minute (bpm) was observed 40 % of the time and exceeded 10 bpm 10 % of the time. In the part II data, even when including QT measurements preceded by variable heart rates, correction of QT durations for RR interval values derived through a simple QT/RR hysteresis model with 95 % adaptation in 120 s led to mean intra-subject standard deviation of QTc (Fridericia formula) of only 7.14 ± 1.98 and 6.38 ± 1.50 ms in women and men, respectively.Conclusion: The QT/RR hysteresis model with 95 % adaptation in 120 s is universally applicable to healthy subjects, providing small QTc variability. Supine positions do not generally stabilize heart rates in healthy subjects. Universally applicable QT/RR hysteresis correction allows clinical QT/QTc studies to include variable heart rate episodes in the time points. [ABSTRACT FROM AUTHOR]

Using data from two postpartum depression randomized trials, we examined the association between postpartum depressive symptoms and parenting practices among a diverse group of mothers. We examined the association between safety practices (back sleep position, car seat use, smoke alarm), feeding practices (breastfeeding, infant intake of cereal, juice, water), and health care practices (routine well child and Emergency Room (ER) visits) with 3-month postpartum depressive symptoms assessed using the Edinburgh Depression Scale (EPDS ≥10). Fifty-one percent of mothers were black or Latina, 33 % had Medicaid, and 30 % were foreign born. Depressed mothers were less likely to have their infant use back sleep position (60 vs. 79 %, p < .001), always use a car seat (67 vs. 84 %, p < .001), more likely to feed their infants water, juice, or cereal (36 vs. 25 %, p = .04 respectively), and to bring their babies for ER visits (26 vs. 16 %, p = .03) as compared with non-depressed mothers. In multivariable model, depressed mothers remained less likely to have their infant use the back sleep position, to use a car seat, and to have a working smoke alarm in the home. Findings suggest the need to intervene early among mothers with depressive symptoms and reinforce positive parenting practices. [ABSTRACT FROM AUTHOR]

Background: The sagittal abdominal diameter (SAD) measured in supine position is an alternative adiposity indicator that estimates the quantity of dysfunctional adipose tissue in the visceral depot. However, supine SAD’s distribution and its association with health risk at the population level are unknown. Here we describe standardized measurements of SAD, provide the first, national estimates of the SAD distribution among US adults, and test associations of SAD and other adiposity indicators with prevalent dysglycemia. Methods and Findings: In the 2011–2012 National Health and Nutrition Examination Survey, supine SAD was measured (“abdominal height”) between arms of a sliding-beam caliper at the level of the iliac crests. From 4817 non-pregnant adults (age ≥20; response rate 88%) we used sample weights to estimate SAD’s population distribution by sex and age groups. SAD’s population mean was 22.5 cm [95% confidence interval 22.2–22.8]; median was 21.9 cm [21.6–22.4]. The mean and median values of SAD were greater for men than women. For the subpopulation without diagnosed diabetes, we compared the abilities of SAD, waist circumference (WC), and body mass index (BMI, kg/m2) to identify prevalent dysglycemia (HbA1c ≥5.7%). For age-adjusted, logistic-regression models in which sex-specific quartiles of SAD were considered simultaneously with quartiles of either WC or BMI, only SAD quartiles 3 (p<0.05 vs quartile 1) and 4 (p<0.001 vs quartile 1) remained associated with increased dysglycemia. Based on continuous adiposity indicators, analyses of the area under the receiver operating characteristic curve (AUC) indicated that the dysglycemia model fit for SAD (age-adjusted) was 0.734 for men (greater than the AUC for WC, p<0.001) and 0.764 for women (greater than the AUC for WC or BMI, p<0.001). Conclusions: Measured inexpensively by bedside caliper, SAD was associated with dysglycemia independently of WC or BMI. Standardized SAD measurements may enhance assessment of dysfunctional adiposity. [ABSTRACT FROM AUTHOR]

Elevated intraocular pressure (IOP) and venous congestion may produce a low ocular perfusion state that can lead to postoperative visual loss (POVL). The literature cites the importance of early IOP reduction to prevent optic nerve damage and visual loss. This study examined dorzolamide hydrochloride and timolol maleate (Cosopt) eyedrops on reducing elevated IOP during laparoscopic surgery with the patient in steep Trendelenburg position. A quasi-experimental study design was used. Subjects involving robotic urologic and gynecologic procedures at 3 separate medical centers were included. The medication was administered topically to both eyes at time points when IOP approached 40 mm Hg. The IOP was measured at 30-minute intervals compared with a supine, anesthetized baseline and final postprocedure supine measurements. A total of 194 patients were recruited, and 63 patients received dorzolamide-timolol treatment when IOP levels reached 38 to 40 mm Hg. Repeated-measures analysis of variance showed that IOP values dropped significantly after drug intervention at 60, 90, and 120 minutes (P < .001). Effect sizes of pharmacologic intervention on IOP reduction were strong (partial n2 of 0.60 to 0.66). Treatment with dorzolamide-timolol eyedrops significantly reduces elevated IOP of patients who undergo lengthy laparoscopic surgery in the steep Trendelenburg position. [ABSTRACT FROM AUTHOR]

The article presents a case study of a two-and-a-half-month-old infant who was diagnosed by sudden infant death syndrome (SIDS) after being pronounced dead. This incident helped change the licensing regulations and inculcated a safer sleep environment for infants in licensed child-care centers in Arkansas. The article provides information on SIDS, suggests ways that nurses can help teach caregivers about SIDS, and features the progress of the educational initiatives for SIDS.

This study's objective was to assess the knowledge, opinions, and practices of infants' sleep positions and their association with demographics. A cross-sectional descriptive design was used to survey a convenience sample of military beneficiary parents being seen at a military treatment facility in the United States. A 19-item investigator- designed questionnaire was adapted using the "Safe Sleep Survey" developed by Indiana Perinatal Network. A sample of 161 parents responded. Forty percent were fully aware of the sate sleep facts for infants; 85% believed supine position was the safest; and 69% of those who believed supine position to be the safest also practiced their belief. Major reasons for nonsupine sleeping positions were for infant preference, comfort, and fear of choking: whereas supine position was for safety reasons. Parents' opinions of safe position and their practices (p < 0.001) were significantly associated, whereas knowledge on infant safe sleep facts (p = 0.611) was not. The results indicate that there is still a need for education. However, merely providing information to increase knowledge alone is not enough to change behavior, as attitude was an important factor for the behavior. Theory-based intervention associated with change in behavior will have an impact on parents' attitudes. [ABSTRACT FROM AUTHOR]

Purpose This study utilises an ecological design to analyse the relation between concurrent temporal trends in sudden infant death syndrome (SIDS) rates and prevalence of smoke-free households with infants in the USA, controlling for an important risk factor, infant supine sleep position. Methods Annual state-specific SIDS cases were computed using period linked birth/infant death files; the prevalence of 100% smoke-free homes with infants using Tobacco Use Supplement to the Current Population Survey data, and percentage of infants in supine sleep position from National Infant Sleep Position data, for years 1995-2006. Incidence rate ratios relating trends in SIDS cases and risk factors were determined using time-series negative binomial regression. Population-level health effects were assessed with secondhand smoke (SHS) exposure population attributable fractions and excess attributable SIDS deaths. Results For every 1% absolute increase in the prevalence of smoke-free homes with infants, SIDS rates decreased 0.4% from 1995 to 2006, controlling for supine sleep position. Nationally, it is possible that 20% of the 1326 total SIDS cases were attributable to childhood SHS exposure at home in 2006 with potentially 534 fewer infant deaths attributable to SHS exposure in 2006 than in 1995, owing to an increasing prevalence of 100% smoke-free homes with infants. Cumulatively, 4402 (lower 95% CI) to 6406 (upper 95% CI) excess SIDS cases may have been attributable to SHS exposure in the home over the 12-year study period. Conclusions The uptake of voluntary restrictions on smoking inside the home may present a public health benefit for infants in their first year of life. In light of inherent ecological study design limitations, these results warrant further individual level research linking postnatal SHS exposure and SIDS. [ABSTRACT FROM AUTHOR]

The article discusses the recommendation of the American Academy of Pediatricts to place infants in supine position for sleep in order to reduce the risk of sudden infant death syndrome (SIDS). It notes that before discharge from the neonatal intensive care unit (NICU), staff should make it sure that parents were given instruction regarding infant sleep position and risk factors for SIDS. Surveys as of December 2010 in which 85% of the respondent nurses said that this recommendation is an effective way of reducing the risk of SIDS are discussed.

This study describes perceptions of African American mothers related to infant health care. The study's significance arises from the increased incidence of SIDS and disparity in infant mortality among African Americans. SIDS disproportionately affects African American infants and failure of parents to adhere to supine sleep is offered as a contributing factor. An understanding of parents' perceptions of healthcare provider interactions can uncover barriers to adherence with recommendations for safe infant sleep. Interviews revealed that African American mothers valued care from friendly, caring, attentive, respectful nurses. As a result of receiving respectful care, mothers indicated increased likelihood of adhering to health teachings. [ABSTRACT FROM AUTHOR]

INTRODUCTION: A partial sitting position has been reported to increase functional residual capacity (FRC) in lean subjects, whereas FRC does not change with position in the morbidly obese. The effects of positioning in the subgroup of overweight and mildly to moderately obese subjects have not been examined. We hypothesized that a change in FRC may be related to adipose tissue distribution. METHODS: We investigated the hypotheses that a 30° Fowler's position would increase the FRC and decrease the closing-capacity-to-FRC ratio in subjects with a body mass index in the 25.0 -39.9 kg/m² range. We tested whether body fat distribution, measured by waist circumference and waist-to-hip ratio, correlated with the lung-volume changes. RESULTS: The 30° Fowler's position did not improve the FRC, when compared to the supine position (n = 32). The closing-capacity-to-FRC ratio was > 1 in 5 of 7 subjects while sitting, and in all 7 subjects while supine or in the 30° Fowler's position. The waist-to-hip ratio was correlated with closing capacity in all positions, and correlated with closing-capacity-to-FRC ratio in the supine position. CONCLUSIONS: Standard position changes purported to increase FRC are ineffective in the overweight and mildly to moderately obese, a subpopulation represented by almost 67% of Americans. Bedside caregivers may need to modify current practices when the clinical goal is to improve resting lung volumes in sedentary patients. [ABSTRACT FROM AUTHOR]

The article explores how vaccine rate declining and informs about addressing vaccine hesitancy around sudden infant death syndrome. Topics include Covid-19 pandemic has triggered a decline in pediatric vaccination rates across the country, as parents avoid taking their children into clinics or hospitals for fear of coming into contact with the coronavirus; and the safety concern could be around a perceived link between vaccines and Sudden Infant Death Syndrome (SIDS).

Since 1992, the optimal sleeping position for infants in the United States has been supine. This position has been shown to greatly reduce the rate of Sudden Infant Death Syndrome (Skadberg, Morild, & Markestad, 1998). However, the supine position may lead to other unintended consequences or complications. Through a review of literature, this article explores some of the complications associated with the &rsquopBack to Sleep’ campaign in the U.S. and discusses educational strategies for perinatal educators. [ABSTRACT FROM AUTHOR]

Objective. Despite the fact that 20% of sudden infant death syndrome (SIDS) deaths occur in child care settings, many child care providers continue to be unaware of the association of SIDS and infant sleep position and/or are misinformed as to the risks and benefits of the various sleep positions. The objective of this study was to determine whether an educational program for child care providers regarding SIDS and safe sleep environment is effective in 1) providing basic information and understanding regarding SIDS risk reduction practices, 2) changing child care provider behavior, and 3) promoting development of written sleep position policies. Methods. We designed a 60-minute educational in-service for child care providers, to be led by a trained health educator. All providers who attended the in-service were asked to complete surveys before and after the in-service. Surveys assessed provider knowledge, beliefs, and practices. A 6-month follow-up interview was conducted with child care centers that had providers participating in the in-service. Results. A total of 96 child care providers attended the educational in-service. Providers who were using the supine position exclusively increased from 44.8% to 78.1%. This change in behavior was sustained, with 85% of centers placing infants exclusively supine 6 months after the intervention. Awareness of the American Academy of Pediatrics recommendation of supine as the preferred position for infants increased from 47.9% to 78.1%, and 67.7% of centers continued to recognize supine as the recommended position 6 months later. The percentage of centers that reported written sleep position policies increased from 18.8% to 44.4%. Conclusions. A targeted educational in-service for child care providers is effective in increasing awareness and knowledge, changing child care provider behavior, and promoting development of... [ABSTRACT FROM AUTHOR]

Purpose: Despite the 2016 American Academy of Pediatrics recommendations for preventing sudden unexpected infant death, there are approximately 3,400 sudden unexpected infant deaths annually in the United States. Modeling of safe sleep practices by nurses in the hospital influences parents' practice at home; however, safe sleep practices are not consistently modeled during the childbirth hospitalization., Methods: A quality improvement project was conducted to implement a safe sleep initiative based on the 2016 American Academy of Pediatrics recommendations for nurses caring for hospitalized infants after birth. Evaluation included testing of nurses' knowledge, infant crib audits, and nurses' evaluation of the intervention., Results: A significant improvement was found in overall nurse education scores. Crib audits demonstrated a significant improvement in the following elements: use of multiple blankets, swaddling of the infant, and parent teaching. Nursing surveys reported an increase in confidence to practice safe sleep recommendations and educate and redirect parents., Clinical Implications: Implementing a safe sleep initiative can increase nurses' knowledge, improve adherence to recommendations with modeling safe sleep practices, and increase parent awareness of safe sleep recommendations, potentially positively affecting adherence after discharge., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Each year in the United States, ∼3500 infants die of sleep-related infant deaths, including sudden infant death syndrome (SIDS) (International Classification of Diseases, 10th Revision [ICD-10] R95), ill-defined deaths (ICD-10 R99), and accidental suffocation and strangulation in bed (ICD-10 W75). After a substantial decline in sleep-related deaths in the 1990s, the overall death rate attributable to sleep-related infant deaths has remained stagnant since 2000, and disparities persist. The triple risk model proposes that SIDS occurs when an infant with intrinsic vulnerability (often manifested by impaired arousal, cardiorespiratory, and/or autonomic responses) undergoes an exogenous trigger event (eg, exposure to an unsafe sleeping environment) during a critical developmental period. The American Academy of Pediatrics recommends a safe sleep environment to reduce the risk of all sleep-related deaths. This includes supine positioning; use of a firm, noninclined sleep surface; room sharing without bed sharing; and avoidance of soft bedding and overheating. Additional recommendations for SIDS risk reduction include human milk feeding; avoidance of exposure to nicotine, alcohol, marijuana, opioids, and illicit drugs; routine immunization; and use of a pacifier. New recommendations are presented regarding noninclined sleep surfaces, short-term emergency sleep locations, use of cardboard boxes as a sleep location, bed sharing, substance use, home cardiorespiratory monitors, and tummy time. Additional information to assist parents, physicians, and nonphysician clinicians in assessing the risk of specific bed-sharing situations is also included. The recommendations and strength of evidence for each recommendation are included in this policy statement. The rationale for these recommendations is discussed in detail in the accompanying technical report., (Copyright © 2022 by the American Academy of Pediatrics.)

Objective: To assess trends in racial disparity in supine sleep positioning (SSP) across racial/ethnic groups of infants born early preterm (Early preterm; <34 weeks) and late preterm (Late preterm; 34-36 weeks) from 2000 to 2015., Study Design: We analyzed Pregnancy Risk Assessment Monitoring System data (a population-based perinatal surveillance system) from 16 US states from 2000 to 2015 (Weighted N = 1 020 986). Marginal prevalence of SSP by year was estimated for infants who were early preterm and late preterm, adjusting for maternal and infant characteristics. After stratifying infants who were early preterm and late preterm, we compared the aOR of SSP trends across racial/ethnic groups by testing the time-race interaction., Results: From 2000 to 2015, Non-Hispanic Black infants had lower odds of SSP compared with Non-Hispanic White infants for early preterm (aOR 0.61; 95% CI 0.47-0.78) and late preterm (aOR 0.44; 95% CI 0.34-0.56) groups. For Hispanic infants, there was no statistically significant difference for either preterm group when compared with Non-Hispanic White infants. aOR of SSP increased (on average) annually by 10.0%, 7.3%, and 7.7%, respectively, in Non-Hispanic White, Non-Hispanic Black, and Hispanic early preterm infants and by 5.8%, 5.9%, and 4.8% among Non-Hispanic White, Non-Hispanic Black, and Hispanic late preterm infants. However, there were no significant between-group differences in annual changes (Early preterm: P = .11; Late preterm: P = .25)., Conclusions: SSP increased for all racial/ethnic preterm groups from 2000 to 2015. However, the racial/ethnic disparity in SSP among early preterm and late preterm groups persists., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Aim: To determine which factors are associated with sudden unexpected infant death (SUID) by time of day., Methods: Data were analysed from the National Fatality Review Case Reporting System (2006-2015). Out of 20 005 SUID deaths in 37 states, 12 191 (60.9%) deaths had a recorded nearest hour of discovery of the infant. We compared distribution patterns between time of death and 118 variables to determine which were significantly correlated with SUID time of death using advanced statistical modelling techniques., Results: The 12-hour time periods that were most different were 10:00 to 21:00 (daytime) and 22:00 to 09:00 (nighttime). The main features that were associated with nighttime SUID were bed sharing, younger infants, non-white infants, placed supine to sleep and found supine, and caregiver was the parent. Daytime SUID was associated with older infants, day care, white infants, sleeping in an adult bed and prone sleep position. Factors not associated with time of death were sex of the infant, smoking and breastfeeding., Conclusion: Sudden unexpected infant death deaths that occur at night are associated with a separate set of risk factors compared to deaths that occur during the day. However, to minimise risk, it is important to practice safe sleep guidelines during both nighttime and daytime sleep., (© 2020 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.)

The article discusses the findings of the study "Racial and ethnic trends in sudden unexpected infant deaths" by S. E. Parks, A. B. Erck Lambert, and C. K. Shapiro-Mendoza published in the same issue. Topics covered include the use of race and ethnicity in determining different outcomes in sudden infant death syndrome (SIDS) and sudden unexpected infant death (SUID), the "Black to Sleep" campaign, and the noted genetic, racial and biological risk factors for SIDS.

Questions regarding sleep position safety are often posed for any OB/GYN or midwife practicing obstetrics. [ABSTRACT FROM AUTHOR]

Objective: To investigate the current practice of intratympanic steroid (ITS) injection for sudden sensorineural hearing loss (SSNHL) in the United Kingdom and link the data with data from the United States and continental Europe., Methods: A survey of 21 questions was distributed to members of the British Society of Otology using an online survey platform via ENT UK. Data obtained from UK otolaryngologists (n = 171) were integrated with previously published data from other countries, including the United States (n = 63) and continental Europe (n = 908)., Results: In the United Kingdom, 62% of responding otolaryngologists use ITS injection for SSNHL, while 38% do not. Of those using ITS, 59% use it as first-line treatment, either using it in conjunction with oral steroids (51%) or using it as monotherapy (8%). Of those that use ITS, a majority (83%) use it as salvage therapy when primary treatment with systemic steroids has failed, and similar results are found in the continental Europe and US surveys. The most commonly used preparation is dexamethasone. Responses to questions regarding treatment regimes used are enlightening and show considerable variation in the treatment regimes used within and between countries., Conclusions: There is a wide variation in practice with regards to ITS for SSNHL hearing loss in the United Kingdom, United States, and continental Europe. In the absence of protocols or definitive guidance from published literature, knowledge of contemporary practice may help guide or encourage reevaluation of clinical practice and will help guide the design of future clinical trials.

Objective: To identify facilitators and barriers to the implementation of safe sleep recommendations from the American Academy of Pediatrics from the perspective of hospital staff as part of a needs assessment that was used to design a successful quality improvement intervention to change clinical practice., Design: Qualitative design., Setting: Multiple sites of three hospitals in the northeastern and southern United States., Participants: We used purposeful sampling to identify 46 participants who cared for infants on inpatient hospital units (nurses and other staff members)., Methods: A qualitative researcher used grounded theory to moderate the focus groups. We constructed the initial interview guide and then changed it as needed to capture more information about new ideas as they arose. Researchers from diverse backgrounds participated in the analysis and used the constant comparative method to select important concepts and to develop codes and subsequent themes. We continued to collect data until saturation was reached., Results: We identified themes and subthemes, and the taxonomy fit into the Grol and Wensing framework for change in clinical practice. The six primary themes included The Innovation Itself, The Individual Health Care Professional, The Patient, The Social Context, The Organizational Context, and The Economic and Political Context., Conclusion: Participants described facilitators and barriers to the implementation of the American Academy of Pediatrics recommendations for safe infant sleep. Identification of these themes informed our quality improvement intervention to promote safe infant sleep. Findings can be used by others when faced with the need for similar change., (Copyright © 2019 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

PURPOSE: Cranio-spinal irradiation (CSI) poses a challenging planning process due to the complex target volume. Typically the target volume includes entire spinal cord and whole brain. As these patients have potentially improved survival rates, the concern of reducing late side effects has become very important. Second malignancies are a major cause of morbidity and mortality for childhood cancer survivors, hence it is essential to adapt The ALARA ("As Low As Reasonably Achievable") principle in our practice. Traditionally three dimensional conformal radiotherapy (3D-CRT) has been in practice over the years. In this 3D-CRT planning modality, the reduction is dose to organs at risk (OARs) is not optimally achievable due to the technique. Hence as an attempt is made through different planning modality, namely volumetric modulated arc therapy (VMAT), for the treatment of CSI to reduce the dose of organs at risk (OAR) while maintaining appropriate coverage to the target. In this planning study we compared the dose parameters between volumetric modulated arc therapy (VMAT) and 3D-CRT plans. Materials and Methods: We at our centre have a multimodality linear accelerator having IGRT, IMRT and VMAT alongwith the treatment planning system (Eclipse (v11.0)) (Varian Medical Systems, USA). Six patients with cases of Medulloblastoma and Ependymoma were selected for the study. Aquaplast thermoplastic masks were used for head immobilization, vacloc was used for whole body immobilization. Patients were stimulated in prone position. CTV includes whole brain and the spinal canal till S2-S3 and thecal sac. Further 5mm margin for CTV Brain and 10 mm margin for CTV spinal cord was given for PTV. Organs at risk heart, thyroid, kidneys, lungs, esophagus, eye, lens, and optic nerves were delineated. All the patients were planned for traditional 3DCRT plans (two lateral cranio-cervical opposed ?elds adjoined two posterior spinal ?eld) . The prescription dose for treatment was 36 Gy in 20 fractions. All patients were treated in 3D-CRT technique. For dosimetric comparative study, VMAT plans were generated for these cases using 3 isocenters and modulated arcs for the same prescribed dose. The first isocenter was localized in the brain to have one partial arcs (220?-140?). The choice of partial arc was to avoid entrance of beam through eyes. The second isocenter was placed at D3-D6 and third isocenter was placed at L1-L3 spinal cord. For spinal fields full arcs with avoidance sector (250?-290?, 70?-110?) were used to avoid shoulders and hands. Qualitative and quantitative dose evaluations were carried for all the volumes for the both techniques. Results: The average Homogeneity Index for 3DCRT and VMAT plans was 11.2 and 8.5, and Conformity Index was 2.2 and 1.1 respectively. The Mean heart dose was reduced to 5.5 Gy in VMAT plans compared to 16.9 Gy in 3DCRT. The Mean dose for thyroid and esophagus was also reduced to 7 Gy and 11.6 Gy in VMAT compared to 27.3 Gy and 29.3 Gy in 3DCRT plans. Mean lung dose in VMAT plans was found slightly increased to 5.3 Gy from 4.9 Gy in 3DCRT plans. The mean doses of kidneys, optic nerve and eye in 3DCRT plans was 5.2 Gy, 34.4 Gy and 20 Gy, whereas in VMAT it was 5.0 Gy, 17.7 Gy and 10.2 Gy respectively. Conclusion: Compared to traditional 3D-CRT technique for the treatment of CSI, VMAT plans showed better Conformity Index (CI) and Homogeneity Index (HI). Substantial dose reduction observed in the form of lower mean dose to OARs. VMAT allows the treatment in supine position also; resulting in greater patient compliance. As the overall treatment time is reduced in VMAT delivery, the chances of second malignancies are expected to be reduced further. Use of field matching/junction shift is avoidable in VMAT, resulting in reduction in cold and hot spots. Conflict of Interest: NIL [ABSTRACT FROM AUTHOR]

Despite the release of guidelines by the American Academy of Pediatrics (AAP) on safe infant sleep and public service campaigns aimed at reducing risk factors over the past 25 years, deaths due to Sudden Infant Death Syndrome (SIDS) and Sudden Unexplained Infant Death (SUID) are still the 4th leading causes of infant death in the United States. Findings from several studies demonstrate that nurses do not consistently model safe sleep practices with infants due to a lack of education on evidence-based practice and misconceptions regarding safe infant sleep. The aim of this paper is to demonstrate the need for expanded education to both nurses and parents on the principles of safe infant sleep and the impact it can have on decreasing risk factors for SIDS and SUID. Strategies are outlined for additional education for nurses and parents to enhance adherence to safe sleep guidelines and quality improvement projects aimed at the implementation of culture change are discussed. Going forward it is critical that nurses take an active role in seeking additional education on modifiable risk factors linked to SIDS and SUID and use that education to model and teach safe infant sleep practices with every infant at every encounter., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Purpose: To measure changes in registered nurse (RN) knowledge/beliefs and practices, parents' recall of infant safe sleep (ISS) teaching, and inpatient infant sleep environments and safety after implementing an ISS initiative., Design and Methods: This longitudinal quasi-experimental study took place in three hospitals in the United States. An existing infant safe sleep tool was revised and updated to align with current recommendations on sleep environments. A bundled intervention included educating nurses, changing unit processes and implementing crib cards and room signs. Paired questionnaires surveyed 62 nurses before and 2 months after the intervention. Audits of 462 cribs/sleep environments with parent conversations assessed infant sleep conditions and parents' recall of RN teaching before and after the intervention., Results: After Bonferroni correction, eight of 19 items for RN knowledge/beliefs and self-reported practice showed statistically significant improvements with moderate effect sizes. All 11 items for parents' recall of RN teaching showed statistically significant improvements, with odds ratios ranging from 7 to 76. Five of six real-time sleep safety conditions (from crib/sleep environment audits) had statistically significant improvements. Odds ratios ranged from eight to 83., Conclusion: An updated educational tool improved nurses' and parents' knowledge and practices related to current and updated safety factors for infant sleep conditions. Inpatient adherence to infant sleep safety recommendations improved., Practice Implications: A two-hour investment of nurses' time yielded statistically significant improvements. Factors critical to the success of the ISS project roll-out are reported. Improvements in parents' recall of teaching and actual sleep environments suggest potential for long-term changes in infant safety at home., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Purpose: A Black infant dies every 13 hours in the state of Indiana. The overall infant mortality rate in 2013 was 7.2 deaths per 1000 live births, but for Black infants, the rate was 15.3 deaths per 1000 live births. For over 20 years, placing an infant to sleep on his back has decreased the death rate from sudden unexpected infant death (SUID) and sudden infant death syndrome (SIDS), but many Black families continue to advocate bed sharing, prone sleeping, and inappropriate bedding/sleep surfaces, predisposing an infant to a significantly higher risk for SUID/SIDS. Therefore, the purpose of this study is to understand why Black women are less likely than White women to follow safe sleep recommendations for their infants., Design: A rigorous search of the literature was performed by searching the Web of Science, OVID, CINAHL, PsychINFO, and PubMed using the search terms: infant or child, death, loss, SIDS, SUID, qualitative, African American, Black, culture, safe sleep, experiences, and United States. A total of 217 articles were obtained. After review of inclusion and exclusion criteria and critical appraisal, only seven articles remained for the research study., Methods: The meta-synthesis of these seven original qualitative studies was performed using the Qualitative Assessment and Review Instrument from the Joanna Briggs Institute to assist with data management. Data were extracted and representative quotations were categorized. Categories were arranged into like themes. Themes were then synthesized with meta-aggregation., Results: A total of 17 subthemes were identified and were formulated into three primary themes: convenience, safety, and culture. The final synthesized theme was that Black mothers are motivated by their beliefs., Practice Implications: Black mothers tend to believe that SUIDS/SIDS is a random occurrence and is not preventable, so they see a little reason to make their infant sleep in a cold, hard crib, when they could sleep in a warm, comfortable bed with them. Nurses should work with Black mothers to understand their cultural beliefs while educating them about safe sleep practices., (© 2018 Wiley Periodicals, Inc.)

The article discusses research on supine sleep in infants. It references a study by E. R. Colson et al, published in a 2009 issue of the "Archives of Pediatrics & Adolescent Medicine." The study found that more infants are in supine sleep position. It also revealed that among the population groups, African-Americans use the position less.

The article offers information on the research conducted on the correlation of supine body position and neural responses in the U.S. Researchers found that the body movements of human beings affect their emotional processes. Moreover, simple body postures also impact other emotive responses, as well as their other emotive responses and neural activations associated with it.

Background and Objectives: The American Academy of Pediatrics recommends infants be placed supine for sleep. Our objectives in this study were to, in a nationally representative sample, examine (1) prevalence of maternal intention regarding infant sleeping position and of actual practice and (2) factors associated with their choices., Methods: We recruited mothers from 32 US hospitals, oversampling African American and Hispanic mothers, in a nationally representative sample of mothers of infants aged 2 to 6 months. Survey questions assessed choice of usual infant sleeping position, all sleeping positions, intention for sleep position, as well as actual practice. Multivariable logistic regression analyses controlled for demographic, receipt of doctor advice, and theory of planned behavior variables (attitudes, subjective norms, and perceived control)., Results: Of the 3297 mothers, 77.3% reported they usually placed their infants in the supine position for sleep, but fewer than half reported that they exclusively did so. Only 43.7% of mothers reported that they both intended to and then actually placed their infants exclusively supine. African American mothers and those who did not complete high school were more likely to intend to use the prone position. Theory of planned behavior factors (attitudes, subjective norms, and perceived control) and doctor advice were associated with maternal choice., Conclusions: Not all mothers place their infants exclusively supine for sleep. Many mothers intend to place their infants supine yet often do not do so in actual practice. Factors potentially amenable to intervention including attitudes, subjective norms, and doctor advice are associated with intention and practice., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2017 by the American Academy of Pediatrics.)

Objective: Supine sleep positioning (SSP) has been shown to reduce the risk of sudden infant death syndrome (SIDS) and preterm infants are at higher risk for SIDS. Population-based estimates of SSP are lacking for the preterm population. The objectives of this study are: (1) compare the prevalence of SSP after hospital discharge for preterm and term infants in the United States; and (2) assess racial/ethnic disparities in SSP for preterm and term infants., Study Design: We analyzed the 2000 to 2011 data from the Pregnancy Risk Assessment Monitoring System of Centers for Disease Control and Prevention from 35 states. We measured prevalence of SSP by preterm and term gestational age (GA) categories. We calculated adjusted prevalence ratios (APR) to evaluate the likelihood of SSP for each GA category compared with term infants and the likelihood of SSP for non-Hispanic black (NHB) and Hispanic infants compared with non-Hispanic white (NHW) infants., Results: Prevalence of SSP varied by GA: ⩽27, 59.7%; 28 0/7 to 33 6/7, 63.7%; 34 0/7 to 36 6/7 (late preterm), 63.6%; and 37 0/7 to 42 6/7 (term) weeks, 66.8% (P<0.001). In the adjusted analyses, late preterm infants were slightly less likely to be placed in SSP compared with term infants (APR: 0.96, confidence interval: 0.95 to 0.98). There were racial/ethnic disparities in SSP for all GA categories when NHB and Hispanic infants were compared with NHW infants., Conclusions: All infants had suboptimal adherence to SSP indicating a continued need to better engage families about SSP. Parents of late preterm infants and families of NHB and Hispanic infants will also require greater attention given their decreased likelihood of SSP.

Sudden infant death syndrome (SIDS) is the sudden unexpected death of a child younger than one year during sleep that cannot be explained after a postmortem evaluation including autopsy, a thorough history, and scene evaluation. The incidence of SIDS has decreased more than 50% in the past 20 years, largely as a result of the Back to Sleep campaign. The most important risk factors relate to the sleep environment. Prone and side sleeping positions are significantly more dangerous than the supine position. Bed sharing with a parent is strongly correlated with an increased risk of SIDS, especially in infants younger than 12 weeks. Apparent life-threatening events are not a risk factor for SIDS. Parents should place infants on their backs to sleep, should not share a bed, and should avoid exposing the infant to tobacco smoke. Other risk-reducing measures include using a firm crib mattress, breastfeeding, keeping vaccinations up to date, avoiding overheating due to overbundling, avoiding soft bedding, and considering the use of a pacifier during sleep once breastfeeding is established. One consequence of the Back to Sleep campaign is a significant increase in the incidence of occipital flattening. Infants who develop a flat spot should be placed with the head facing alternating directions each time he or she is put to bed. Supervised prone positioning while the infant is awake, avoiding excessive use of carriers, and upright positioning while awake are also recommended.

The article reports on the increase in the number of suffocation deaths in infants in the U.S. between 2000 and 2009. It identifies the core elements of a safe sleeping environment for newborns which include supine positioning, a firm sleep surface with a fitted crib sheet, and absence of loose bedding. The need to educate new parents on safe sleeping environments for infants is emphasized.

Background: Sudden infant death syndrome (SIDS) continues to be one of the main causes of infant mortality in the United States. The objective of this study was to analyse the association between diphtheria-tetanus-pertussis (DTP) immunisation and SIDS over time., Methods: The Centers for Disease Control and Prevention provided the number of cases of SIDS and live births per year (1968-2009), allowing the calculation of SIDS mortality rates. Immunisation coverage was based on (1) the United States Immunization Survey (1968-1985), (2) the National Health Interview Survey (1991-1993), and (3) the National Immunization Survey (1994-2009). We used sleep position data from the National Infant Sleep Position Survey. To determine the time points at which significant changes occurred and to estimate the annual percentage change in mortality rates, we performed joinpoint regression analyses. We fitted a Poisson regression model to determine the association between SIDS mortality rates and DTP immunisation coverage (1975-2009)., Results: SIDS mortality rates increased significantly from 1968 to 1971 (+27% annually), from 1971 to 1974 (+47%), and from 1974 to 1979 (+3%). They decreased from 1979 to 1991 (-1%) and from 1991 to 2001 (-8%). After 2001, mortality rates remained constant. DTP immunisation coverage was inversely associated with SIDS mortality rates. We observed an incidence rate ratio of 0.92 (95% confidence interval: 0.87 to 0.97) per 10% increase in DTP immunisation coverage after adjusting for infant sleep position., Conclusions: Increased DTP immunisation coverage is associated with decreased SIDS mortality. Current recommendations on timely DTP immunisation should be emphasised to prevent not only specific infectious diseases but also potentially SIDS.

Reports that rates of sudden infant death syndrome (SIDS) declined significantly among infants who were placed supine instead of in the prone position in sleep, according to a survey of 1,000 caregivers of infants. When the survey was conducted; Statistical information on SIDS in the United States.

Purpose: To perform external validation of a computer-assisted registration algorithm for prone and supine computed tomographic (CT) colonography and to compare the results with those of an existing centerline method., Materials and Methods: All contributing centers had institutional review board approval; participants provided informed consent. A validation sample of CT colonographic examinations of 51 patients with 68 polyps (6-55 mm) was selected from a publicly available, HIPAA compliant, anonymized archive. No patients were excluded because of poor preparation or inadequate distension. Corresponding prone and supine polyp coordinates were recorded, and endoluminal surfaces were registered automatically by using a computer algorithm. Two observers independently scored three-dimensional endoluminal polyp registration success. Results were compared with those obtained by using the normalized distance along the colonic centerline (NDACC) method. Pairwise Wilcoxon signed rank tests were used to compare gross registration error and McNemar tests were used to compare polyp conspicuity., Results: Registration was possible in all 51 patients, and 136 paired polyp coordinates were generated (68 polyps) to test the algorithm. Overall mean three-dimensional polyp registration error (mean ± standard deviation, 19.9 mm ± 20.4) was significantly less than that for the NDACC method (mean, 27.4 mm ± 15.1; P = .001). Accuracy was unaffected by colonic segment (P = .76) or luminal collapse (P = .066). During endoluminal review by two observers (272 matching tasks, 68 polyps, prone to supine and supine to prone coordinates), 223 (82%) polyp matches were visible (120° field of view) compared with just 129 (47%) when the NDACC method was used (P < .001). By using multiplanar visualization, 48 (70%) polyps were visible after scrolling ± 15 mm in any multiplanar axis compared with 16 (24%) for NDACC (P < .001)., Conclusion: Computer-assisted registration is more accurate than the NDACC method for mapping the endoluminal surface and matching the location of polyps in corresponding prone and supine CT colonographic acquisitions.

Objective: To compare the timing of hospital discharge, time to outpatient follow-up, and home care practices (breastfeeding initiation and continuation, tobacco smoke exposure, supine sleep position) for late-preterm (LPT; 34 0/7-36 6/7 weeks) and early-term (ET; 37 0/7-38/6/7 weeks) infants with term infants., Methods: We analyzed 2000-2008 data from the Centers for Disease Control and Prevention's Pregnancy Risk Assessment Monitoring System. χ(2) Analyses were used to measure differences in maternal and infant characteristics, hospital discharge, outpatient care, and home care among LPT, ET, and term infants. We calculated adjusted risk ratios for the risk of adverse care outcomes among LPT and ET infants compared with term infants., Results: In the adjusted analysis, LPT infants were less likely to be discharged early compared with term infants, whereas there was no difference for ET infants (risk ratio [RR; 95% confidence interval (CI)]: 0.65 [0.54-0.79]; 0.95 [0.88-1.02]). [corrected]. LPT and ET infants were more likely to have timely outpatient follow-up (1.07 [1.06-1.08]; 1.02 [1.02-1.03]), more likely to experience maternal tobacco smoke exposure (1.09 [1.05-1.14]; 1.08 [1.06-1.11]), less likely to be initially breastfed (0.95 [0.94-0.97]; 0.98 [0.97-0.98]), less likely to be breastfed for ≥10 weeks (0.88 [0.86-0.90]; 0.94 [0.93-0.96]), and less likely to be placed in a supine sleep position (0.95 [0.93-0.97]; 0.97 [0.96-0.98])., Conclusions: Given that LPT and ET infants bear an increased risk of morbidity and mortality, greater efforts are needed to ensure safe and healthy posthospitalization and home care practices for these vulnerable infants.

Unintentional suffocation is the leading cause of injury death among children aged <1 year in the United States, accounting for nearly 1,000 infant deaths annually. Since 1984, an estimated fourfold increase has been observed in accidental suffocation and strangulation in bed, with many of these deaths linked to unsafe sleep environments. Infant sleep positioners (ISPs) are devices intended to keep an infant in a specific position while sleeping, yet ISPs have been reported to have been present in the sleep environment in some cases of unintentional infant suffocation. Some specific ISPs have been cleared by the Food and Drug Administration (FDA) for the management of gastroesophageal reflux or plagiocephaly (asymmetry of the skull). However, many unapproved ISPs have been marketed to the general public with claims of preventing sudden infant death syndrome (SIDS), improving health, and enhancing sleep comfort. To characterize infant deaths associated with ISPs, FDA, the U.S. Consumer Product Safety Commission (CPSC), and CDC examined information reported to CPSC about 13 infant deaths in the past 13 years associated with the use of ISPs. In this case series, all infants but one were aged ≤3 months, and most were placed on their sides to sleep. Many were found prone (i.e., lying on their abdomens). Accompanying medical issues included prematurity and intercurrent respiratory illnesses. When providing guidance for parents of newborns, health-care providers need to emphasize the importance of placing infants to sleep on their backs in a safe sleep environment. This includes reminders about the American Academy of Pediatrics (AAP) recommendations against side sleep position, ISPs and pillows, comforters, and other soft bedding.