Aris Christine, Stevens Timothy P, Lemura Catherine, Lipke Bethann, McMullen Sherri, Côté-Arsenault Denise, Consenstein Larry
St. Joseph's Hospital Health Center, Syracuse, NY 13203, USA.
Adv Neonatal Care. 2006 Oct;6(5):281-94. doi: 10.1016/j.adnc.2006.06.009.
Infants requiring neonatal intensive care are often placed prone during their acute illness. After hospital discharge the American Academy of Pediatrics (AAP) recommends supine sleep position to reduce the risk of Sudden Infant Death Syndrome (SIDS). Little is known about nursing knowledge and practice regarding best sleep positions for infants as they transition from neonatal intensive care to home.
To explore and describe neonatal intensive care unit (NICU) nurses' knowledge and practice in the NICU, and to determine the content of parent instruction regarding infant sleep position at discharge.
This survey was conducted in 2 phases. In Phase I, a questionnaire was designed and completed by 157 neonatal nurses currently practicing in Level III and IV NICUs in the state of New York. After content analysis of responses and item revisions, a panel of experts reviewed questionnaire items. Phase II involved completion of the final questionnaire by 95 NICU nurses in 4 additional hospitals. The combined results of Phase I and II are reported.
Of 514 questionnaires distributed, 252 (49%) were completed and analyzed. During NICU hospitalization, nurse respondents identified prone position as the best general sleep position for preterm infants (65%) followed by either prone or side-lying (12%). The nurses' assessment of the infants' readiness for supine sleep position at the time of NICU discharge varied. Most nurses responded that preterm infants were ready to sleep supine anytime (29%), close to discharge (13%), when maintaining their body temperature in an open crib (25%), between 34 to 36 weeks postmenstrual age (PMA) (15%), after 37 weeks PMA (13%), and when the infant's respiratory status was stable (6%). Typical sleep positions chosen for full-term infants in the NICU were supine (40%), side or supine (30%), all positions (18%), side (8%), prone or side (3%), and prone (1%). Frequently cited reasons to place full-term infants to sleep prone were: reflux (45%), upper airway anomalies (40%), respiratory distress (29%), inconsolability (29%), and to promote development (17%). At NICU discharge, 52% of nurses instructed parents to place their infants in the supine position for sleep. The most common nonsupine sleep positions recommended by nurses at discharge were either supine or side (38%), and exclusive side positioning (9%).
Nearly 95% of respondents identified a nonsupine sleep position as optimal for hospitalized preterm infants. Further, only 52% of neonatal nurses routinely provide discharge instructions that promote supine sleep positions at home. This study suggests that nursing self-reports of discharge teaching practices are inconsistent, and in some cases in direct conflict with the national "Back to Sleep" recommendations, which emphasize that the supine position is the safest position for healthy full-term and preterm infants after hospital discharge.
需要新生儿重症监护的婴儿在急性疾病期间通常采取俯卧位。出院后，美国儿科学会（AAP）建议采用仰卧睡眠姿势以降低婴儿猝死综合征（SIDS）的风险。对于婴儿从新生儿重症监护过渡到家庭后的最佳睡眠姿势，护理知识和实践方面了解甚少。
探讨并描述新生儿重症监护病房（NICU）护士在NICU中的知识和实践，并确定出院时关于婴儿睡眠姿势的家长指导内容。
本调查分两个阶段进行。在第一阶段，设计了一份问卷，由纽约州三级和四级NICU中目前执业的157名新生儿护士填写。在对回复进行内容分析和项目修订后，由一组专家对问卷项目进行审查。第二阶段涉及另外4家医院的95名NICU护士完成最终问卷。报告了第一阶段和第二阶段的综合结果。
在分发的514份问卷中，252份（49%）被填写并分析。在NICU住院期间，参与调查的护士认为俯卧位是早产儿最佳的一般睡眠姿势（65%），其次是俯卧或侧卧位（12%）。护士对NICU出院时婴儿准备好仰卧睡眠姿势的评估各不相同。大多数护士回答说，早产儿随时准备仰卧睡眠（29%），接近出院时（13%），在开放式婴儿床中能保持体温时（25%），孕龄（PMA）34至36周之间（15%），PMA 37周后（13%），以及婴儿呼吸状况稳定时（6%）。NICU中足月儿选择的典型睡眠姿势是仰卧（40%）、侧卧或仰卧（30%）、所有姿势（18%）、侧卧（8%）、俯卧或侧卧（3%）以及俯卧（1%）。将足月儿放置为俯卧睡眠的常见原因有：反流（45%）、上呼吸道异常（40%）、呼吸窘迫（29%）、无法安抚（29%）以及促进发育（17%）。在NICU出院时，52%的护士指导家长让婴儿仰卧睡眠。护士在出院时推荐的最常见非仰卧睡眠姿势是仰卧或侧卧（38%），以及单纯侧卧位（9%）。
近95%的受访者认为非仰卧睡眠姿势对住院早产儿是最佳的。此外，只有52%的新生儿护士常规提供促进在家中仰卧睡眠姿势的出院指导。这项研究表明，护理人员关于出院教学实践的自我报告不一致，在某些情况下与国家“仰睡”建议直接冲突，该建议强调仰卧位是健康足月儿和早产儿出院后最安全的姿势。
