McIntosh Christine, Trenholme Adrian, Stewart Joanna, Vogel Alison
Primary Health and Community Services, Counties Manukau Health, Auckland, New Zealand.
Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand.
J Paediatr Child Health. 2018 Apr;54(4):377-382. doi: 10.1111/jpc.13772. Epub 2017 Nov 10.
Sudden unexpected death in infancy (SUDI) rates for Māori and Pacific infants remain higher than for other ethnic groups in New Zealand and bed-sharing is a major risk factor when there is smoking exposure in pregnancy. Sleep space programmes of education and Pēpi-Pod baby beds require evaluation.
Two hundred and forty Māori and Pacific women and infants were randomised 1:1, to the Pēpi-Pod sleep space programme, or to a control group with 'usual care'. When infants were under 2 weeks of age, baseline interviews occurred, followed up by interviews at 2 and 4 months of age to assess safe sleep knowledge, infant care practices and Pēpi-Pod use and acceptability. All participants were offered a New Zealand Standard approved portable cot.
At baseline, 25% of babies did not have a baby bed. Knowledge of smoking and bed-sharing as SUDI risks improved at follow-up in both groups. One quarter regularly bed-shared at follow-up in both groups. Intention to bed-share was a strong predictor of subsequent behaviour. Pēpi-Pods were regularly used by 46% at 2 months and 16% at 4 months follow-up.
Bed-sharing and knowledge improvement were similar irrespective of group. It is likely that the impact of the intervention was reduced because the control group received better support than 'usual care' and all participants had a baby bed. New Zealand SUDI rates have declined since sleep space programmes have been available. Sleep space programmes should be prioritised for those with modifiable SUDI risk.
新西兰毛利族和太平洋岛族婴儿的婴儿猝死综合征(SUDI)发生率仍高于其他族裔群体,孕期吸烟时同床睡眠是一个主要风险因素。教育睡眠空间项目和佩皮婴儿床需要进行评估。
240名毛利族和太平洋岛族妇女及婴儿按1:1随机分组,分别接受佩皮睡眠空间项目或“常规护理”对照组。婴儿2周龄以下时进行基线访谈,随后在2个月和4个月龄时进行访谈,以评估安全睡眠知识、婴儿护理习惯以及佩皮床的使用情况和可接受性。所有参与者都获得了一张新西兰标准认可的便携式婴儿床。
基线时,25%的婴儿没有婴儿床。两组随访时关于吸烟和同床睡眠作为SUDI风险的知识都有所改善。两组随访时均有四分之一的人经常同床睡眠。同床睡眠的意愿是后续行为的一个有力预测指标。随访2个月时,46%的人经常使用佩皮床,4个月时为16%。
无论组别如何,同床睡眠情况和知识改善情况相似。干预措施的影响可能有所降低,因为对照组得到了比“常规护理 ”更好的支持,且所有参与者都有一张婴儿床。自睡眠空间项目推出以来,新西兰的SUDI发生率有所下降。对于有可改变的SUDI风险的人群,应优先开展睡眠空间项目。