Improving infant sleep safety via electronic health record communication: a randomized controlled trial

Abstract

Background With increased use of telehealth, interventions to improve infant sleep environments have not been explored. This study sought to assess the feasibility and efficacy of using electronic health record patient portals to transmit photographs of infant sleep between mothers and healthcare professionals as part of an intervention to promote sleep environments consistent with AAP guidelines. Methods One hundred eighty-four mother-newborn dyads consented to participate in a randomized trial requiring patient portal registration within 1 month of delivery. We first assessed feasibility as measured by a) the proportion of consented mothers enrolling in the portal and b) maternal adherence to prompts to submit photographs of their infant sleeping to the research team through the patient portal. Intervention group mothers were prompted at 1 and 2 months; controls were prompted only at 2 months. Efficacy was determined via research assistant review of submitted photographs. These assistants were trained to detect sudden unexplained infant death risk factors utilizing AAP guidelines. Standardized feedback was returned to mothers through the patient portal. We used Fisher’s Exact test to assess group differences in guideline adherence at 2 months. Results One hundred nine mothers (59%) enrolled in the patient portal and were randomized to intervention (N = 55) and control (N = 54) groups. 21 (38, 95% CI 25–52%) intervention group participants sent photographs at 1 month and received personalized feedback. Across both groups at 2 months, 40 (37, 95% CI 28–46%) sent photographs; 56% of intervention group participants who submitted photographs met all safe sleep criteria compared with 46% of controls (difference 0.10, 95% CI − 0.26 to 0.46, p = .75). Common reasons for guideline non-adherence were sleeping in a room without a caregiver (43%), loose bedding (15%) and objects (8%) on the sleep surface. Conclusions Utilizing the patient portal to individualize safe infant sleep is possible, however, we encountered numerous barriers in this trial to assess its effects on promoting safe infant sleep. Photographs of infants sleeping showed substantial non-adherence to AAP guidelines, suggesting further needs for improvement to promote safe infant sleep practices. Trial registration Name: Improving Infant Sleep Safety With the Electronic Health Record; Clinicaltrials.gov: NCT03662048; Date of Registration: September 7, 2018; Data Sharing Statement: None

Atmung und Schlafregulation beim Neugeborenen

“…Historische Thesen, dass zentrale Apnoen und vermehrte periodische Atemmuster als Prädilektionsfaktoren für SIDS anzusehen sind, haben sich nicht bestätigt [14] [17]. Der Effekt telemedizinischer Beratungen zur Verbesserung der Schlafsituation im frühen Säuglingsalter ist nicht gesichert [18]. Die Auswertung von Konversationen in den sozialen Medien (Facebook) zeigte in Bezug auf SUDI, dass Fachinformationen einfach und klar kommuniziert werden müssen und auf folgende Aspekte zielen sollten [19] [31,32,33].…”

Digital health intervention on patient safety for children and parents: A scoping review

“…Several studies focussed on patient safety education in the home setting. These interventions included educating parents on the safe positioning and placement of infants (Cooray et al, 2021), managing the infant sleep environment at home (Canty et al, 2020), and educating parents on various safety measures to prevent falls, poisoning, drowning, burn injuries, sudden infant death syndrome, attention-deficit hyperactivity disorder, and influenza vaccination (Christakis et al, 2006;van Beelen et al, 2013van Beelen et al, , 2014. In addition, interventions aimed at educating parents to prevent injuries included using safety seats, proper poison storage, and home safety equipment (Gittelman et al, 2014;McDonald et al, 2005;Shields et al, 2013).…”

“…Patient safety education in the home setting was characterized by the provision of tailored messages or notifications based on the parents' knowledge levels. Another study implemented an interactive education system where mothers and healthcare providers collaborated to share feedback on the transition process (Canty et al, 2020). In contrast to most interventions in the selected studies that emphasized patient safety education, one study adopted a preventive approach using a checklist to systematically address errors in the surgical process in hospitals (Elger et al, 2020).…”

“…Additionally, participation was used as an outcome variable in studies on child safety. This referred to whether parents or caregivers engaged in specific preventive activities or followed professional advice related to their children's safety (Bardach et al, 2022;Canty et al, 2020;Christakis et al, 2006).…”

Correction to: Improving infant sleep safety via electronic health record communication: a randomized controlled trial

“…Following the publication of the original article [ 1 ], authors spotted mistake in the Funding section. The funding source captured was the Ashley K. Shellenberger SIDS Research Fun, when it should have been the Ashley Nicole Shellenberger SIDS Research Fund.…”