Grants awarded for 2017

$30,000 Grant to develop NHMRC Infant Safe Sleeping Guidelines

In 2017 the Governors of the Windermere Foundation agreed to support a project to develop a national evidence-based literature review and National Health and Medical Research Council guideline for Safe Infant Sleeping that will inform and guide both clinical care and parental behaviour.

The project was undertaken by:

Professor Rosemary Horne, Department of Paediatrics, Monash University
Professor Euan Wallace, Department of Obstetrics and Gynaecology, Monash University
Professor Christine East, School of Nursing and Midwifery, Monash University

Background information:

Safe infant sleeping campaigns, introduced in the early 1990′s, which publicised the risks of sleeping babies on their tummies (prone sleeping) and maternal smoking for contributing to Sudden Unexpected Death in Infancy (SUDI) have arguably been one of the most successful public health awareness campaigns. In Australia, between 1989 and 2014, almost 5,000 babies died suddenly and unexpectedly. Baby deaths attributed to SUDI have fallen by 80% and it is estimated that 9,000 babies’ lives have been saved as a direct result of Australian baby safe sleeping campaigns. However, despite this dramatic decline in incidence, SUDI still remains the major cause of unexpected death in infants in western countries contributing to almost half of all post-neonatal deaths. Despite these dramatic reductions in baby deaths – the numbers of babies dying suddenly and unexpectedly has remained constant f9r the last 10-15 years and new methods are now required to further reduce or even eliminate these unnecessary and often preventable deaths.

Although most parents and health professionals are aware of the risks of sleeping infants on their tummies, there are now emerging risks where advice is not clear. This is because currently advice differs between Australian states and territories and there is no nationally agreed guideline. This has led to variations in clinical care and confused, and confusing, messages being provided to new parents. The major area of concern is that of co-sleeping or bed-sharing. This is important because parent-infant bed sharing is common, with nearly half of parents reporting bed-sharing with their infant occasionally and 10% routinely. Studies from a number of countries show that more than half of all SUDI deaths occur whilst the infant is bed-sharing. While initial studies identified that the risk of SUDI was greatest for infants who bed-share with parents who smoked, it has now become apparent that the risk of SUDI is also increased in young infants under 3 months of age even if neither parent is a smoker. Despite calls from State Coroners for consistent advice to parents – this is still an area where advice is inconsistent and is not based on the latest scientific evidence.

Another area of concern is the increasing number of deaths in the postnatal period – frequently infants are placed prone on the parent’s chest soon after birth or are left to sleep with mothers to encourage breast feeding. There has been an alarming increase in babies dying on the postnatal ward in these situations. Likewise the old age practice of wrapping or swaddling may increase the risk of SUDI – there are a growing number of products on the market in which to wrap babies and the vast majority have no instruction for their use and importantly for when to stop using them once babies can roll. Being wrapped in the prone position is a death knell and increasing numbers of babies are dying in this situation as parents are unaware of these risks. In contrast, there is now growing evidence that giving babies a dummy is protective against SUDI, but this is not widely recommended in Australia.

Clear and concise guidelines are important as research has demonstrated that hospital and community midwives and maternal and child health nurses play pivotal roles in discussing and checking safe sleepinq arranqements for infants with families.