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| [PMID]: | 28742913 |
| [Au] Autor: | Moon RY; Hauck FR; Colson ER; Kellams AL; Geller NL; Heeren T; Kerr SM; Drake EE; Tanabe K; McClain M; Corwin MJ |
| [Ad] Endereço: | Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville. |
| [Ti] Título: | The Effect of Nursing Quality Improvement and Mobile Health Interventions on Infant Sleep Practices: A Randomized Clinical Trial. |
| [So] Source: | JAMA;318(4):351-359, 2017 07 25. | | [Is] ISSN: | 1538-3598 |
| [Cp] País de publicação: | United States |
| [La] Idioma: | eng |
| [Ab] Resumo: | Importance: Inadequate adherence to recommendations known to reduce the risk of sudden unexpected infant death has contributed to a slowing in the decline of these deaths. Objective: To assess the effectiveness of 2 interventions separately and combined to promote infant safe sleep practices compared with control interventions. Design, Setting, and Participants: Four-group cluster randomized clinical trial of mothers of healthy term newborns who were recruited between March 2015 and May 2016 at 16 US hospitals with more than 100 births annually. Data collection ended in October 2016. Interventions: All participants were beneficiaries of a nursing quality improvement campaign in infant safe sleep practices (intervention) or breastfeeding (control), and then received a 60-day mobile health program, in which mothers received frequent emails or text messages containing short videos with educational content about infant safe sleep practices (intervention) or breastfeeding (control) and queries about infant care practices. Main Outcomes and Measures: The primary outcome was maternal self-reported adherence to 4 infant safe sleep practices of sleep position (supine), sleep location (room sharing without bed sharing), soft bedding use (none), and pacifier use (any); data were collected by maternal survey when the infant was aged 60 to 240 days. Results: Of the 1600 mothers who were randomized to 1 of 4 groups (400 per group), 1263 completed the survey (78.9%). The mean (SD) maternal age was 28.1 years (5.8 years) and 32.8% of respondents were non-Hispanic white, 32.3% Hispanic, 27.2% non-Hispanic black, and 7.7% other race/ethnicity. The mean (SD) infant age was 11.2 weeks (4.4 weeks) and 51.2% were female. In the adjusted analyses, mothers receiving the safe sleep mobile health intervention had higher prevalence of placing their infants supine compared with mothers receiving the control mobile health intervention (89.1% vs 80.2%, respectively; adjusted risk difference, 8.9% [95% CI, 5.3%-11.7%]), room sharing without bed sharing (82.8% vs 70.4%; adjusted risk difference, 12.4% [95% CI, 9.3%-15.1%]), no soft bedding use (79.4% vs 67.6%; adjusted risk difference, 11.8% [95% CI, 8.1%-15.2%]), and any pacifier use (68.5% vs 59.8%; adjusted risk difference, 8.7% [95% CI, 3.9%-13.1%]). The independent effect of the nursing quality improvement intervention was not significant for all outcomes. Interactions between the 2 interventions were only significant for the supine sleep position. Conclusions and Relevance: Among mothers of healthy term newborns, a mobile health intervention, but not a nursing quality improvement intervention, improved adherence to infant safe sleep practices compared with control interventions. Whether widespread implementation is feasible or if it reduces sudden and unexpected infant death rates remains to be studied. Trial Registration: clinicaltrials.gov Identifier: NCT01713868. |
| [Mh] Termos MeSH primário: |
Cuidado do Lactente/métodos
Cuidados de Enfermagem/normas
Melhoria de Qualidade
Sono
Telemedicina
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| [Mh] Termos MeSH secundário: |
Adulto
Atitude Frente à Saúde
Roupas de Cama, Mesa e Banho
Aleitamento Materno
Feminino
Seres Humanos
Recém-Nascido
Masculino
Mães
Morte Súbita do Lactente/prevenção & controle
Decúbito Dorsal
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| [Pt] Tipo de publicação: | JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL |
| [Em] Mês de entrada: | 1707 |
| [Cu] Atualização por classe: | 180124 |
[Lr] Data última revisão:
| 180124 |
| [Sb] Subgrupo de revista: | AIM; IM |
| [Da] Data de entrada para processamento: | 170726 |
| [Cl] Clinical Trial: | ClinicalTrial
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| [St] Status: | MEDLINE |
| [do] DOI: | 10.1001/jama.2017.8982 |
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