Randomised trial of infant sleep location on the postnatal ward

Ball, H. I.; Ward-platt, M. P.; Heslop, E.; Leech, S. J.; Brown, K. A.
December 2006
Archives of Disease in Childhood;Dec2006, Vol. 91 Issue 12, p1005
Academic Journal
Objective: To determine whether postnatal mother-infant sleep proximity affects breastfeeding initiation and infant safety. Design: Randomised non-blinded trial analysed by intention to treat. Setting: Postnatal wards of the Royal Victoria Hospital (RVI), Newcastle upon Tyne, UK. Participants: 64 newly delivered mother-infant dyads with a prenatal intention to breastfeed (vaginal deliveries, no intramuscular or intravenous opiate analgesics taken in the preceding 24 h). Intervention: Infants were randomly allocated to one of three sleep conditions: baby in mother's bed with cot-side; baby in side-car crib attached to mother's bed; and baby in stand-alone cot adjacent to mother's bed. Main outcome measures: Breastfeeding frequency and infant safety observed via night-time video recordings. Results: During standardised 4-h observation periods, bed and side-car crib infants breastfed more frequently than stand-alone cot infants (mean difference (95% confidence interval (CI)): bed v stand-alone cot = 2.56 (0.72 to 4.41); side-car crib v stand-alone cot= 2.52 (0.87 to 4.17); bed v side-car crib = 0.04 (-2.10 to 2.18)). No infant experienced adverse events; however, bed infants were more frequently considered to be in potentially adverse situations (mean difference (95% CI): bed v stand-alone cot = 0.13 (0.03 to 0.23); side-car crib v stand-alone cot = 0.04 (-0.03 to 0.12); bed v side-car crib =0.09 (-0.03–0.21)). No differences were observed in duration of maternal or infant sleep, frequency or duration of assistance provided by staff, or maternal rating of postnatal satisfaction. Conclusion: Suckling frequency in the early postpartum period is a well-known predictor of successful breastfeeding initiation. Newborn babies sleeping in close proximity to their mothers (bedding-in) facilitates frequent feeding in comparison with rooming-in. None of the three sleep conditions was associated with adverse events, although infrequent, potential risks may have occurred in the bed group. Side-car cribs are effective in enhancing breastfeeding initiation and preserving infant safety in the postnatal ward.


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