1. Bagwell, Gail A. DNP, APRN, CNS

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The infant mortality rate in the United States is one of the highest in the world for industrialized nations. The US rate of 5.8/1000 live births ranks us 55 out of 224 nations.1 This is a concern as infant mortality is used as a marker for a nation's health. In the United States, sudden unexpected infant death (SUID) is the number 1 cause of deaths for infants from 1 month to 1 year of age.2


Since 1992, the American Academy of Pediatrics (AAP) in an effort to prevent SUIDs has published recommendations every 5 years for infant safe sleep, with the most recent being in 2016.3 The guideline unfortunately applies mostly to the home setting with the exception of healthcare providers endorsing and modeling safe sleep.


Realizing that there are no guidelines on how to implement safe sleep practices in the hospital setting, the National Association of Neonatal Nurses (NANN) has developed and published a Safe Sleep Guideline for use by healthcare providers to assist them in the implementation of safe sleep for all hospitalized infants regardless of location. The guidelines are evidence based and all recommendations are graded for the level of evidence using the hierarchy of evidence as described by Melynk and Fineout-Overholt.4


The guideline gives an overview of the history of safe sleep and sleep-related deaths, the controversies related to infant safe sleep recommendations, barriers to implementing safe sleep in the hospital, and recommendations on how to implement safe sleep recommendations in the hospital. Recommendations are divided into the following categories of general recommendations, parent and caregiver education, modeling safe sleep behaviors, implementing the AAP recommendations in the postpartum and well-baby nursery, the special care and intensive care nurseries, the pediatric intensive care units, and general pediatric units. The guideline also lists resources for healthcare providers as well as for parents.5


NANN's hope is that the guideline will become a valuable resource for healthcare providers and hospitals in implementing safe sleep practices. The guideline is currently available in the NANN bookstore and is available at




1. Central Intelligence Agency. World fact book. Accessed January 15, 2020. [Context Link]


2. Centers for Disease Control and Prevention. Infant mortality. Accessed January 15, 2020. [Context Link]


3. American Academy of Pediatrics Taskforce on Sudden Infant Death Syndrome. SIDS and other sleep-related deaths: updated 2016 recommendations for a safe infant sleeping environment. Pediatrics. 2016;138(5):e20162938. doi:10.1542/peds.2016.2938. [Context Link]


4. Melynk BM, Fineout-Overholt E. Evidence-Based Practice in Nursing and Healthcare. Philadelphia, PA. Wolters Kluwer Health; 2015. [Context Link]


5. National Association of Neonatal Nurses. Guideline Newborn Safe Sleep. Chicago, IL. National Association of Neonatal Nurses; 2019. [Context Link]