Transition to a Safe Home Sleep Environment for the NICU Patient

Pediatrics. 2021 Jul;148(1):e2021052046. doi: 10.1542/peds.2021-052046. Epub 2021 Jun 21.


Of the nearly 3.8 million infants born in the United States in 2018, 8.3% had low birth weight (<2500 g [5.5 lb]) and 10% were born preterm (gestational age of <37 completed weeks). Many of these infants and others with congenital anomalies, perinatally acquired infections, and other disease require admission to a NICU. In the past decade, admission rates to NICUs have been increasing; it is estimated that between 10% and 15% of infants will spend time in a NICU, representing approximately 500 000 neonates annually. Approximately 3600 infants die annually in the United States from sleep-related deaths, including sudden infant death syndrome International Classification of Diseases, 10th Revision (R95), ill-defined deaths (R99), and accidental suffocation and strangulation in bed (W75). Preterm and low birth weight infants are particularly vulnerable, with an incidence of death 2 to 3 times greater than healthy term infants. Thus, it is important for health care professionals to prepare families to maintain their infant in a safe sleep environment, as per the recommendations of the American Academy of Pediatrics. However, infants in the NICU setting commonly require care that is inconsistent with infant sleep safety recommendations. The conflicting needs of the NICU infant with the necessity to provide a safe sleep environment before hospital discharge can create confusion for providers and distress for families. This technical report is intended to assist in the establishment of appropriate NICU protocols to achieve a consistent approach to transitioning NICU infants to a safe sleep environment as soon as medically possible, well before hospital discharge.

MeSH terms

  • Body Temperature Regulation
  • Breast Feeding
  • Clinical Protocols*
  • Critical Care
  • Humans
  • Infant, Low Birth Weight*
  • Infant, Newborn
  • Infant, Newborn, Diseases / therapy
  • Infant, Premature*
  • Intensive Care Units, Neonatal / organization & administration*
  • Kangaroo-Mother Care Method
  • Patient Discharge*
  • Prone Position
  • Risk Assessment
  • Sleep*
  • Sudden Infant Death / etiology
  • Sudden Infant Death / prevention & control*
  • Supine Position