PREVALENCE AND PREDICTORS OF THE PRONE SLEEP POSITION AMONG INNER-CITY INFANTS

Context.-The prone sleep position is associated with an increased risk of sudden infant death syndrome (SIDS), but few studies have assessed factors associated with the choice of infant sleep position. Objectiv es.-To describe infant sleep position in a cohort of infants born to p redominantly low-income, inner-city mothers and to identify predictors of the prone sleep position in this population. Design.-Prospective b irth cohort study. Patients and Setting.-Three hundred ninety-four mot her-infant dyads, systematically selected from 3 District of Columbia hospitals between August 1995 and September 1996, Mothers were intervi ewed shortly after delivery and again at 3 to 7 months postpartum. Mai n Outcome Measures.-Position in which infants were placed for sleep on the night prior to the 3- to 7-month interview. Results.-At 3 to 7 mo nths of age, 157 infants (40%) were placed for sleep in the prone posi tion. Independent predictors of prone sleep position included poverty (odds ratio [OR], 1.81; 95% confidence interval [CI], 1.10-2.99), blac k race (OR, 2.06; 95% CI, 1.05-4.04), presence of infant's grandmother in the home (OR, 1.83; 95% CI, 1.11-3.00), and intent, as measured sh ortly after delivery, to place the infant in the prone position (OR, 2 .28; 95% CI, 1.44-3.60), Importantly, of the 43 mothers who observed t heir infants in the prone sleep position while in the hospital, 40 (93 %) intended to place their infants prone at home. Conclusions.-A subst antial proportion of infants in this predominantly low-income populati on were placed in the prone sleep position. Educational efforts should address both initial intentions and reinforcement of the correct slee p position, once initiated. Hospitals should ensure that healthy newbo rn infants are placed in the supine sleep position during the postpart um hospital stay.