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Newborn falls in hospitals, while rare, may increase with rooming-in

(Reuters Health) – Hospital efforts to support breastfeeding by having babies “room-in” with mothers may have a rare unintended consequence: an increased risk of newborn falls.

Neonatal falls are increasingly recognized as a postpartum safety risk, with as many as 1,600 newborn falls occurring in U.S. hospitals each year, researchers note in Pediatrics. While this represents a miniscule fraction of all births, doctors are increasingly concerned that at least some of these falls may be resulting from new mothers falling asleep while breastfeeding babies in their hospital beds.

To assess the potential for breastfeeding programs to influence the risk of newborn falls, researchers looked at three cases that happened after one hospital initiated several changes designed to support breastfeeding and mother-baby bonding.

“To encourage successful breastfeeding, it is important to keep mothers and babies together in one room, as much as possible,” said lead study author Dr. Colleen Hughes Driscoll of the University of Maryland School of Medicine in Baltimore.

“This practice is somewhat different from earlier decades when babies spent a significant part of the postpartum hospitalization in the nursery, away from their mother,” Driscoll said by email. “Though this separation was likely a barrier to successful breastfeeding, it may have provided additional opportunities for mothers to rest and recover.”

The researchers examined data on newborn falls recorded in medical records from January 2011 to February 2018. They also looked at data on breastfeeding from medical records and from patient surveys done starting in 2015 as part of a new effort to support breastfeeding and rooming-in at the hospital.

Three falls occurred within one year of starting a range of breastfeeding supports the hospital needed to implement in order to be designated as a “baby friendly hospital.” Qualifying as Baby-Friendly, under the joint WHO and UNICEF program that created the designation, requires policies that include educating families to make informed decisions about infant feeding, encouraging mothers to hold babies skin-to-skin right after birth, allowing rooming-in and offering lactation support.

“We found that as we improved our ability to support mothers with successful breastfeeding there was a surge in newborn falls,” Driscoll said. “This suggests that we may be adding to the burden of maternal fatigue, and increasing the risk of newborn falls.”

Not all of the falls exclusively involved breastfeeding, however. Maternal exhaustion did appear to play a role in all three cases.

In one instance, a mother fell asleep while breastfeeding and woke up to discover the baby crying on the hospital floor. The infant had a skull fracture but was sent home that evening, only to arrive at the emergency room at age 7 weeks with seizures.

Another case involved a baby that was initially breastfed, but switched to formula. This baby’s mother fell asleep while burping the infant after a bottle; the baby later fell to the floor when cries startled the mother awake. This baby had cuts and a bump on its head, but no fracture.

With the final case, a mother fell asleep while breastfeeding and the baby fell, landing unharmed on a pillow on the floor.

While these cases should serve as a reminder that hospitals and new parents need to take precautions to prevent falls, they shouldn’t discourage breastfeeding or rooming-in, said Dr. Michael Goodstein of WellSpan Health in York, Pennsylvania.

“Mothers should notify staff if they are feeling drowsy, so they don’t fall asleep while caring for the baby,” Goodstein, who wasn’t involved in the study, said by email. “Mothers should also make use of their support people (in hospital and at home) if they are concerned that they may fall asleep while breastfeeding in bed.”

“At home it is preferred that night breastfeeding occur in the bed, with hazardous materials (pillows, comforters, loose sheets) kept away from the infant,” Goodstein added. “Mothers should never feed the baby on a couch – this is the most dangerous place for a baby, with risk of SIDS or suffocation increasing up to 70 times.”

SOURCE: Pediatrics, online December 28, 2018.

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