Study sheds light on 'newborn falls'

Recent research that has received national attention had its origins in a Vermont hospital where a maternity nurse worked prior to enrolling in an Indiana State University graduate program.

Tara Matteson Heglund, a 2013 graduate of Indiana State's master's degree program in nursing, was shocked and saddened to learn that, during a 2½-year period, five newborns had fallen to the floor at Fletcher Allen Health Care in Burlington. At least one infant who had fallen suffered multiple skull fractures.

"This prompted me to start wondering what was going on," said Heglund, now a nurse educator for the University of Pittsburgh Medical Center and adjunct instructor at Indiana State. "It was the first time I had ever heard about this happening."

A review of hospital records showed that five newborns had fallen from their parents' arms while in bed in 2½-years, a period in which the hospital recorded about 5,000 births.

"It was a high-risk, low-volume situation but something we really needed to look into," she said.

The hospital eliminated such incidents after expanding parental education around safe-sleep practices.

"We made sure that if the parent was tired, or taking medication that could make them tired, that the baby went into their own safe sleep space," Heglund said. "We previously allowed parents to hold babies skin-to-skin while sleeping, because it's really good for breast feeding or bonding. But this could turn into a potentially harmful situation. If we found the mom going to sleep, we had to put the baby back into its own bassinet or separate sleep space."

When Heglund enrolled at Indiana State to become a nurse educator, she was required to develop an evidence-based manuscript. She recalled finding only one published report on the topic of "newborn falls" at the time of the Vermont incidents and set out with Jessica Nelson, then assistant professor of advanced practice nursing, to determine just how widespread the problem was.

"What we found was that there (still) wasn't a whole lot on it," said Nelson, noting that only three articles were published and one article was from a 1948 issue of the journal Pediatrics. "So, it's a problem now; it was a problem way back in 1948, but there wasn't a lot of research because no one wants to talk about it, either in the hospital setting or in home," she said.

The limited available data suggest up to 1,600 such incidents occur annually nationwide, but the actual number is likely much higher, said Nelson, now assistant professor and chair of the baccalaureate nursing completion department.

"It doesn't just happen within hospital settings. I think it's happening more often at home, too," she said.

Injuries from falls could be as minor as a scrape or as serious as death, Nelson said.

"If the infant is dropped, parents often do not want to tell anybody, and then the infant is not given an assessment to determine what damage may have occurred," she said. "Closed-head injuries are traumatic, especially in an infant because they are so fragile. If parents are not reporting those falls, the children are going to have a lot of effects that you will not see until later when they become too great."

Educating new parents and hospital staff is important. If a fall happens, there needs to be action taken on what can be done better and follow up steps on how to prevent falls in the future, Nelson said.

"There are longitudinal studies that could be done following parents and children after a fall. What kind of effects did it have on their parenting skills and their confidence?" she said. "I just had a baby. The recommendations we gave here are always in the back of my mind. You don't realize how things can happen so quickly. You're tired, overwhelmed and often on medication. Some people have additional children in the home. Sometimes as new parents we think we can do everything."

MCN: The American Journal of Maternal/Child Nursing recently published an eight-page paper by Heglund, Audrey Henderson-Williams, GR '12, clinical coordinator at DeKalb Medical Center in Georgia, and Nelson said that was recognized by the National Institutes of Health as a "premier article."

It was Heglund's first published research, Nelson noted.

"For a master's student, that's pretty impressive, because she wasn't working on a large thesis," she noted. "This article shed light on a problem and now has the potential to impact future practice within a variety of settings.

"We hope the national attention our research has received will prompt hospitals across the country to examine this little reported, but serious problem, and take steps to address it," Heglund said.