Background:
According to the Joint Commission, every year approximately 600-1600 newborn falls occur in hospitals in the United States. Newborn falls can be defined as falls that occur in newborn from birth to one month. Several factors influence the rate of newborn falls in hospitals. With the emphasis on exclusive breast feeding tired mothers were reported to have slept while feeding the baby causing the newborns to fall from their arms. The outcome of newborn falls vary and quality improvement measures should be in place to address this major health risk, in this most vulnerable population, at a time when the parents are exhausted. Newborn falls is an under-researched area of infant care; therefore, data are minimal. Several hospitals have initiated quality improvement programs to identify and manage the factors that contribute to the fall of newborns.
The actual number of newborn falls may be higher as most newborns leave the hospital by 2-3 days of age. Newborn falls that occur outside the hospitals may not get reported unless serious injury occurs. Though this is an important concern, falls that occur at home is not included in this review, to minimize discussions on potential abuse and neglect.
Methods
An integrated review of literature was conducted in CINAHL, PsychInfo, and PubMed using search terms ‘newborn’, ‘falls’, and ‘hospital’ and limited the query for years 2012-2017 to yield 248 articles. Duplicates and irrelevant ones were removed to yield 18 full text articles. These articles were explored for factors that contribute to the fall, consequences of the fall, injury to the newborn and measures to prevent future newborn falls.
Results
The majority of the falls tend to occur at the early morning hours - between 1AM and 7AM, during the first week. Potential factors include sleepy mother, recent pain medication, sick mothers, careless parents, post caesarian section status, younger mother, substance use resulting in withdrawal, accidental fall form crib, or ‘dragged down’ by a jealous sibling. Newborn falls also occur while transferring a newborn to another person or to a crib. Injuries reported include bruises, fractures, head injury, or burns. Consequences noted in literature include legal allegation of abuse by parents, parental guilt, parental suicide, and punishment of the sibling. Parental guilt may result in underreporting unless a serious injury occurs. Though small in incidence, this is becoming a mandatory reporting incident in hospitals across the US.
Implications for practice
Nurses can prevent the incidence of newborn falls to a great extent. Measures to prevent falls may include: family support, particularly for first time mothers; safety protocol; hourly rounding; breast feeding support; increasing nurse patient ratio; safer design of hospital equipment (bed with a different type of rails and lower bassinet); close monitoring; raising awareness; maternal blood sugar check; extra personnel for breast feeding supervision during high-risk hours; infant safety signage and recruitment of interdisciplinary team to discuss the risk. Nurses also must support the parents after the newborn falls happen, to reduce emotional trauma that occurred, while examining the newborn for any impact of the fall. Quality improvement initiatives in hospitals will provide evidence for an appropriate measure to address these concerns. A national database and mandatory reporting, even if there is no injury, will help to identify the extent of the problem. It is essential to support family bonding while eliminating falls in newborns.