An Acute Event in a Newborn

Abstract

Please view the video of a newborn with an acute event. The most likely diagnosis for the infant in this video is a(n): 1. Sudden unexpected postnatal collapse 2. Brief resolved unexplained event 3. Ductal-dependent congenital heart lesion 4. Severe combined immune deficiency 5. Inborn error of metabolism ### Case The 3-kg female infant described in this case was born at 39 weeks’ gestation to a 31-year-old gravida 2, para 2 woman via spontaneous vaginal delivery. Prenatal maternal laboratory testing revealed blood type A positive with unremarkable serologic findings. Rupture of membranes occurred 7 hours before delivery and the amniotic fluid was clear. The infant emerged active and had an Apgar score of 9 at 1 and 5 minutes after birth. The infant was then placed skin to skin with her mother. Subsequently, the infant was breastfed and fell asleep in her mother’s arms. Within 2 hours, the nurse found the infant to be limp and cyanotic. A full resuscitation was initiated with positive pressure ventilation and chest compressions, and the infant underwent intubation. An umbilical venous catheter was placed and 2 doses of epinephrine were administered. However, after 20 minutes of cardiopulmonary resuscitation, the infant remained asystolic so resuscitative efforts were stopped and the infant was pronounced dead. A postmortem examination and case review was unrevealing about underlying infectious, metabolic, or structural etiologies. A diagnosis of sudden unexpected postnatal collapse was rendered. ### Sudden Unexpected Postnatal Collapse A “new” clinical entity has been characterized in the European, Australian, and United States literature, which has been called by various names including sudden unexpected postnatal collapse (SUPC). (1)(2)(3)(4)(5)(6) This sudden collapse occurs in apparently healthy term newborns soon after birth, commonly during initial skin-to-skin contact or the initial breastfeeding session. (1)(2)(7) Video 1 depicts a simulated case of SUPC …