Sudden Deaths and Apparent Life-Threatening Events in Hospitalized Neonates Presumed to Be Healthy

Abstract

We describe 10 apparently healthy newborns who were patients in a level 1 nursery and were found by caregivers to be limp, apneic, and requiring resuscitation. All patients were between ages 15 hours and 3 1/2 days, products of term gestations, and of appropriate weight for gestational age. Prenatal or perinatal complications were present in nine of the 10 patients; in no patient was the complication considered a risk for serious, late-onset neonatal problems. All patients had been examined by a physician and were deemed to be in good health before the apparent life-threatening event. Subsequent to the event, each patient required positive pressure ventilation and seven patients received chest compressions. Five patients died. Autopsies were performed on four of the five patients and in none was an adequate explanation for death established. Intrathoracic petechiae were found in one patient whose sibling had died of sudden infant death syndrome at age 11 weeks. Evaluation of the five survivors failed to determine a cause for the episodes. Of the five survivors, one had normal results of developmental examination at age 6 months, while the remaining four survivors had severe neurologic impairment at age 1 year. Apparent life-threatening events occur in hospitalized newborns presumed to be normal and may be a manifestation of early sudden infant death syndrome or early near-miss sudden infant death syndrome.