Sudden unexpected post-natal collapse (SUPC) during skin-to-skin care (SSC): where is the trouble?

L Roncati,F Piscioli

doi:10.12891/ceog5081.2019

Abstract

Skin-to-skin care (SSC) consists in the early and prolonged skin-to-skin contact between the newborn and the mother. This practice brings several benefits to infants, such as cardiorespiratory stability, breastfeeding, thermoregulation and crying reduction; therefore, SSC application represents the best practice in the birth points around the world. However, it is not risk free; in fact, the occurrence of a sudden unexpected post-natal collapse (SUPC) has been reported many times in literature. SUPC can be defined as a sudden and unexpected postnatal collapse affecting term or near term infant, who appears well at birth, but who unexpectedly collapses within the first week of life, in such a way as to require intensive care or to develop encephalopathy or to die. New research acquisitions suggest that the hypoplasia of the rostral pontine Kölliker-Fuse nucleus, notoriously deputy to regulate the breathing rate, may represent the cause of death for SUPC during SSC.

Highlights

According to the British Association of Perinatal Medicine, sudden unexpected post-natal collapse (SUPC) can be defined as a sudden and unexpected postnatal collapse affecting term or near term infants (> 35 gestational weeks), who appears well at birth, but who unexpectedly collapses within the first week of life, in such a way as to require intensive care or to develop encephalopathy or to die [7]
This alteration was found in only two of the remaining ten cases, in which the Skin-to-skin care (SSC) had not been practiced, and in no control case (0%). These results suggest that the hypoplasia of the Kölliker-Fuse nucleus may represent the cause of death for SUPC during SSC [14]
A thorough neuropathological examination in case of sudden and unexpected neonatal death is essential, especially if this occurs during SSC, following a specific protocol, well-developed by the ‘Lino Rossi’ Research Center, which provides, in addition to the histological examination by serial sections of the brain stem to search for morphological alterations, the application of immunohistochemistry, in order to highlight life-treating dysfunctions [17-19]

Summary

Introduction

In 2016 a Cochrane review collected data from 21 studies including 3,042 low birth-weight babies (less than 1,500 grams at birth), highlighting that newborns provided with SSC have a reduced risk of death, hospital-acquired infection or hypothermia and a gain in terms of weight and breastfeeding rates [4]. The SSC application in the first hours of life represents the best practice in the birth points, for healthy full-term newborns, and the International Kangaroo Care Awareness Day is cel-

Results

Conclusion