Postnatal Collapse Research Articles

The use of in-hospital guidelines for prevention of sudden unexpected postnatal collapse: A national survey.

Sudden unexpected postnatal collapse is a life-threatening event and may occur in any newborn infant. Safe skin-to-skin contact, and awareness of sudden unexpected postnatal collapse are key to its prevention. The aim of this study was to survey the presence of skin-to-skin contact and/or sudden unexpected postnatal collapse protocols in the 70 perinatal centres in the Netherlands. We performed a survey among Dutch paediatricians to examine the safe skin-to-skin contact and sudden unexpected postnatal collapse protocols. We received data from 59/70 (85%) perinatal centres. At least one case of sudden unexpected postnatal collapse was reported in 35/59 (59%) of these centres. Nearly half the centres had safe skin-to-skin contact and/or sudden unexpected postnatal collapse protocols. Ultimately, 16 protocols were available for analysis. They showed considerable differences in the type of perinatal care provided. Most protocols lacked recently published insights on safe skin-to-skin contact. Besides, protocols failed to incorporate awareness of and knowledge on how to prevent sudden unexpected postnatal collapse. This study underlines the importance of drawing up uniform, multidisciplinary guidelines containing recommendations for the prevention of sudden unexpected postnatal collapse in the Netherlands.

Sudden unexpected postnatal collapse and BUB1B mutation: first forensic case report

Sudden unexpected postnatal collapse (SUPC) is a sudden collapse of the clinical conditions of a full-term or near-term newborn, within the first 7 days of life, that requires resuscitation with positive ventilation and who either dies, has hypoxic-ischemic encephalopathy, or requires intensive care. The incidence of SUPC is very low, and most often presents a negative prognosis. The BUB1B gene is a mitotic checkpoint of serine/threonine kinase B that encodes a protein crucial for maintaining the correct number of chromosomes during cell division. Mutations in the BUB1B gene are linked to mosaic variegated aneuploidy syndrome 1 (MVA1), a rare autosomal recessive disorder characterized by diffuse mosaic aneuploidies involving several chromosomes and tissues. This paper discusses a case of a newborn who had a spontaneous delivery. After 2 h and 10 min, the infant showed generalized hypotonia and cyanosis, and his doctors performed orotracheal intubation, cardiac massage, pharmacological hemodynamic therapy, mechanical ventilation, antibiotic therapy, and hypothermic treatment. The newborn was discharged after 5 months with the diagnosis of hypoxic-ischemic encephalopathy. Suspecting an SUPC, a complete genetic analysis was performed demonstrating a compound heterozygous mutations in the BUB1B gene. The newborn died at 6 months of life, 1 month after discharge. A complete autopsy was performed, determining that the cause of death was due to sepsis starting from a brocopneumonic process, with outcomes of hypoxic-ischemic encephalopathy (HIE). In this scenario, it is not possible to demonstrate the causal effect of this mutation, considering that it could play a causal or concausal role in the onset of SUPC. Further research based on multicenter studies, as well as on animal models, could be very useful to clarify the pathological effect of this mutation.

Sudden Unexpected Postnatal Collapse: Review and Management.

Sudden unexpected postnatal collapse (SUPC) of healthy newborns is a catastrophic event caused by cardiorespiratory collapse in a healthy newborn. The most common cause of SUPC is poor positioning of the newborn during skin-to-skin contact or breastfeeding when the newborn is not being observed by a health professional, attentive parent, or caretaker. Maternal/newborn health care professionals need to know about the essential information, definitions, incidence, risk factors, clinical presentation, outcomes, and prevention and management strategies to minimize the occurrence and impact of SUPC. A sample SUPC hospital policy is included in the manuscript.

Prevention of sudden unexpected postnatal collapse (SUPC) of a newborn in relation to skin-to skin-contact

Abstract Aim. This study aimed to scoping review the existing literature on the Safe Utilization of Skin-to-Skin Contact (SSC) for neonates in the delivery room, focusing on interventions to enhance newborn safety and to prevent sudden unexpected postnatal collapse (SUPC). Material and methods. A comprehensive scoping review in line with PRISMA-ScR guidelines was conducted, by searching for scholarly articles published between 2011 and 2022 in scientific databases like ScienceDirect, Web of Science, and PubMed. Results. From an initial pool of 1,011 articles, relevant and topical ones were identified and categorized into four thematic areas: Knowledge and Proficiency of Delivery Room Nursing Staff; Use of Assessment Tools and Surveillance Strategies; Organizational Aspects of Delivery Rooms; Maternal Education and Active Participation. Conclusions. To prevent SUPC-related issues, a holistic approach involving both clinical and mechanical monitoring is crucial, emphasizing maternal education and support from skilled nursing staff .

Causes of sudden neonatal mortality disclosed by autopsy and histopathological examination.

The neonatal period, or the first 28 days of life, is the most vulnerable time in a child's life. Neonatal mortality has decreased in recent years. However, this progress varies at the national level, which necessitates actual regional data from different countries to identify local handicaps for life-saving precautions. This study aimed to investigate the causes for neonatal deaths as revealed by autopsy and histopathological examinations. A retrospective cross-sectional study was designed to identify the main causes of neonatal deaths in children who were autopsied at our institution between January 1, 2014, and December 31, 2021. Children who died within the first 28 days after birth (1-28 days of age) were referred to as neonatal cases. The main causes of neonatal death in children were determined via autopsy and histopathological and toxicological examinations. Furthermore, the causes of death were classified according to their manner of death. During this period, 122 neonatal children were autopsied at our institution. This group comprised 57 girls and 65 boys. For the manner of the death, natural causes were the most common cause (n = 91, 74.5%). Among natural causes, pneumonia (n = 66) was the leading one, representing 54% of all neonatal deaths, followed by perinatal conditions (n = 16, 13.1%). One of the pioneering reasons for death was sudden, unexpected postnatal collapse (n = 24, 19.6%), which was categorized under the undetermined group considering the manner of death. Unintentional (accidental) deaths accounted for 0.8% (n = 1) of total deaths, and intentional deaths were responsible for 6 neonates (4.9%) losses. This study shows that newborn children still die from simple and treatable infectious causes, probably arising from various familial and/or public inadequacies. In addition, sudden and unexpected postnatal collapse remains an important cause of neonatal mortality that has yet to be fully resolved. This study points out valuable inferences for caregivers and competent authorities to take preventive measures to prevent avoidable neonatal deaths.

Sudden unexpected postnatal collapse (SUPC): analysis of two neonatal deaths in the same family

Sudden unexpected postnatal collapse (SUPC): analysis of two neonatal deaths in the same family

Sudden Unexpected Postnatal Collapse and Therapeutic Hypothermia: What's Going On?

Sudden unexpected postnatal collapse (SUPC) is a rare event, potentially associated with catastrophic consequences. Since the beginning of the 2000s, therapeutic hypothermia (TH) has been proposed as a treatment for asphyxiated neonates after SUPC. However, only a few studies have reported the outcome of SUPC after TH. The current study presents the long-term neurodevelopmental outcome of four cases of SUPC treated with TH in a single Italian center. Furthermore, we reviewed the previous literature concerning 49 cases of SUPC treated with TH. Among 53 total cases (of whom four occurred in our center), 15 (28.3%) died before discharge from the NICU. A neurodevelopmental follow-up was available only for 21 (55.3%) out of the 38 surviving cases, and seven infants developed neurodevelopmental sequelae. TH should be considered in neonates with asphyxia after SUPC. However, SUPC is a rare event, and there is a lack of comparative clinical data to establish the risk/benefit of TH after SUPC with different degrees of asphyxia. Analysis of large cohorts of newborns with SUPC, whether treated with TH or untreated, are needed in order to better identify infants who should undergo TH.

Implementation of a Regional Education Program on Sudden Unexpected Postnatal Collapse for Perinatal Staff and Their Patients–Families

Sudden unexpected postnatal collapse (SUPC) is likely more common than reported. Studies indicate estimates are lower than actual collapses in hospitals and tend to reflect only severe events. Most hospitals do not screen for SUPC in at-risk newborns or women giving birth and have no standardized protocols or patient–family teaching materials regarding possible dangers during skin-to-skin care (SSC) and breastfeeding. The Loyola Administrative Perinatal Center (APC) surveyed its six network hospitals’ perinatal educators, asking what staff and patient–family SUPC education and safe infant-holding practices they provided.

Survival following upward cerebellar herniation in a neonate: a case report

Background: Herniation of the brain within the cranial vault is rare in newborns and carries a high mortality. Reported cases show herniation downward, through the foramen magnum. This case report uniquely describes upward herniation through the cerebellar tentorium. Case Presentation: A male infant born at 38 weeks gestation had a postnatal collapse at 17 hours. There were no spontaneous movements with hypotonia, reduced reflexes, nystagmus, and seizures. Cranial ultrasound showed diffuse changes in the posterior fossa, with acute cerebellar hematoma confirmed on MRI scan with significant mass effect, herniating the right cerebellar hemisphere in an upward direction. The baby was initially managed on a palliative care pathway but stabilized with clinical and MRI improvements. He survived to discharge and has mild neurological deficits at 14 months of age. Conclusion: Herniation can occur in an upward direction, evoking cerebellar signs like nystagmus in a neonate and it appears to be potentially survivable.

Mother’s Bed Incline and Desaturation Episodes in Healthy Term Newborns during Early Skin-to-Skin Contact: A Multicenter Randomized Controlled Trial

Introduction: Early skin-to-skin contact (ESSC) is associated with rare, sudden, unexpected postnatal collapse episodes. Placing the newborn in ESSC closer to an upright position may reduce the risk of airway obstruction and improve respiratory mechanics. This study assessed whether a greater inclination of the mother’s bed during ESSC would reduce the proportion of healthy term newborns (HTNs) who experienced episodes of pulse oximeter saturation (SpO₂) <91%. Methods: We conducted a multicenter randomized controlled trial comparing the effect of the mother’s bed incline, 45° versus 15°, on desaturation in HTNs during ESSC. Before delivery on 1,271 dyads, randomization was conducted, and stringent criteria to select healthy mothers and term newborns were monitored until after birth. Preductal SpO₂ was continuously monitored between 10 min and 2 h after birth. The primary outcome was the occurrence of at least one episode of SpO₂ <91%. Results: 254 (20%) mother-infant dyads were eligible for analysis (45°, n = 126; 15°, n = 128). Overall, 57% (95% confidence interval [CI]: 51%–63%) of newborns showed episodes of SpO₂ <91%. The proportion of infants with SpO₂ <91% episodes was 52% in 45° and 62% in 15° (relative risk: 0.80; 95% CI: 0.6–1.07). Conclusions: We did not show that a high mother bed inclination during ESSC led to significantly fewer HTNs who experienced episodes of SpO₂ <91%. Desaturation episodes from 10 min to 2 h after birth occurred in more than half of HTNs.

Compound Heterozygous Mutation of SLC25A1 Gene in Glutaric Aciduria Type 2

Background: Sudden unexplained postnatal collapse (SUPC) is a condition in which a newborn born at term or near term, and an Apgar score &gt;8 at 5 min and deemed healthy, presents with sudden unexpected cardiorespiratory collapse within the 1st week of life. This can be due to multiple, heterogeneous causes. Clinical Description: A term male neonate developed lethargy and refusal to feed at 56 h of life. The baby was cyanosed, apneic, in peripheral circulatory failure and normothermic. Supportive management was started. Sepsis and congenital heart disease were ruled out. The presence of hypoglycemia, metabolic acidosis and hyperammonemia prompted us to think of a metabolic disorder. Metabolic profile was suggestive of glutaric acuduria (GA). Exome sequencing showed heterozygous missense variants in in exon 7 and 8 of SLC25A1 gene indicative of GA II but reported as of uncertain significance. Both parents were carriers. Management: The final diagnosis was neonatal onset GA II without congenital anomalies. He was started on riboflavin and carnitine. Mechanical ventilation and inotropes were gradually withdrawn and breastfeeding started. Genetic counseling was done. The baby was doing well at the 4-month follow-up visit. Conclusions: Identifying and managing a newborn with SUPC is critical for the outcome. An individualized and rational approach should be used to identify the cause. The management of GA II is primarily supportive with tiding over of metabolic crises and dietary modifications.

Use of Therapeutic Hypothermia in Sudden Unexpected Postnatal Collapse: A Retrospective Study.

Sudden and unexpected postnatal collapse is a rare event with potentially dramatic consequences. Intervention approachesare limited, but hypothermia has been considered after postnatal collapse. The aim of this study was to analyse sudden and unexpected postnatal collapse cases that underwent therapeutic hypothermia in the five Portuguese hypothermia centres. In this multicentre, retrospective and descriptive study, clinical, ultrasonography, amplitude-integrated electroencephalography and brain magnetic resonance findings of newborns with postnatal collapse that underwent therapeutic hypothermia are reported (2010 - 2018). Statistical analysis was performed by using IBM SPSS Statistics version 21. Twenty-two cases of sudden and unexpected postnatal collapse were referred for therapeutic hypothermia (82% outborn), all ≥ 36 weeks, with Apgar 5´ ≥ 8. Collapse occurred during the first two hours in 73% (all < 24 hours), 50% during skin-to-skin care, 55% related to feeding and 23% during co-bedding. Moderate-severe encephalopathy and severe acidosis were observed (median: Thompson score 16, pH 6.90, base deficit 22 mmol/L). Amplitude-integrated electroencephalogram was abnormal in 95% and magnetic resonance imaging showed severe brain injury in 46%. The mortality rate was 50%. A possible cause was identified in 27%. The incidence rate of 2.7 sudden cases of postnatal collapse per 100 000 births, is possibly under-estimated. All infantssuffered the collapse in the first day, mostly within the first two hours, as reported before. Possible causes were identified in less than a third of cases, but multiple predisposing conditions were identified, suggesting that prevention may be possible. Newborn positioning and skin-to-skin care have been the most discussed practices. A significant proportion of infants had poor outcomes. Lower Thompson score, electroencephalogram amplitude normalization and normal magnetic resonance imaging seemed to indicate better outcomes.Although conclusive trials on therapeutic hypothermia after postnatal collapse are not available, its use has been considered individually. No severe adverse effects directly related to hypothermia were registered in this study, but the results do not allow drawing meaningful conclusions. In our national sample of 22 infants who suffered sudden and unexpected postnatal collapse and underwent therapeutichypothermia, a significant proportion had poor outcomes. Absolute conclusions from our experience with hypothermia in postnatal collapse cannot be drawn, but systematic reporting of cases and long-term clinical evaluation would facilitate understanding of the real benefits of hypothermia. As this procedure has not been validated with clinical trials for this indication, its use should be considered on a case-by-case approach. The potentially avoidable nature of unexpected postnatal collapse is evident from its association with certain behaviours and risk factors. Surveillance practices during the first hours should be implemented, whilst the benefits of breastfeeding and skin-to-skin care should continue to be widely promoted.

MRI combined with early clinical variables are excellent outcome predictors for newborn infants undergoing therapeutic hypothermia after perinatal asphyxia.

BackgroundBinary prediction-models for outcome [death, cognition, presence and severity of cerebral palsy (CP)], using MRI and early clinical data applicable for individual outcome prediction have not been developed.MethodsFrom Dec 1st 2006 until Dec 31st 2013, we recruited 178 infants into a population-based cohort with moderate or severe hypoxic-ischaemic encephalopathy (HIE) including postnatal collapse (PNC, n = 12) and additional diagnoses (n = 12) using CoolCap/TOBY-trial entry-criteria including depressed amplitude-integrated EEG (aEEG). Early clinical/biochemical variables and MRI scans (median day 8) were obtained in 168 infants. Injury severity was scored for cortex, basal ganglia/thalami (BGT), white matter (WM) and posterior limb of the internal capsule, summating to a total injury score (TIS, range 0–11). Outcome was categorized as adverse or favourable at 18–24 months from Bayley-III domains (cut-off 85) and neurological examination including CP classification.FindingsHIE and entry-aEEG severity were stable throughout the study. Outcome was favourable in 133/178 infants and adverse in 45/178: 17 died, 28 had low Cognition/Language scores, (including 9 with severe CP and 6 mild); seven had mild CP with favourable cognitive outcome. WMxBGT product scores and TIS were strong outcome predictors, and prediction improved when clinical/biochemical variables were added in binary logistic regression. The Positive Predictive Value for adverse outcome was 88%, increasing to 95% after excluding infants with PNC and additional diagnoses. Using WMxBGT in the regression predicted 8 of the 9 children with severe CP.InterpretationBinary logistic regression with WMxBGT or TIS and clinical variables gave excellent outcome prediction being 12% better than single variable cross-tabulation. Our MRI scoring and regression models are readily accessible and deserve investigation in other cohorts for group and individual prediction.FundingWe thank the National Health Service (NHS) and our Universities and funders in UK and Norway: SPARKS, The Moulton Foundation, The Norwegian Research Council, The Lærdal Foundation for Acute Medicine and charitable donations for their support for cooling therapy.

Sudden Unexpected Postnatal Collapse Resulting in Newborn Death in the United States.

Sudden Unexpected Postnatal Collapse Resulting in Newborn Death in the United States.

Sudden unexpected postnatal collapse in a neonate

A healthy full-term female neonate, aged 3 days and born by vaginal delivery (with a 1-minute Apgar score of 10 and a 5-minute Apgar score of 10), had unexpected cardiac and respiratory arrests in the early morning on day 3 after birth and recovered to spontaneous breathing and heartbeat after a 10-minute resuscitation. The child had poor response and convulsion after resuscitation. Blood gas analysis showed metabolic acidosis, and amplitude-integrated EEG showed a burst-suppression pattern. She was diagnosed with sudden unexpected postnatal collapse but improved after hypothermia and symptomatic/supportive treatment. This article reports the first case of sudden unexpected postnatal collapse in China and summarizes related risk factors, pathophysiological mechanisms, and preventive and treatment measures of this disorder.

Sudden Unexpected Postnatal Collapse Resulting in Newborn Death in the United States.

The sudden collapse of an apparently healthy newborn, or sudden unexpected postnatal collapse (SUPC) is fatal in about half of cases. Epidemiological characteristics of sudden unexpected infant death (SUID) in the first week of life differ from those in the postperinatal age group (7-365 days). To describe the characteristics of SUPC resulting in neonatal death. We analyzed the Centers for Disease Control and Prevention Birth Cohort Linked Birth/Infant Death Data Set (2003-2013: 41,125,233 births and 37,624 SUIDs). SUPC was defined as infants born ≥35 weeks gestational age, with a 5-minute Apgar score of ≥7, who died suddenly and unexpectedly in the first week of life. Of the 37,624 deaths categorized as SUID during the study period, 616 met the SUPC criteria (1.5/100,000 live births). Eleven percent occurred on the first day of life and nearly three quarters occurred during postnatal days 3-6. SUPC deaths differed statistically from SUID deaths occurring 7-364 days of age, in particular for sex, marital status, and live birth order. These data support the need for adequate nurse staffing during the immediate recovery period and for the entire postpartum stay as well as nurse rounding for new mothers in the hospital setting.

Heart-rate agreement between ECG and a new, wireless device during early skin-to-skin contact.

To assess the agreement of heart rate (HR) between the new device - a fabric jacket for neonates, with integrated sensors detecting ECG signals and a Bluetooth connection to a computer (ComfTech, HOWDY) - and the clinical reference, ECG, during the skin-to-skin contact (SSC) in the first 2h after birth, for the potential use of early detection of Sudden and Unexpected Postnatal Collapse (SUPC). We enrolled newborns ≥35+0 weeks of gestation, with Apgar score >8 at 5min in a prospective, observational study in the delivery room, excluding infants with need for resuscitation, clinical instability or major malformations. We assessed HR within 20min after birth by both devices simultaneously: the index test ComfTech HOWDY and the standard ECG (Vita Guard VG 3100, Getemed). We compared HR between the two methods at 0, 15, 30, 45, 60, 90 and 120min by the Bland-Altman plot. We included 60 infants. The mean difference between the methods was -1.3bpm, 95%LoA -12.4 to 9.7bpm. Spearman rank correlation coefficient ρ=-0.06. ComfTech HOWDY presents reliable agreement with the ECG and might assist in identifying infants at risk for SUPC.

Continuous pulse oximetry during skin-to-skin care: An Australian initiative to prevent sudden unexpected postnatal collapse.

To examine the use of continuous pulse oximetry monitoring (CPOM) of newborns as a non-invasive and non-intrusive standard of care for promoting early and safe skin-to-skin contact between mothers and newborns immediately after birth and to gather acceptability feedback from midwifery staff and mothers. All babies receiving skin-to-skin contact (SSC) had continuous pulse oximetry monitoring (CPOM) for the first-hour postbirth. Staff were trained with education sessions before implementation. Midwives and mothers were surveyed post-implementation and again after distribution of an education brochure regarding CPOM. Seventy per cent of midwives and 66% of mothers responded to the survey. The majority of midwives received the practice positively and felt reassured by the use of CPOM in the immediate postpartum period. The survey identified gaps in maternal knowledge of the risk and benefits of SSC which improved significantly after the distribution of the educational brochure (P=.01). Continuous pulse oximetry monitoring with a compact monitor in the first-hour postbirth is a simple, non-invasive and innovative approach to enhance safe skin-to-skin care by improving vigilance of newborns. Our study confirmed the acceptance of such approach by midwives and mothers in our population.

Prevalence and Components of Newborn Assessment Policies Related to Sudden Unexpected Postnatal Collapse

ObjectiveTo describe, in a convenience sample, different hospitals’ nursing care policies related to normal newborn assessment, to summarize common components of those policies related to sudden unexpected postnatal collapse (SUPC) of the newborn, and to correlate characteristics of the hospitals with the presence or absence of a normal newborn assessment policy. DesignDescriptive evaluative design. SettingHospital representatives were contacted to complete a questionnaire and provide a copy of their policies regarding normal newborn assessment. ParticipantsRepresentatives from 39 hospitals that provide maternal/newborn services within the United States completed the questionnaire and/or provided the investigator with a written nursing care policy for normal newborn assessment. Intervention/MeasurementsComponents of the hospitals’ normal newborn assessment policies were evaluated according to the framework of recommended components outlined by the American Academy of Pediatrics in Feldman-Winter et al. (2016). ResultsThe four components most often included in the policies submitted by 26 hospitals were maternal/newborn dyad assessments (n = 25, 96%), sequence of events postpartum (n = 15, 58%), monitoring (n = 9, 35%), and skin-to-skin contact procedures (n = 8, 30%). Differences were noted based on the size of the hospital as defined by the number of births and number of beds and also by the type of unit. ConclusionFew policies in this study aligned with the recommended suggestions from the American Academy of Pediatrics outlined in Feldman-Winter et al. (2016). It is also important to note that these recommended suggestions relate to safe skin-to-skin contact and rooming-in practices, which may in turn affect the incidence of SUPC. There is much work to be done in terms of disseminating evidence and developing and implementing newborn assessment policies related to SUPC.

Guidance to reduce the risk of Sudden and Unexpected Postnatal Collapse

Early skin-to-skin contact (SSC) between mothers and healthy term newborns is a key part of the Unicef Baby Friendly Initiative Standards. SSC immediately after birth provides cardiorespiratory stability, improves prevalence and duration of breastfeeding, improves maternalinfant bonding and decreases maternal stress. There is a concern about cases of sudden unexpected postnatal collapse during a period of SSC with the infant prone on the mother´s chest. Said collapse includes both severe apparent lifethreatening event and sudden unexpected early neonatal death in the first week of life. Even if considered rare, consequences are serious with death in half of the cases and remaining disability in majority of the cases reported. For these reasons during SSC and for at least the first 2 hours after delivery, health care personnel in the delivery and recovery room should observe and assess for any sign of decompensation in the infant.