SID or S-ALTE may occur in the first 24 hours after birth, particularly within the first 2 hours. Events seem often related to a potentially asphyxiating position. Parents may be too fatigued or otherwise not able to assess their infant's condition correctly. Closer observation during these earliest hours seems warranted.

Objective To identify potential risk factors for unexpected sudden infant deaths (SID) and severe apparent life-threatening events (S-ALTE) within 24 h of birth. Design Case-control study embedded in an epidemiological survey over a 2-year period. Patients and methods Throughout 2009, every paediatric department in Germany was asked to report cases of unexplained SID or S-ALTE in term infants with a 10-min Apgar score ≥8 to the Surveillance Unit for Rare Pediatric Conditions. Throughout 2010, the inclusion criteria were extended to infants ≥35 week gestational age and those where an explanation for the deterioration had been found. For each unexplained case, hospitals were asked to fi ll in a questionnaire for 3 (near-)term controls with good postnatal adaptation at the age (in minutes) when the event had occurred in the case under study. Results Of the 85 cases reported, 34 fulfi lled the entry criteria; of these, two were near-term newborns and, in three cases, a cause had been identifi ed for the event.For the 31 cases with unknown cause for the event (13 males; mean (SD) gestational age 38.9 (1.7) week), the authors gathered 93 controls (51 male infants; 38.9 (1.4) week). As signifi cant risk factors for S-ALTE and SID, the authors could identify primipara (OR 6.22; 95% CI 2.11 to 18.32) and potentially asphyxiating position (OR 6.45; 95% CI 1.22 to 34.10). Conclusions Close observation of newborns seems necessary, particularly in primipara; a potentially asphyxiating position should be avoided. INTRODUCTIONIn Germany, in 2009, we determined the incidence of unexpected sudden infant deaths (SID) and severe apparent life-threatening events (S-ALTE) in term infants (≥37 weeks' gestational age) within 24 h of birth after a good postnatal adaptation (10-min Apgar score ≥8). 1 Seventeen cases met inclusion criteria, corresponding to an incidence of 2.6 per 100 000 live births.It was noticeable that more than half of the events occurred within 2 h of birth (mostly after vaginal delivery) and more than two-thirds of affected newborns were lying on the breast or abdomen of their mother or near to and facing her. It was also striking that most mothers were primipara, and that, in 7 of 17 cases, the mother had not recognised the deterioration of her baby despite her being present and awake.In 2010, we continued the survey. As risk factors remain speculative without adequate controls, our aim was to obtain information on birth characteristics and postnatal practices for infants born in hospitals reporting a case, and to compare cases and controls concerning putative risk factors. METHODSAs part of the Surveillance Unit for Rare Pediatric Conditions in Germany, 2 all paediatric departments in Germany were sent monthly reporting cards between 1 January 2009 and 31 December 2009 asking them to notify the study centre of any case of unexplained SID or S-ALTE occurring within 24 h of birth in a full-term infant (≥37 week gestational age) after a good postnatal adaptation (10-min Apgar score ≥8). S-ALTE was defi ned ...

Nasal continuous positive airway pressure (NCPAP) devices using variable (vf-) and continuous (cf-) flow or synchronized nasal intermittent positive pressure ventilation (s-NIPPV) are used to prevent or treat intermittent hypoxia (IH) in preterm infants. Results concerning which is most effective vary. We aimed to investigate the effect of s-NIPPV and vf-NCPAP compared to cf-NCPAP on the rate of IH episodes. Preterm infants with a gestational age of 24.9–29.7 weeks presenting with IH while being treated with cf-NCPAP were monitored for eight hours, then randomized to eight hours of treatment with vf-NCPAP or s-NIPPV. Data from 16 infants were analyzed. Due to an unexpectedly low sample size, the results were only reported descriptively. No relevant changes in the rate of IH events were detected between cf- vs. vf-NCPAP or between cf-NCPAP vs. s-NIPPV. Although limited by its small sample size, s-NIPPV, vf- and cf-NCPAP seemed to be similarly effective in the treatment of IH in these infants.

Abstract Background: Nasal continuous positive airway pressure (NCPAP) devices using variable (vf-) and continuous (cf-) flow or synchronized nasal intermittent positive pressure ventilation (s-NIPPV) are used to prevent or treat intermittent hypoxia (IH) in preterm infants. Results on which is most effective vary. We aimed to investigate the effect of s-NIPPV and vf-NCPAP compared to cf-NCPAP on the rate of IH episodes.Methods: Preterm infants with a gestational age of 24.9-29.7 weeks presenting with IH while being treated with cf-NCPAP were monitored for 8 hours, then randomized to 8 h of treatment with vf-NCPAP or s-NIPPV. Data from 16 infants were analyzed. Due to an unexpectedly low sample size, results are only reported descriptively.Results: No relevant changes in the rate of IH events were detected between cf- vs. vf-NCPAP or between cf-NCPAP vs. s-NIPPV.Conclusion: Although limited by its small sample size, s-NIPPV, vf- and cf-NCPAP seemed to be similarly effective in the treatment of IH in these infants.Trial registration: This study was registered with the German Clinical Trials register - DRKS00005387. Registered 12 November 2013, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00005387