Early sudden unexpected death in infancy (ESUDI) – three case reports and review of the literature

Abstract

Aim: Early sudden unexpected death in infancy (ESUDI) is a rare cause of death occurring in newborns during the first hours of life. Our aim was to find additional data for the identification of risk factors and establishment of prevention strategies. Methods:We describe three cases of ESUDI and give an overview of the literature. Results: ESUDI was observed in term babies with normal birth weight after good postnatal adaptation within the first four hours of life. Maternal age was between 29 and 36 years, mothers were primiparous and of normal weight. All three events occurred during unobserved early skin-to-skin contact. Autopsy and post-mortem metabolic screening revealed no cause of death. A search of the MEDLINE and Web of Science (Thomson Reuters) databases brought to light 132 cases of ESUDI reported in the literature from 1985 to 2012. Concurrent with our observations, first parity and unobserved early skin-toskin contact seem to be prime predictors of ESUDI. Other pre-described risk factors such as mode of delivery, birth weight, mother's age and body mass index were not seen in our patients. Conclusion:Close observation during the first hours of life is essential and can be life-saving, especially during early skin-to-skin contact.

Immediate or early skin‐to‐skin contact after a Caesarean section: a review of the literature

“…The majority of these incidents occur within 4 h after birth (Gnigler et al . ). Some of these events may have been caused by the obstruction of the newborns airway, associated with SSC and the newborn being in a prone position (Dageville et al .…”

“…; Gnigler et al . ; Pejovic & Herlenius ). Staff should ensure safe newborn positioning during SSC, for example, making sure the newborns nares are visible and monitor the baby frequently in the first few hours after birth (Nakamura & Sano ; Andres et al .…”

“…; Gnigler et al . ; Pejovic & Herlenius ). Authors also recommend that all mothers of newborns should be educated about the importance of letting staff know if there are any changes in their newborns (Poets et al .…”

“…; Gnigler et al . ; Pejovic & Herlenius ). Caution is also advised after a Caesarean section because of the newborns having a significant increased risk of lower Apgar scores, respiratory problems and hypoglycaemia soon after birth (Karlstrom et al .…”

“…; Fleming ; Gnigler et al . ; Pejovic & Herlenius ). The aim of this review is to evaluate existing evidence on the facilitation of immediate or early (within 1 h) SSC following Caesarean section for healthy term newborns and identify facilitators, barriers and associated maternal and newborn outcomes.…”