Risk factors for early sudden deaths and severe apparent life-threatening events: Table 1

Abstract

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 ...

Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants

“…11,12 They recorded each study's relevance to the clinical question, research design, setting, time period covered, sample size, patient eligibility criteria, data source, variables collected, key results, study e6 in the updated (n = 18) and original (n = 37) systematic review (Supplemental Table 7). 6,7,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] The resulting systematic review was used to develop the guideline recommendations by following the policy statement from the AAP Steering Committee on Quality Improvement and Management, "Classifying Recommendations for Clinical Practice Guidelines." 29 Decisions and the strength of recommendations were based on a systematic grading of the quality of evidence from the updated literature review by 2 independent reviewers and incorporation of the previous systematic review.…”

Unexpected collapse of healthy newborn infants: risk factors, supervision and hypothermia treatment

“…Fourteen cases fulfilled all Poets et al. criteria for inclusion in their national surveys of deliveries in Germany: normal postnatal adaption with sudden unexpected collapse occurring within 24 h after birth with subsequent need for intensive resuscitation, neonatal intensive care or surveillance where no aetiology was found . Tables summarize the perinatal data of the SUPC cases fulfilling all the above SUPC criteria.…”

“…(20 infants) but only mentioned in other studies , for example Poets et al. . Notably, early ALTE cases that recover after vigorous stimulation are also included in the recently published guidelines for investigation of SUPC .…”

“…A comparison with the recent UK and German national surveys was made feasible by dividing the SUPC cases into two categories: (i) severe SUPC where no aetiology was found, in accordance with the two recent German surveys , and (ii) collapses where either a plausible aetiology was found, such as congenital abnormality, infection or congenital neurological/metabolic disease, in accordance with the UK survey , or where vigorous stimulation, Continuous positive airway pressure (CPAP) or ventilation less than a minute enabled the infant to resuscitate and recover. These SUPC cases have been included in some reports but only mentioned in the national surveys and not included in their estimations of SUPC incidence . However, they are included in the recent UK consensus guidelines for investigation of SUPC and require extra investigations as well as surveillance and are thus included in the present investigation.…”

Successful Outcome of Therapeutic Hypothermia in A Case of Sudden Postnatal Cardiac Arrest and Asphyxia: A Case Report and Literature Review

“…Though, sudden unexpected postnatal collapse is rare but can lead to devastating outcomes, in addition to, severe disability. These events have been found to occur with skin to skin and prone positions in more than threequarters of the time [4][5][6][7].…”