Sudden Unexpected Postnatal Collapse

Monnelly, Vix; Becher, Julie-Clare

doi:10.1007/978-3-030-28829-7_10

Cited by 6 publications

(30 citation statements)

References 52 publications

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“…These practices have increasingly been recognized as risk factors for unmonitored apnea, desaturation, and SUPC's with evidence suggesting that risk may increase with younger gestational age. 18,19,21,[45][46][47] There are also studies reporting brief resolved unexplained events, cardiovascular collapse secondary to apnea, and death for term and preterm infants positioned in car seats. [48][49][50] Moreover, apnea has been shown to be more frequently identified in the NICU setting compared to a level I or level II nursery.…”

Section: Transfersmentioning

confidence: 99%

“…16,17 Conversely, infants especially LPI, admitted to the level I nursery are at risk for the aforementioned problems as well as unmonitored apnea, cyanosis, and sudden unexpected postnatal collapse (SUPC). 18,19 These risks are often greatest within 2 hours of birth but may occur throughout the hospitalization, especially during breastfeeding. 19 LPI thus present a unique dilemma, as there are a large percentage of infants in this gestational age cohort that may not require intensive level care but may be admitted to the NICU nonetheless.…”

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confidence: 99%

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Short-Term Outcomes following Standardized Admission of Late Preterm Infants to Family-Centered Care

et al. 2019

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Objective The study compares the short-term outcomes of late preterm infants (LPI) at an academic center in San Diego, California after a change in protocol that eliminated a previously mandatory 12-hour neonatal intensive care unit (NICU) observation period after birth. Study Design This is a retrospective observational study examining all LPI born with gestational age 35 to 366/7 weeks between October 1, 2016 and October 31, 2017. A total of 189 infants were included in the review. Short-term outcomes were analyzed before and after the protocol change. Results Transfers to the NICU from family-centered care (FCC) were considerably higher (23.2%) following the protocol change, compared to before (8.2%). More infants were transferred to the NICU for failed car seat tests postprotocol compared to preprotocol. Length of stay before the protocol change was 5.13 days compared to 4.80 days after. Conclusion LPI are vulnerable to morbidities after delivery and through discharge. We found an increase in failed car seat tests in LPI cared for in FCC after elimination of a mandatory NICU observation after birth. The transitions of care from delivery to discharge are key checkpoints in minimizing complications.

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Section: Transfersmentioning

confidence: 99%

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confidence: 99%

Short-Term Outcomes following Standardized Admission of Late Preterm Infants to Family-Centered Care

et al. 2019

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“…3 Guidelines endorsed by the British Association of Perinatal Medicine in 2014 defined SUPC as "a term or near-term infant who is well at birth, assigned to routine postnatal care and who collapses unexpectedly within the first seven days of life, requiring resuscitation with intermittent positive pressure ventilation and who either dies, requires ongoing intensive care or develops encephalopathy". 6,7 This definition is increasingly accepted across the perinatal community.…”

Section: Introductionmentioning

confidence: 99%

“…1,3,4,[8][9][10][11] This wide interval can be attributed to differences in definition and inclusion criteria, including gestational and postnatal age and severity of the collapse (with milder cases being excluded from most studies), suggesting that this situation is underreported. 3,4,6 One-third of SUPC cases tend to occur in the first two hours after birth, another third between two and 24 hours and the last third between one and seven postnatal days. 5,10 Earlier studies highlighted an even earlier occurrence, varying between 55% and 73% within the first and second postnatal hours.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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Introduction: Sudden and unexpected postnatal collapse is a rare event with potentially dramatic consequences. Intervention approaches are 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.Material and Methods: 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.Results: 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%.Discussion: The incidence rate of 2.7 sudden cases of postnatal collapse per 100 000 births, is possibly under-estimated. All infants suffered 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.Conclusion: In our national sample of 22 infants who suffered sudden and unexpected postnatal collapse and underwent therapeutic hypothermia, 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.

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“…Prevention of SUPC is heavily focused on non‐invasive, discrete measures. Guidelines predominantly recommend ‘vigilant observation’ of the newborn, and multiple studies have recommended the use of checklists to facilitate observation of factors including newborn oxygen saturations, airway position, breathing, colour and temperature 14‐16 …”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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Aim 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. Methods 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. Results 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). Conclusion 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.

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Sudden Unexpected Postnatal Collapse

Cited by 6 publications

References 52 publications

Short-Term Outcomes following Standardized Admission of Late Preterm Infants to Family-Centered Care

Short-Term Outcomes following Standardized Admission of Late Preterm Infants to Family-Centered Care

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

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

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