Unexpected collapse in apparently healthy newborns – a prospective national study of a missing cohort of neonatal deaths and near-death events

Becher, Julie-Clare; Bhushan, Shetty; Lyon, Andrew

doi:10.1136/adc.2010.208736

Cited by 100 publications

(117 citation statements)

References 16 publications

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“…In a recently published nationwide survey in the UK, which was very similar to our study design, the incidence was slightly higher 4. This could be related to a better reporting of cases or to a less-intense postnatal surveillance, leading to a higher number of events.…”

Section: Discussionsupporting

confidence: 67%

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

Poets¹,

Urschitz²,

Steinfeldt³

et al. 2012

Arch Dis Child Fetal Neonatal Ed

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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 ...

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Section: Discussionsupporting

confidence: 67%

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

Poets¹,

Urschitz²,

Steinfeldt³

et al. 2012

Arch Dis Child Fetal Neonatal Ed

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“…Most of these cases found a primiparous mother, skin-to-skin contact and mother and baby left unaccompanied in the delivery room. Becher et al (2012) examined ALTE's that occurred within the first 12 h of birth over a 13-month period in the United Kingdom, and their results echo the findings and characteristics of previous studies. Their criteria included term neonates with Apgar scores of 8 or greater at 5 min of life who required positive pressure ventilation for an ALTE.…”

Section: Introductionsupporting

confidence: 50%

Discovering apparent life-threatening events in the first 24 hours of birth: A case study

Thompson

Matyas

Abate

et al. 2015

Journal of Neonatal Nursing

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“…51 Other authors suggested that 73% of SUPC events occur in the first 2 hours of life. 52 In the case series by Pejovic and Herlenius, 51 15 of the 26 cases of SUPC were found to have occurred during SSC in a prone position. Eighteen were in primiparous mothers, 13 occurred during unsupervised breastfeeding at <2 hours of age, and 3 occurred during smart cellular phone use by the mother.…”

Section: Safety Concerns Regarding Immediate Sscmentioning

confidence: 99%

Safe Sleep and Skin-to-Skin Care in the Neonatal Period for Healthy Term Newborns

Feldman-Winter¹,

Goldsmith²

2016

Pediatrics

163

110

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Skin-to-skin care (SSC) and rooming-in have become common practice in the newborn period for healthy newborns with the implementation of maternity care practices that support breastfeeding as delineated in the World Health Organization's "Ten Steps to Successful Breastfeeding." SSC and rooming-in are supported by evidence that indicates that the implementation of these practices increases overall and exclusive breastfeeding, safer and healthier transitions, and improved maternal-infant bonding. In some cases, however, the practice of SSC and rooming-in may pose safety concerns, particularly with regard to sleep. There have been several recent case reports and case series of severe and sudden unexpected postnatal collapse in the neonatal period among otherwise healthy newborns and near fatal or fatal events related to sleep, suffocation, and falls from adult hospital beds. Although these are largely case reports, there are potential dangers of unobserved SSC immediately after birth and throughout the postpartum hospital period as well as with unobserved rooming-in for at-risk situations. Moreover, behaviors that are modeled in the hospital after birth, such as sleep position, are likely to infl uence sleeping practices after discharge. Hospitals and birthing centers have found it diffi cult to develop policies that will allow SSC and rooming-in to continue in a safe manner. This clinical report is intended for birthing centers and delivery hospitals caring for healthy newborns to assist in the establishment of appropriate SSC and safe sleep policies.

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Unexpected collapse in apparently healthy newborns – a prospective national study of a missing cohort of neonatal deaths and near-death events

Cited by 100 publications

References 16 publications

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

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

Discovering apparent life-threatening events in the first 24 hours of birth: A case study

Safe Sleep and Skin-to-Skin Care in the Neonatal Period for Healthy Term Newborns

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