Sudden Unexpected Postnatal Collapse of Newborn Infants: A Review of Cases, Definitions, Risks, and Preventive Measures

Abstract

This study aimed to review available published reports concerning sudden unexpected postnatal collapse (SUPC) of apparently healthy infants within the first days of postnatal life, establish a structured presentation and delineate recommendations for preventive measures. All published reports of SUPC cases were retrospectively analyzed, and three not previously published SUPC cases at Karolinska University Hospital were detailed to exemplify the varying presentations and outcomes of SUPC. We found 398 published cases of SUPC occurring during first postnatal week. Estimated incidence of the SUPC of a presumably healthy infant after birth differs widely, ranging from 2.6 cases to 133 cases/100,000. However, definition, inclusion, and exclusion criteria vary substantially between reports. Our summary indicates that reported SUPC occurs more frequently than expected from recent surveys. About half of the infants die, and of the remaining survivors, half have neurological sequela. Of the 233 cases of sudden unexpected death described, no etiology was found in 153 cases. When a defined time for the SUPC event is described, approximately one third of reported events occur during the first 2 h, between 2 and 24 h and between 1 and 7 days after birth, respectively. Adequate education of caregivers and appropriate surveillance during the first days of newborns should enable us to save hundreds of lives.

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

“…Twenty-five of the 26 cases had favorable neurologic outcomes in 1 series; however, in another review, mortality was as high as 50%, and among survivors, 50% had neurologic sequelae. 53 Experimental models suggest that autoresuscitation of breathing after hypoxic challenge takes longer with lower postnatal age and decreased core body temperature. 54 SUPC, in some definitions, includes acute life-threatening episodes; however, the latter is presumed to be more benign.…”

“…An apparent lifethreatening episode, or what may be referred to as a brief resolved unexplained event, may be low risk and require simple interventions such as positional changes, brief stimulation, or procedures to resolve airway obstruction. 46,53 Falls are another concern in the immediate postnatal period. Mothers who are awake and able to respond to their newborn infant immediately after birth may become suddenly and unexpectedly sleepy, ill, or unable to continue holding their infant.…”

Update on congenital heart disease and sudden infant/perinatal death: from history to future trends

“…About 50% of infants with SUPC die, and 50% of the remaining survivors have neurological sequelae 66. Further research is needed to identify any ‘hidden sign’ of a future critical state and to explore the relationship between a brief resolved unexplained event and SIDS–SIUDS.…”

“…In the past 10 years, the SIDS rate has declined by 26% 72. Overall, despite progress on CHD and SIDS–SIUDS over the past 50 years, the epidemiological data are still limited, with a general worldwide lack of data, and despite modern advances in maternal–infant care, over the past 25 years, the rates of unexpected stillbirth have not declined significantly 66 71…”

Injury and Repair in the Immature Brain

“…Herlenius et al draw our attention to the perhaps less well-known clinical entity of sudden unexpected postnatal collapse of apparently healthy infants within the first days of postnatal life [13], providing a review of cases, definitions, risks, and preventive measures. They argue that adequate education of caregivers and appropriate surveillance during the first days of life should enable us to save hundreds of lives.…”