Unexpected Collapse shortly after Term Delivery

Pejovic NJ, Herlenius E: Unexpected collapse of healthy newborn infants: risk factors, supervision and hypothermia treatment. Acta Paediatrica 2013, 102(7):680-688. There are now a few similar studies and some case reports of this phenomenon. Otherwise healthy normal full term babies who have a cardio-respiratory arrest shortly after being born. Very often they are in skin to skin contact with the mother, often lying prone on the mothers chest, often the mother is exhausted after labour and may fall asleep. This new article adds that they may be distracted by using their smartphones. This was a large cohort study from 5 Stockholm hospitals. The incidence was much higher than other previous studies, 38 per 100,000, the definitions are slightly different in the studies and the data collection details were different, which may account for the differences.

There are also national prospective cohorts (Becher J-C, Bhushan SS, Lyon AJ: Unexpected collapse in apparently healthy newborns – a prospective national study of a missing cohort of neonatal deaths and near-death events. Archives of Disease in Childhood – Fetal and Neonatal Edition 2011 only included events within 12 hours of birth,  Poets A, Urschitz MS, Steinfeldt R, Poets CF: Risk factors for early sudden deaths and severe apparent life-threatening events. Archives of Disease in Childhood – Fetal and Neonatal Edition 2012, 97(6):F395-F397 also included events within 24 hours)

These cohorts had lower frequencies, from Becher in the UK about 5 per 100,000, and the incidence in Germany from Poets was 2.9 per 100,000.

Whatever the incidence it is quite uncommon, but devastating. Mortality is frequent, encephalopathy may occur and long term outcomes may be severely affected. although many will resuscitate quickly and do well. The new article reports use of therapeutic hypothermia, which I think is quite reasonable if there is encephalopathy. 

I think all babies should be observed during the first few hours after birth, the mother should not be left alone in a room with a baby on her chest, but non-intrusive observation to ensure that the baby is OK should be continuous. It could be the father if there is one and if he can stay awake, and is told to keep an eye on the baby. Oh and don’t use your smartphone while breast-feeding!

About Keith Barrington

I am a neonatologist and clinical researcher at Sainte Justine University Health Center in Montréal
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