Sudden Unexpected Postnatal Collapse AWHONN Virginia 2017 Section Conference

Defining the issue Sudden Unexpected Postnatal Collapse Respiratory failure Cardiac Arrest Limpness, pallor, bradycardia, cyanosis Death Neurodevelopmental Impairment

Defining the issue Sudden Unexpected Postnatal Collapse Full term or near term infant Apgar of 8 or more at 5 minutes

Defining the issue Sudden Unexpected Postnatal Collapse Greatest risk in first 2 hours of life Up to 12 hours, 24 hours, 3 days, 7 days of life

Scope of the problem Distinguishing from other terminology: Apparent life threating event (ALTE) Brief resolved unexplained event (BRUE) Sudden infant death syndrome (SIDS)

Incidence Likely underreported 2.6 per 100,000 births to 133 per 100,000 births

Risk Factors Maternal fatigue Maternal analgesia/anesthesia Magnesium sulfate

Risk Factors First Breastfeeding Newborn in prone position Mother in supine position Maternal BMI >25 kg/m2 ***Baby friendly initiatives

Risk Factors Primiparous mother Parental distraction Decreased surveillance by medical team

Etiology Pneumothorax Persistent pulmonary hypertension of the newborn Trisomy 21 Meconium aspiration Large for gestational age Congenital diaphragmatic hernia Cyanotic congenital heart disease PDA closure Arrhythmia Structural anomaly Maternal lupus

Etiology Metabolic/Endocrine disorders Seizures Infection Galactosemia Congenital adrenal hyperplasia Seizures Structural abnormality Hypoxic Ischemic Encephalopathy Neonatal epilepsy Infection GBS, E coli, Listeria HSV

Resuscitation Warmer Activation of neonatal code NRP Access Infant found limp, pale, cyanotic, bradycardic, apneic: Warmer Activation of neonatal code NRP Access

Evaluation Obstetric history Family history Labor details Painting the picture of the collapse: Who was present Was infant feeding How was infant positioned Physical exam Laboratory evaluation, including placental pathology Imaging

Measures to decrease risk Elevate head of mother’s bed to 35° to 80° Back to sleep Skin to skin: infant’s head turned to side, neck straight, nares uncovered Verbal reinforcement of safe practices Increased presence of medical team during first 2 hours after birth

Surveillance Protocol RAPP assessment: Respiratory Status Activity Perfusion Position Pennsylvania Hospital in Philadelphia: Nursing for Women’s Health, Volume 20, Issue 3, June-July 2016

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