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Sudden Unexpected Postnatal Collapse
AWHONN Virginia 2017 Section Conference
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Defining the issue Sudden Unexpected Postnatal Collapse
Respiratory failure Cardiac Arrest Limpness, pallor, bradycardia, cyanosis Death Neurodevelopmental Impairment
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Defining the issue Sudden Unexpected Postnatal Collapse
Full term or near term infant Apgar of 8 or more at 5 minutes
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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
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Scope of the problem Distinguishing from other terminology:
Apparent life threating event (ALTE) Brief resolved unexplained event (BRUE) Sudden infant death syndrome (SIDS)
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Incidence Likely underreported
2.6 per 100,000 births to 133 per 100,000 births
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Risk Factors Maternal fatigue Maternal analgesia/anesthesia
Magnesium sulfate
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Risk Factors First Breastfeeding Newborn in prone position
Mother in supine position Maternal BMI >25 kg/m2 ***Baby friendly initiatives
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Risk Factors Primiparous mother Parental distraction
Decreased surveillance by medical team
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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
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Etiology Metabolic/Endocrine disorders Seizures Infection Galactosemia
Congenital adrenal hyperplasia Seizures Structural abnormality Hypoxic Ischemic Encephalopathy Neonatal epilepsy Infection GBS, E coli, Listeria HSV
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Resuscitation Warmer Activation of neonatal code NRP Access
Infant found limp, pale, cyanotic, bradycardic, apneic: Warmer Activation of neonatal code NRP Access
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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
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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
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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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