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Sudden Unexpected Postnatal Collapse

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Presentation on theme: "Sudden Unexpected Postnatal Collapse"— Presentation transcript:

1 Sudden Unexpected Postnatal Collapse
AWHONN Virginia 2017 Section Conference

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

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

4 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

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

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

7 Risk Factors Maternal fatigue Maternal analgesia/anesthesia
Magnesium sulfate

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

9 Risk Factors Primiparous mother Parental distraction
Decreased surveillance by medical team

10 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

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

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

13 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

14 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

15 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

16 Questions?


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