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?