PC3025: A Sudden Collapse in a Healthy Newborn Infant Within First Hour of Life

Introduction: Sudden unexplained postnatal collapse (SUPC) describes a phenomenon when a newborn suddenly experiences cardiopulmonary collapse after an uneventful delivery followed by spontaneous breaths. There is no current consensus on the definition of SUPC. In general, the diagnosis includes a healthy full-term infant with APGAR score 8 or higher at 5 minutes, not requiring resuscitation with positive pressure ventilation, who suffers from cardiopulmonary collapse within 12 hours of delivery, resulting in death or needing intensive care treatment. SUPC typically has poor outcomes, with up to half of the cases resulting in neonatal death and the other half ranging from poor neurologic outcome to full recovery.

Case Description: A 2.87 kg infant born at 39+1 weeks to a 31-year-old gravida 1, para 1 woman via spontaneous vaginal delivery with clear amniotic fluid. Patient’s APGAR scores were 8 and 9 at 1 and 5 minutes, respectively. The delivery was uneventful, and the patient began skin-to-skin and breastfeeding immediately after delivery. The Neonatal Intensive Care Unit (NICU) resident was called at 40 minutes of life when the nurse returned to the room and found the patient apneic, cyanotic, and limp. On arrival to the patient’s room, the NICU team consisting of the resident, respiratory therapist, and nurse, provided bag-mask ventilation to the patient, which improved the heart rate to greater than 100 bpm and oxygen saturation to 60%. Patient was quickly transitioned to non-invasive positive pressure ventilation and admitted to the NICU. The patient was initially found to be in heart failure requiring multiple pressors and had acute kidney injury. The patient’s creatinine normalized by hospital day 2. On hospital day 3 the patient was weaned to room air. Multiple pressors were discontinued on hospital day 4. Repeat echocardiogram showed good heart function. A MRI brain was obtained on hospital day 5 and showed no evidence of hypoxic-ischemic encephalopathy. Workup was negative for infectious, metabolic, neurologic, toxic, cardiac, or structural causes. A diagnosis of sudden unexplained postnatal collapse was made. The patient was discharged on day 9 of life from the hospital with outpatient follow up.

Discussion: SUPC is thought to be secondary to suffocation and asphyxia leading to cardiopulmonary collapse. It most commonly occurs during breastfeeding and skin-to-skin. During SUPC the infant may appear unresponsive, have color changes, bradycardia, or bradypnea. Risk factors for SUPC include first time mother, maternal fatigue, breastfeeding, skin-to-skin, maternal medication that causes drowsiness, maternal smoking during pregnancy, unsafe positioning, and distracted caregivers.

Conclusion: To best avoid SUPC, it is important to continuously monitor the infant for the first 2 hours after birth and provide education to the mother regarding the position during skin-to-skin and breastfeeding. It is also important to increase awareness of SUPC among physicians and nurses to mitigate the risk.