Incidence of Sudden Unexpected Postnatal Collapse in the Therapeutic Hypothermia Era

Abstract

Objective Hypothermia is considered the treatment of choice for newborns with hypoxic-ischemic encephalopathy. Even though currently no consensus exists regarding the opportunity to extend this treatment also to newborns with sudden unexpected postnatal collapse (SUPC), this treatment is frequently adopted. The aim of the study was to evaluate whether the availability of hypothermia also for collapsed newborns in a tertiary level center may impact the estimated incidence of SUPC.

Study Design A retrospective study was performed comparing the number of newborns admitted with the diagnosis of SUPC in the tertiary referral Neonatal intensive care unit of Florence in the period before (2008–2010) and after (2011–2014) the introduction of hypothermia treatment for newborns with SUPC.

Result After introducing active cooling also to newborns with SUPC, the number of newborns with SUPC admitted to our center augmented and, consequently, SUPC incidence apparently increased from 5.3 to 15.5/100,000 live births, even though this difference did not reach statistical significance (odds ratio = 0.340; 95% confidence interval = 0.071–1.639; p = 0.179).

Conclusion The apparent increase of SUPC incidence is probably related to a more effective centralization of newborns in our referral center but suggests that the real incidence of SUPC is probably significantly higher than currently estimated.

Keywords

therapeutic hypothermia - SUPC - hypoxic-ischemic encephalopathy - newborn

• References

• 1 Pejovic NJ, Herlenius E. Unexpected collapse of healthy newborn infants: risk factors, supervision and hypothermia treatment. Acta Paediatr 2013; 102 (07) 680-688
• 2 Poets A, Steinfeldt R, Poets CF. Sudden deaths and severe apparent life-threatening events in term infants within 24 hours of birth. Pediatrics 2011; 127 (04) e869-e873
• 3 Guidelines for the Investigation of Newborn Infants Who Suffer a Sudden and Unexpected Postnatal Collapse in the First Week of Life: Recommendations from a Professional Group on Sudden Unexpected Postnatal Collapse. London, United Kingdom: WellChild; 2011
• 4 Becher JC, Bhushan SS, Lyon AJ. Unexpected collapse in apparently healthy newborns--a prospective national study of a missing cohort of neonatal deaths and near-death events. Arch Dis Child Fetal Neonatal Ed 2012; 97 (01) F30-F34
• 5 Byard RW. Breast feeding and unexpected neonatal and infant death. Arch Dis Child Fetal Neonatal Ed 2012; 97 (01) F75 . Doi: 10.1136/archdischild-2011-300804
• 6 Ludington-Hoe SM, Morgan K. Infant assessment and reduction of sudden unexpected postnatal collapse risk during skin-to-skin contact. Newborn Infant Nurs Rev 2014; 14: 28-33
• 7 Moore ER, Anderson GC, Bergman N, Dowswell T. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev 2012; (05) CD003519 . Doi: 10.1002/14651858.CD003519.pub4
• 8 Fleming PJ. Unexpected collapse of apparently healthy newborn infants: the benefits and potential risks of skin-to-skin contact. Arch Dis Child Fetal Neonatal Ed 2012; 97 (01) F2-F3
• 9 Jaafar SH, Lee KS, Ho JJ. Separate care for new mother and infant versus rooming-in for increasing the duration of breastfeeding. Cochrane Database Syst Rev 2012; (09) CD006641 . Doi: 10.1002/14651858.CD006641.pub2
• 10 Herlenius E, Kuhn P. Sudden unexpected postnatal collapse of newborn infants: a review of cases, definitions, risks, and preventive measures. Transl Stroke Res 2013; 4 (02) 236-247
• 11 Andres V, Garcia P, Rimet Y, Nicaise C, Simeoni U. Apparent life-threatening events in presumably healthy newborns during early skin-to-skin contact. Pediatrics 2011; 127 (04) e1073-e1076
• 12 Gatti H, Castel C, Andrini P. , et al. Cardiorespiratory arrest in full term newborn infants: six case reports [in French]. Arch Pediatr 2004; 11 (05) 432-435
• 13 Hays S, Feit P, Barré P. , et al. Respiratory arrest in the delivery room while lying in the prone position on the mothers' chest in 11 full term healthy neonates [in French]. Arch Pediatr 2006; 13 (07) 1067-1068
• 14 Dageville C, Pignol J, De Smet S. Very early neonatal apparent life-threatening events and sudden unexpected deaths: incidence and risk factors. Acta Paediatr 2008; 97 (07) 866-869
• 15 Rodríguez-Alarcón J, Melchor JC, Linares A. , et al. Early neonatal sudden death or near death syndrome. An epidemiological study of 29 cases. Acta Paediatr 1994; 83 (07) 704-708
• 16 Jacobs SE, Berg M, Hunt R, Tarnow-Mordi WO, Inder TE, Davis PG. Cooling for newborns with hypoxic ischaemic encephalopathy. Cochrane Database Syst Rev 2013; 1 (01) CD003311 . Doi: 10.1002/14651858.CD003311.pub2
• 17 Cornet MC, Maton P, Langhendries JP. , et al. Use of therapeutic hypothermia in sudden unexpected postnatal collapse [in French]. Arch Pediatr 2014; 21 (09) 1006-1010
• 18 Gancia P, Pomero G. Therapeutic hypothermia in the prevention of hypoxic-ischaemic encephalopathy: new categories to be enrolled. J Matern Fetal Neonatal Med 2012; 25 (Suppl. 04) 94-96
• 19 Wyckoff MH, Aziz K, Escobedo MB. , et al. Part 13: Neonatal Resuscitation: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015; 132 (18) (Suppl. 02) S543-S560
• 20 Filippi L, Poggi C, la Marca G. , et al. Oral topiramate in neonates with hypoxic ischemic encephalopathy treated with hypothermia: a safety study. J Pediatr 2010; 157 (03) 361-366
• 21 Sarnat HB, Sarnat MS. Neonatal encephalopathy following fetal distress. A clinical and electroencephalographic study. Arch Neurol 1976; 33 (10) 696-705
• 22 Leow JY, Platt MP. Sudden, unexpected and unexplained early neonatal deaths in the North of England. Arch Dis Child Fetal Neonatal Ed 2011; 96 (06) F440-F442
• 23 Tsao PC, Chang FY, Chen SJ. , et al. Sudden and unexpected and near death during the early neonatal period: a multicenter study. J Chin Med Assoc 2012; 75 (02) 65-69
• 24 Weber MA, Ashworth MT, Risdon RA, Brooke I, Malone M, Sebire NJ. Sudden unexpected neonatal death in the first week of life: autopsy findings from a specialist centre. J Matern Fetal Neonatal Med 2009; 22 (05) 398-404
• 25 Polberger S, Svenningsen NW. Early neonatal sudden infant death and near death of fullterm infants in maternity wards. Acta Paediatr Scand 1985; 74 (06) 861-866
• 26 Burchfield DJ, Rawlings DJ. Sudden deaths and apparent life-threatening events in hospitalized neonates presumed to be healthy. Am J Dis Child 1991; 145 (11) 1319-1322
• 27 Toker-Maimon O, Joseph LJ, Bromiker R, Schimmel MS. Neonatal cardiopulmonary arrest in the delivery room. Pediatrics 2006; 118 (02) 847-848
• 28 Feldman-Winter L, Goldsmith JP. ; Committee on Fetus and Newborn; Task Force on Sudden Infant Death Syndrome Safe sleep and skin-to-skin care in the neonatal period for healthy term newborns. Pediatrics 2016; 138 (03) e20161889 . Doi: 10.1542/peds.2016-1889
• 29 Davanzo R, De Cunto A, Paviotti G. , et al. Making the first days of life safer: preventing sudden unexpected postnatal collapse while promoting breastfeeding. J Hum Lact 2015; 31 (01) 47-52
• 30 Moon RY. ; Task Force on Sudden Infant Death Syndrome. SIDS and other sleep-related infant deaths: expansion of recommendations for a safe infant sleeping environment. Pediatrics 2011; 128 (05) 1030-1039