Sudden Unexpected Postnatal Collapse: A Retrospective Cohort Study Describing Incidence, Risk Factors and Role of...

Area of Science:

• Neonatal Medicine
• Pediatric Cardiology
• Public Health

Background:

• Sudden unexpected postnatal collapse (SUPC) is a rare but devastating event in newborns.
• The incidence, risk factors, and underlying causes of SUPC remain poorly understood.
• Existing data on SUPC are limited, necessitating further investigation.

Purpose of the Study:

• To determine the incidence of SUPC in a large cohort of newborns.
• To identify key risk factors and potential etiological factors associated with SUPC.
• To inform preventative strategies for SUPC.

Main Methods:

• Retrospective cohort study of 483,284 infants born in Stockholm, Sweden (2002-2022).
• Screening of patient records for SUPC diagnoses, defined as collapse within 7 days of life in well-adapted neonates.
• Analysis of maternal, infant, and event characteristics; urine prostaglandin E2 (PGE2) metabolite levels in a subgroup.

Main Results:

• Identified 149 SUPC cases, an incidence of 31 per 100,000 live births, higher than early-onset Group B Streptococcus sepsis.
• 50% of SUPC events occurred within the first 4 postnatal hours; mortality was 7%, with 26% experiencing neurological sequelae.
• Peak risk for SUPC correlated with the postnatal surge in PGE2 levels.

Conclusions:

• All newborns are susceptible to SUPC, particularly within the first 24 hours post-birth.
• SUPC is associated with unsupervised skin-to-skin care and bed-sharing.
• Implementing safe sleep and supervised skin-to-skin care guidelines is vital for SUPC prevention.