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

AIM: This study aimed to investigate the incidence, risk factors and possible aetiology of sudden unexpected postnatal collapse (SUPC), a potentially fatal yet poorly understood event.

METHODS

In a retrospective cohort, patient records from 483 284 infants born in Stockholm, Sweden, between 2002 and 2022 were screened for SUPC-related diagnoses. SUPC was defined as a collapse within the first 7 days of life in near-term infants with good postnatal adaptation. Maternal, infant and event characteristics were collected. Urine was analysed for prostaglandin E2 (PGE2) metabolites in a subgroup of cases.

RESULTS

We identified 149 cases of SUPC, corresponding to an incidence of 31 per 100 000 live births, exceeding that of early onset sepsis caused by Group B Streptococcus. Half the SUPC cases occurred during the first four postnatal hours. The mortality was 7% and 26% suffered from neurological sequelae. The highest risk of SUPC coincided with the postnatal peak in PGE2 levels.

CONCLUSION

All newborn infants were at risk of SUPC, especially within 24 h of birth. SUPC was associated with early unsupervised skin-to-skin care and bed sharing. Guidelines promoting safe sleep and skin-to-skin care should be implemented to prevent SUPC and save the lives of newborn babies.