Sudden Unexpected Postnatal Collapse

Identified as a group by BPSU, led by Julie-Clare Becher in Edinburgh.  As with SUDI, previously well appearing baby suddenly suffers cardiorespiratory failure, with death or severe neurological disability as a result.

Her 2011 report highlighted an association with prone position and breast feeding.  One third of of cases had an underlying pathological or clinical condition but over half probably due to accidental suffocation, frequently unrecognised by parents themselves.

Some suggestion that cases are underreported, and that cases are increasing due to increased early skin-skin practices without adequate supervision.  In a big survey from Sweden, most happen within first 2 hours of birth, often during first breast feeding attempt.

The process of referral to procurator fiscal, bereavement support, prolonged delay in post mortem report etc is common to SUDI, even if only a few of the underlying risk factors are shared.

A BAPM protocol is available, detailing elements of history eg family tree, drug/alcohol/smoking history, obstetric history; plus investigations eg Kleihauer, placental histology, skeletal survey, PHOX2B gene (congenital central hypoventilation syndrome), fibroblast culture from skin biopsy.  In a death, most if not all should be done routinely by pathology.

In terms of prevention, standard SUDI precautions are emphasized – avoid prone position, co-bedding, head covering, beware sedating drugs etc.  Education of parents regarding warning signs and upper airway control.  Better non-obtrusive monitoring.

[Arch Dis Child Fetal Neonatal Ed 2012;97:F30−F34. doi:10.1136/F30 adc.2010.208736; Translational Stroke Research , Volume 4, Issue 2, pp 236-247]