Steph borg 17 may 2012
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SCH Medics Journal Club Unexpected collapse in apparently healthy newborns – a prospective study of a missing cohort of neonatal deaths and near death events. Steph Borg 17 May 2012. SUPC is rare in infants How often does it occur? What are the causes? Jessop guidelines include

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Steph Borg 17 May 2012

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Steph borg 17 may 2012

SCH Medics Journal ClubUnexpected collapse in apparently healthy newborns – a prospective study of a missing cohort of neonatal deaths and near death events

Steph Borg

17 May 2012


Steph borg 17 may 2012

  • SUPC is rare in infants

    • How often does it occur?

    • What are the causes?

  • Jessop guidelines include

    • Immediate care of the newborn

    • Bed sharing and co-sleeping guideine


Search

Search

Sudden OR unexpected AND

Neonatal OR postnatal AND

Collapse or death

Limit to English Language and humans and age <1 month

199 results


Result

Result

Unexpected collapse in apparently healthy newborns – a prospective study of a missing cohort of neonatal deaths and near death event

J-C Becher, S Bhushan & A Lyon

Arch Dis Child Fetal Neonatal Ed 2012 97:F30-F34


Analysis

Analysis


Analysis1

Analysis

“We sought to establish the population incidence of sudden unexpected postnatal collapse (SUPC) in apparently healthy infants within the UK to describe situational factors and the cause for collapse was determined”

  • Population –

    • infants ≥37/40

    • Apgar score of ≥ 8 at 5mins

    • Collapse within 12hrs of birth in hospital requiring resuscitation with PPV and died or received ongoing intensive care


Analysis2

Analysis

  • Risk factors

    • Maternal sedation

    • Breastfeeding/prone position

    • Unattended

    • Underlying disease/pathology

  • Outcomes

    • Incidence of death and collapse

    • Identification of cause of death

    • Neurological follow up at 1 year


Analysis3

Analysis

  • Yes

    • A method of establishing an association between exposure and outcome by following a population over time


Analysis4

Analysis

  • Cases referred to BPSU over 13 months 2008-2009

    • Active surveillance via network of 3000 paediatricians

    • Response rate 94.6%

    • When cases identified further information collected from clinicians

  • Could not verify if all cases reported

  • Study incidence may be underestimate


Analysis5

Analysis

Exposure to risk factors identified retrospectively from BPSU collected data

Ix performed decided by clinical time at the time – not consistent

Cases were anonymised to study team


Analysis6

Analysis


Analysis7

Analysis

  • Study incidence may be underestimated

  • 4 excluded cases due to uncertain eligibility

  • Ix to cause of collapse not always successful

    • 1 death – no cause found and no PM

    • 5 cases no cause identified

  • Clinical judgment of cause where no objective cause identified

  • Outcome data for all surviving cases available


Steph borg 17 may 2012

  • All infants surviving to discharge followed up at 1 yr with neurological assessment

  • Is age 1 yr too early to assess for long term developmental/neurological outcome?


Results

Results

  • 91 cases referred,

    • 32 errors

    • 10 duplications

    • 4 excluded

  • 45 infants of SUPC included

    • 12 (27%) died

    • 33 survived to discharge

  • Population incidence of SUPC in first 12 hours 0.05/1000 (1 in 19000) term live births

  • Mortality 0.01/1000 (1/72000) term live births

  • Where no underlying disease or abnormality id’d population incidence 0.035/1000 (1/29000) term live births


Results1

Results

  • Characteristics of mother, labour and delivery

    • Infants with an underlying condition (n=15)

      • 10 (67%) primiparous

      • Non smokers and healthy

      • 6 SVD, 3 instrumental, 6 LSCS

    • Infants without an underlying condition (n=30)

      • 23 (77%) primiparous

      • 2 smokers, 4 PIH, 8 health professionals


Results2

Results

  • Characteristics of infant

    • 22 (49%) male

    • Mean gestational age 40/40 (range 37-42 weeks)

    • Mean birthweight 3328g (range 2260g-4030g)

    • Apgar of 8 or above at 5 mins

    • Routine postnatal care


Results causes of collapse

Results – causes of collapse


Results following collapse

Results – Following collapse

  • All infants required PPV

  • 22 received CPR

  • 10 received resuscitation drugs

  • 2 died immediately

    • 1 sepsis

    • 1 TGA

  • 43 admitted to neonatal unit

    • Median pH within 1 hr 6.98 ( IQR 6.8-7.18)

    • Median base deficit 17.7mmol/l (IQR 11.4-23.5)

    • 23 multiorgan dysfunction

    • 17 single organ dysfunction


Results infants w o underlying condition

Results – infants w/o underlying condition


Results deaths

Results - deaths

  • 12/45 infants died

  • 10/12 underwent postmortem

    • Underlying cause found in 5 (50%)

      • 2 sepsis; TGA; unidentified metabolic condition; parvovirus

    • No underlying cause found

      • Apparent asphyxiation as per pathologist/clinician

  • 2/10 no PM

    • hyoplastic left heart on echo pre mortem

    • collapse following presumed suffocation – consent for PM not given


Results survivors

Results - survivors

  • 33/45 survived to discharge

    • 8 (24%) neurological abnormalities at 1yr f/u

      • 3 had underlying cause for collapse identified

      • Zellweger’s syndrome

      • Cerebral infarction

      • Culture negative sepsis


Results survivors1

Results – survivors

  • 30 infants with no underlying cause/disease

  • 19/24 presumed accidental suffocation survived to discharge

    • 5 had neurological abnormality at 1 yr f/u

      • 3 with cerebral palsy

      • 1 with probable cerebral palsy

      • 1 with mild global delay and hypotonia

  • 6 infants with no cause identified normal at follow up

    • (but 1 died..)


Results3

Results

There is no statistical analysis in this study


Results4

Results

Results as accurate as medical records kept

Clinical decisions on cause of collapse may be subjective

6/45 infants no cause for collapse identified


Will the results help me locally

Will the results help me locally

  • Yes – Jessop provides care to term babies with Apgars >8 at 5 mins

  • Currently have pathways in our guidelines re

    • Co-sleeping and bed sharing

    • Prevention, detection and management of known risks of hypoglycaemia, GBS


Steph borg 17 may 2012

The first study to document the population incidence in the UK of SUPC in infants assessed as being healthy at birth

Previous case series document risks of accidental suffocation


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