Sudden unexpected postnatal collapse (SUPC) is defined as a term or near-term infant (≥35 weeks’ gestation), who appears well at birth (with a five-minute Apgar score of seven or above and deemed suitable for routine postnatal care), who collapses unexpectedly and requires neonatal resuscitation. 40-50% of survivors have significant neonatal encephalopathy and neurodevelopmental sequelae.¹ Death occurs in over 50% of cases.^2,3,4

The aetiology of SUPC is unclear, with no cause identified in 40-60% of fatal cases.^2,5,6 In 40% of explained cases, an underlying condition was identified such as cardiac disease, congenital anomaly, intracranial haemorrhage or metabolic and endocrine disorders.^1,3,4

One third of reported SUPC events occur during the first two hours after birth, a further one-third occur between two and 24 hours after birth and one-third of cases occur between 24 hours and seven days after birth.² The median age for SUPC to occur is 70 minutes after birth for infants without an underlying pathology.⁵

The State Claims Agency’s Clinical Risk Unit identified five incidents related to SUPC on NIMS, the National Incident Management System, over one quarter as part of its incident surveillance process. Two infants were transferred for therapeutic hypothermia.

Case study

An infant was born with healthy Apgar scores and no signs of distress. Shortly after birth, the baby suddenly went pale in colour, collapsed, and required resuscitation. There was low lighting during delivery. The baby was breastfed after delivery while the mother was undergoing a procedure, and the baby was not clearly observed during this period. A review of the case found that there was a lack of awareness amongst staff that a sudden unexpected collapse of a term infant with normal Apgar scores could occur, with a consequent failure to adequately monitor the infant after delivery. The baby required therapeutic hypothermia.

Risk factors

There are a number of potential risk factors for SUPC, some of which are outlined below:^1,5,7

Evidence-based risk management advice

All staff providing care in the immediate postnatal period should be aware of the possibility of SUPC and the associated risk factors outlined above. In addition, the following actions are advised to minimise the risk of SUPC:

• Ensure appropriate observation of both mother and infant in adequate lighting, particularly in the first hour after birth, during skin-to-skin contact and the first breastfeed^2,6
• Provide education to parents/birthing partners on how to position their baby and how to assess its well-being²
• Encourage parents to raise any concerns or seek help, particularly when extremely fatigued⁸
• Ensure staff are familiar with neonatal resuscitation and have completed the Neonatal Resuscitation Programme (NRP)
• Ensure staff are familiar with the emergency bleep system

*The content of this article was informed by consultation with the HSE’s National Women and Infants Health Programme (NWIHP).

References available upon request.

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