AWHONN Virginia 2017 Section Conference Defining the issue Sudden Unexpected Postnatal Collapse Respiratory failure Cardiac Arrest Limpness pallor bradycardia cyanosis Death Neurodevelopmental Impairment ID: 589524
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Slide1
Sudden Unexpected Postnatal Collapse
AWHONN Virginia
2017 Section ConferenceSlide2
Defining the issue
Sudden
Unexpected Postnatal
Collapse
Respiratory failure
Cardiac Arrest
Limpness, pallor,
bradycardia
, cyanosis
Death
Neurodevelopmental Impairment
Slide3
Defining the issue
Sudden
Unexpected
Postnatal Collapse
Full term or near term infant
Apgar of 8 or more at 5 minutesSlide4
Defining the issue
Sudden Unexpected
Postnatal
Collapse
Greatest risk in first 2 hours of life
Up to 12 hours,
24 hours
, 3 days, 7 days of lifeSlide5
Scope of the problem
Distinguishing from other terminology:
Apparent life threating event (ALTE)
Brief resolved unexplained event (BRUE)
Sudden infant death syndrome (SIDS)Slide6
Incidence
Likely underreported
2.6 per 100,000 births to 133 per 100,000 birthsSlide7
Risk Factors
Maternal fatigue
Maternal analgesia/anesthesia
Magnesium sulfateSlide8
Risk Factors
First Breastfeeding
Newborn in prone position
Mother in supine position
Maternal BMI >25 kg/m
2
***
Baby friendly initiatives Slide9
Risk Factors
Primiparous
mother
Parental distraction
Decreased surveillance by medical teamSlide10
Etiology
Pneumothorax
Persistent pulmonary hypertension of the newborn
Trisomy 21
Meconium aspiration
Large for gestational age
Congenital diaphragmatic hernia
Cyanotic congenital heart disease
PDA closure
Arrhythmia
Structural anomaly
Maternal lupusSlide11
Etiology
Metabolic/Endocrine disorders
Galactosemia
Congenital adrenal hyperplasia
Seizures
Structural abnormality
Hypoxic Ischemic Encephalopathy
Neonatal epilepsy
Infection
GBS, E coli, Listeria
HSVSlide12
Resuscitation
Infant found limp, pale, cyanotic,
bradycardic
, apneic:
Warmer
Activation of neonatal code
NRP
AccessSlide13
Evaluation
Obstetric history
Family history
Labor details
Painting the picture of the collapse:
Who was present
Was infant feeding
How was infant
positioned
Physical exam
Laboratory
evaluation, including placental pathology
I
magingSlide14
Measures to decrease risk
Elevate head of mother’s bed to 35° to 80°
Back to sleep
Skin to skin: infant’s head turned to side, neck straight, nares uncovered
Verbal reinforcement of safe practices
Increased presence of medical team during first 2 hours after birthSlide15
Surveillance Protocol
RAPP assessment:
Respiratory Status
Activity
Perfusion
Position
Pennsylvania Hospital in Philadelphia:
Nursing for Women’s Health, Volume 20, Issue 3, June-July 2016Slide16
Questions?