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• Newborn infants in hospital should also benefit from SIDS prevention measures
  Julie-Clare Becher
  Published on: 22 March 2016

• Published on: 22 March 2016

  Newborn infants in hospital should also benefit from SIDS prevention measures

  • Julie-Clare Becher, Consultant Neonatologist
  • Other Contributors:
    • Andrew J Lyon

  Leow et al (1) report the incidence of sudden, unexpected and unexplained early neonatal death in a retrospective population-based study as 0.35/10,000 live births. The authors conclude that such deaths occur more rarely than previously appreciated and as such 'extra intrusive supervision' following birth is not justified.

  Although SUNC and related-death is rare, it is important to highlight aspects which may co...

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  Leow et al (1) report the incidence of sudden, unexpected and unexplained early neonatal death in a retrospective population-based study as 0.35/10,000 live births. The authors conclude that such deaths occur more rarely than previously appreciated and as such 'extra intrusive supervision' following birth is not justified.

  Although SUNC and related-death is rare, it is important to highlight aspects which may contribute to under-recognition. The natural history of SUNC is that infants who are in a state of extremis are subsequently successfully resuscitated before dying from hypoxic-ischaemic sequelae. Traditionally the cause of death is certified according to the subsequent manifestations despite the cause of collapse being unexplained. Retrospective data collection fails to identify these infants and will underestimate the incidence of such deaths. The recently published UK and German surveillance studies of sudden unexpected neonatal collapse (SUNC) within 12-24 hours of birth, reported mortality as 0.11-0.14/10,000 (2) (3) and CEMACH data confirms a rate of 0.66/10,000 for neonatal deaths in the first week where the cause was certified 'unknown' or secondary to SIDS (4).

  Secondly it is increasingly recognised that many infants collapse in circumstances suggestive of accidental asphyxiation, and therefore although their deterioration is sudden and unexpected, there is a postulated explanation. Such infants accounted for around half of all those in the UK surveillance study and their contribution to unexpected deaths should not be discounted despite there being a putative clinical cause.

  In addition to the mortality from SUNC, many survivors suffer longterm neurological disability. Moreover, around a third of newborns who collapse unexpectedly do so because of an underlying condition, the outcome of which may be modified by earlier identification. A growing body of literature describes a high incidence of risk factors which are common to conventional SIDS. These include prone positioning, maternal sedation and co-sleeping (2,3). For newborn infants receiving postnatal care under the responsibility of the NHS, the authors deem that 'extra intrusive supervision' is unjustified, but have not considered that sensible recommendations about easily modifiable risk factors could be applied universally to newborns however rare SUNC appears to be.

  (1) Leow JY, Ward Platt MP. Sudden, unexpected and unexplained early neonatal deaths in the North of England Arch Dis Child Fetal Neonatal Ed 2011;96:F440-F442 (2) Becher JC, Bhushan SS, Lyon AJ. Unexpected collapse in apparently healthy newborns - a prospective national study of a missing cohort of neonatal deaths and near-death events. Arch Dis Child Fetal Neonatal Ed. 2011 Jun 28. [Epub ahead of print] (3) Poets A, Steinfeldt R, Poets CF. Sudden deaths and severe apparent life-threatening events in term infants within 24 hours of birth. Pediatrics. 2011;127:e869-73. (4) Dominic Acolet, CEMACH, personal communication, 2007

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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