Common patterns and trends in sudden unexpected neonatal collapse
The following relates to a study attempting to identify antecedents to a diagnosis of cerebral palsy by retrospectively analysing 1182 records from the no‐fault Japan Obstetric Compensation System for Cerebral Palsy database. The group identified 45 patients (3.8%) who were subsequently diagnosed with severe cerebral palsy due to sudden unexpected postnatal collapse (SUPC). All the patients were healthy at birth, based on the criteria of five‐minute Apgar scores of seven or more, with normal umbilical cord blood gases and no need for neonatal resuscitation within five minutes of birth (Miyazawa et al., 2019). A particularly interesting finding was that of the 45 patients, 10 developed sudden unexpected postnatal collapse during early skin‐to‐skin contact (SSC). Medical personnel were not present in all 10 cases: nine were being breastfed at the time and eight of the mothers did not notice their infant's abnormal condition until medical staff alerted them. This finding is relevant as the testimony given by the parents in this case is treated with particular sensitivity, owing to the traumatic circumstances of the case. However, such an approach may result in a failure to appropriately identify antecedents to later collapses. Similar to the case at CoCH, a higher proportion of the infants were male (57.8%), and issues with resuscitation were prevalent. Resuscitation was initiated within two hours of birth in 11 (24.4%) infants and within 24 hours of birth in 31 (68.9%) infants. More relevant to the case at CoCH, though, was the finding that of the ten infants that suddenly collapsed during skin-to-skin contact, eight developed SUPC during the night-time or in the early morning shift. In nearly every instance, the infants were being breastfed at the same time. This correlation between night-time feeding and collapse is not unique, as ~85% of SUPC occurs during the night-time hours and subsequent to the infant being fed (Blair et al., 2006).