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Post-labour events

 

Cause identified in review

Number of babies

Neonatal collapse

12

Unexplained

6

Congenital alveolar dysplasia

1

Hyperinsulinaemia

1

Infection

1

Persistent pulmonary hypertension of the newborn

1

Pulmonary haemorrhage – cause unknown

1

Ruptured arteriovenous malformation

1

Difficulty with resuscitation

2

 

 

Difficulty with resuscitation

 

Situation

A mother presented with ruptured membranes. As she was not in labour, she opted – after adequate counselling – for expectant management and was discharged home. Labour did not start spontaneously and so she underwent induction of labour.

As the baby was not delivered after 1 hour of active second stage and the baby was in the occipito-posterior position, the mother consented to a trial of instrumental delivery in theatre.

The baby was delivered by an uneventful rotational ventouse delivery with the paediatrician present. The cord gases were normal. The baby was floppy with poor respiratory effort and a heart rate of over 100 beats/minute. Initially, inflation breaths did not produce chest rise and so the paediatric registrar reassessed the baby. Using a laryngoscope, copious secretions and a large mucus plug were suctioned under direct vision. The baby was stabilised and transferred to the tertiary unit for active cooling.

Grade II HIE was diagnosed, but the baby had no seizures, established breastfeeding and a normal MRI scan.

Commentary

Neonatal resuscitation such as this requires skill and lateral thinking when inflation breaths are not ventilating the baby’s lungs. In this situation, the paediatrician used their skills to maximum effect to deal with an unexpected situation.

 

 

Neonatal collapse

 

Situation

A mother was admitted for induction of labour for reduced fetal movements. The induction was unsuccessful and so she was consented for a caesarean section.

The baby was delivered in good condition with normal gases and was assessed by the paediatrician present for the delivery. Whilst the mother was breastfeeding, the baby was found to be pale and not making any respiratory effort. No heartbeat was detected on the arrival of the paediatric team. Neonatal resuscitation was commenced and the baby was intubated. A heart rate was established and the baby was transferred to the neonatal unit for active cooling. However, the baby had suffered a profound hypoxic brain injury and the decision was made to withdraw care.

Commentary

Neonatal collapse is a devastating and largely unpredictable event. Infection, anaemia or underlying cardiac or metabolic disorders can be the cause in some babies,[i] but in just under half of these babies, such as with this baby, no cause can be identified.[ii] [iii] It can be difficult for healthcare professionals and families to accept that, despite best efforts and evidence-based care, some apparently healthy babies have serious complications, which in some cases lead to the baby’s death.

 

 


[i] Herlenius E, Kuhn P. Sudden unexpected postnatal collapse of newborn infants: a review of cases, definitions, risks, and preventive measures. Transl Stroke Res 2013;4(2):236–47.

[ii] Weber MA, Ashworth MT, Risdon RA, Brooke I, Malone M, Sebire NJ. Sudden unexpected neonatal death in the first week of life: autopsy findings from a specialist centre. J Matern Fetal Neonatal Med 2009;22(5):398–404.

[iii] Eric Herlenius, Pierre Kuhn. Sudden Unexpected Postnatal Collapse of Newborn Infants: A Review of Cases, Definitions, Risks, and Preventive Measures. Translational Stroke Research 2013; 4(2): 236–247. Available from: doi: 10.1007/s12975-013-0255-4. [Accessed on 29th May2017]