1. Simpson, Kathleen Rice PhD, RNC, CNS-BC, FAAN

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In 2015, in the United States, approximately 3,700 infants died suddenly and unexpectedly (Centers for Disease Control and Prevention [CDC], 2017). Sudden unexpected infant death (SUID) is the death of an infant less than 1 year old that occurs suddenly and unexpectedly, and whose cause of death is not immediately obvious before investigation (CDC). The majority of SUID cases are reported as one of three types: sudden infant death syndrome (SIDS), accidental suffocation and strangulation in bed (ASSB), and unknown cause. Infant deaths from SUID declined sharply during the 1990s, in part due to the Back to Sleep Campaign initiated in 1994, and have remained generally stable since 2000 (CDC; Parks, Lambert, & Shapiro-Mendoza, 2017). However, the SUID rate increased slightly from 87.5 deaths per 100,000 live births in 2014 to 92.6 deaths per 100,000 live births in 2015. Since about 2000, types of SUID deaths have changed; deaths from ASSB and unknown causes have increased, whereas SIDS deaths have decreased. The cause for the change is unknown, but could be due to better data collection and stricter adherence to SIDS definitions (CDC).


Some of these deaths, including accidental suffocation, occur in the hospital setting after birth, although the CDC (2017) data do not report specific location and timing based on days of age. Other researchers have noted that the first 2 hours after birth is a time of risk and may be related to a "potentially asphyxiating position" during skin-to-skin care or breastfeeding (Belcher, Bhushan, & Lyon, 2012; Dageville, Pignol, & De Smet, 2008; Pejovic & Herlenius, 2013; Poets & Poets, 2011). These deaths are often classified as sudden unexpected postnatal collapse (SUPC) (Belcher et al.; Pejovic & Herlenius) due to hours of age and health status of the newborn. Risk factors for SUPC have been identified through several large series of case reports. They include first 2 hours of life, prone position of baby, asphyxiating position, skin-to-skin care, unsupervised breastfeeding during first 2 hours of life, a gap of >15 minutes during which the baby was unobserved by a caregiver, being unattended by clinical staff, mother and baby left alone during the recovery period, primiparous mothers, maternal fatigue, and maternal distractions such as smartphone use while holding the baby (Belcher et al.; Dageville et al.; Pejovic & Herlenius; Poets & Poets). Other risk factors identified in reported cases include cesarean birth, maternal obesity, mother receiving narcotics, and lack of availability of a well-baby nursery or lack of a nurse to staff this nursery. These data outlining risk factors support current recommendations of continuous bedside attendance by nurses for mothers and babies during the 2 hour recovery period, and regular (including every 30 minutes for high-risk mothers and babies) monitoring of mother-baby couplets during postpartum hospitalization (American Academy of Pediatrics, 2016; Association of Women's Health, Obstetric and Neonatal Nurses, 2010).




American Academy of Pediatrics. (2016). Safe sleep and skin-to-skin care in the neonatal period for healthy term newborns (Clinical Report). Pediatrics, 138(3), e20161889. doi:10.1542/peds.2016-1889 [Context Link]


Association of Women's Health, Obstetric and Neonatal Nurses. (2010). Guidelines for professional registered nurse staffing for perinatal units. Washington, DC: Author. [Context Link]


Belcher J. C., Bhushan S. S., Lyon A. J. (2012). Unexpected collapse in apparently healthy newborns: A prospective national study of a missing cohort of neonatal deaths and near-death events. Archives in Disease in Childhood, Fetal and Neonatal Edition, 97(1), F30-F34. doi:10.1136/F30 adc.2010.208736 [Context Link]


Centers for Disease Control and Prevention. (2017). Sudden unexpected infant death. Atlanta, GA: Author. [Context Link]


Dageville C., Pignol J., De Smet S. (2008). Very early neonatal apparent life-threatening events and sudden unexpected deaths: Incidence and risk factors. Acta Paediatrica, 97(7), 866-869. doi:10.1111/j.1651-2227.2008.00863.x [Context Link]


Parks S. E., Lambert A. B. E., Shapiro-Mendoza C. K. (2017). Racial and ethnic trends in sudden unexpected infant deaths: United States, 1995-2013. Pediatrics, 139(6), e20163844. doi:10.1542/peds.2016-3844 [Context Link]


Pejovic N. J., Herlenius E. (2013). Unexpected collapse of healthy newborn infants: Risk factors, supervision, and hypothermia treatment. Acta Paediatrica, 102(7), 680-688. doi:10.1111/apa.12244 [Context Link]


Poets A., Poets C. F. (2011). Sudden deaths and severe apparent life-threatening events in term infants within 24 hours of birth. Pediatrics, 127(4), e869-e873. doi:10.1542/peds.2010-2189 [Context Link]