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

Article Content

In this issue of MCN, two articles focus on newborn safety in the hospital setting. In "Sudden Unexpected Postnatal Collapse Resulting in Newborn Death in the United States", Dr. Anderson and her team used a database of ~41 million births in the United States from 2003 to 2013 to identify and describe over 31,000 babies who experienced sudden unexpected infant death within their first year. A subset of these deaths (n = 616) were noted to have occurred in the first week of life and thus were categorized as sudden unexpected postnatal collapse (SUPC). In general, SUPC is defined as any healthy term, or near term, newborn who collapses unexpectedly, that is, found in a condition requiring resuscitation with intermittent positive pressure ventilation, collapses within the first 7 days of life, and either dies, goes on to require intensive care, or develops an encephalopathy. The researchers found characteristics of these babies and their mothers differed from those who died after the first week of life. Approximately 22% of the SUPC deaths occurred in the hospital setting when considering average length of stay for mothers based on whether they had a vaginal or cesarean birth. These are important data with major significance for safe inpatient maternity nursing care.


Knipper and colleagues describe a program implemented in two maternity units in hospitals in one health care system to identify near-miss events of baby drops or falls and to develop preventive strategies in "What a Catch: Safety Intervention to Reframe Newborn Falls and Drops." This nurse-led project generated substantial data about conditions during mother-baby care in the inpatient setting that increase risk of harm to newborns. Their approach is described in detail so other maternity units can adopt all or part of their safety program.


Injury or death of a healthy newborn in the hospital setting is a preventable tragedy if it involves baby suffocation during skin-to-skin positioning, breastfeeding, or other types of baby holding, missed signs of newborn deterioration, baby drops by parents or health care professionals, or baby falls. As a consultant for perinatal patient safety for hospitals and health care systems across the country for 25+ years, I have reviewed too many of these types of cases. Because they are relatively rare, not enough attention is devoted to their prevention. The implications for the mother, parents, their families, and health care professionals are devastating and life-long. Imagine a new mother on narcotics recovering from an unplanned cesarean after a long labor, left alone holding her newborn for hours, who inadvertently falls asleep and wakes up realizing her baby is no longer breathing as his airway has been compromised by positioning. This is most certainly not her fault, but often is portrayed as such to minimize hospital liability. Consider the guilt and emotional damage she will suffer, along with her family and involved health care professionals. We can do better in preventing these events.


The articles highlight critical recommendations from professional organizations to keep newborn babies safe in the hospital. All require adequate nurse staffing, for example, continuous nurse presence at the bedside with attention to the mother and newborn during the 2-hour recovery period, hourly rounding on mother-baby couplets (every 30 minutes for high-risk mothers and babies), availability of a respite nursery staffed by a registered nurse, patient and family education about safe baby positioning while holding and in the bassinet and safe sleep, and a robust reporting system for near-misses and event. Patient assignment should not include more than three healthy mother-baby couplets for each registered nurse. Patient complexity may indicate a less acute assignment in some cases. There are situations where one nurse to two mother-baby couplets is safer care; for example, the mother or baby needs much more nursing attention than routine. This topic has not received the attention it deserves. We are pleased to offer these articles for your review and hope they will generate clinical practice review and change as needed.