Six months of exclusive breast feeding: how good is the evidence?

BMJ 2011; 342 doi: (Published 13 January 2011) Cite this as: BMJ 2011;342:c5955

Re: Six months of exclusive breast feeding: how good is the evidence?

Sudden Unexpected Postnatal Collapse is a condition in which a previously vigorous, spontaneously breathing infant who had a five-minute Apgar of 8 or more, unexpectedly becomes apneic, often necessitating full resuscitation(1). Sudden collapse has also been defined as acute cyanosis/pallor and unconsciousness, requiring bagging, intubation and/or cardiac compressions and has been found to commonly occur with breastfeeding of the newborn(1).
Estimated incidence of the SUPC of a presumably healthy infant after birth differs widely, ranging from 2.6 cases to 133 cases/100,000(2).
SUPC in apparent healthy babies is associated with initial, unsupervised breastfeeding, prone position, primiparity and distractions. Guidelines outlining the appropriate monitoring of newborns and safe early skin-to-skin contact should be implemented(3). The assessment tool is called the Respiratory, Activity, Perfusion, and Position tool (RAPP. The Medscape emphasizes need to monitor RAPP(1).

Components of a safe positioning checklist should include the following (1):

Mother or provider of SSC is in reclining position, not flat

Infant's back is covered and hair is dry

Infant is well-flexed on provider's chest

Infant's shoulders are flat against provider's chest

Infant is chest-to-chest with provider, not over a breast

Infant's head is turned to one side

Infant's face can be seen

Infant's nose and mouth are visible and uncovered
Infant's neck is straight, not bent



2. Herlenius E, Kuhn P. Sudden unexpected postnatal collapse of newborn infants:
a review of cases, definitions, risks, and preventive measures. Transl Stroke
Res. 2013 Apr;4(2):236-47. doi: 10.1007/s12975-013-0255-4. Epub 2013 Feb 23.

3. Pejovic NJ, Herlenius E. Unexpected collapse of healthy newborn infants: risk
factors, supervision and hypothermia treatment. Acta Paediatr. 2013
Jul;102(7):680-8. doi: 10.1111/apa.12244. Epub 2013 Apr 30.

Competing interests: No competing interests

31 May 2014
Kishan Kumar Jani
Chief Medical Officer
Neeru Gupta
Civil Hospital Shahdra, New Delhi