Analysis

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

BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.c5955 (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

References:

1. http://www.medscape.com/viewarticle/822017_2

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
EDMC
Civil Hospital Shahdra, New Delhi