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A 36-week gestation infant was delivered vaginally to a primipara with uncomplicated antenatal period. The baby was well following delivery and was admitted to the postnatal ward with the mother. At 2 hours of life, a registered nurse attended the mother and baby for routine care and found the newborn on mother’s chest, in the skin-to-skin position, with no spontaneous respiration. The baby was bradycardic and required full resuscitation including intubation and cardiac massage. The heart rate normalised but respiratory effort remained poor and ongoing ventilation was required. She was noted to be encephalopathic with an abnormal neurological examination. The patient was transferred to the neonatal intensive care unit following stabilisation and, after discussion with the parents, initiated on therapeutic hypothermia (TH). No apparent cause for the significant collapse was found; there was no pneumothorax, ECG and echocardiography were normal, septic markers and metabolic workup were normal and amplitude integrated EEG did not indicate seizures. The 72-hour TH protocol was completed and the patient was clinically well following rewarming. MRI brain did not show significant abnormalities and the baby was subsequently discharged. She continues to be followed up for neurodevelopmental assessment as an outpatient.
Structured clinical question
Is therapeutic hypothermia (TH) safe in infants following sudden unexpected postnatal collapse (SUPC)?
Search strategy and outcome
MEDLINE using PubMed (1966–August 2022), EMBASE via Ovid (1980–August 2022), CINAHL (1961–August 2022) and Google Scholar (through to August 2022) were searched for evidence related to TH in SUPC using (Sudden Unexpected Postnatal Collapse/SUPC and ‘Infant, Newborn’ (MeSH) and ‘Hypothermia, Induced’ (MeSH)) and similar keywords. The search yielded 126 articles, and following title, abstract screening and removal of duplicates, seven were eligible. All references were cross-checked for key articles. No randomised controlled trials (RCTs) were available; therefore, case series, retrospective studies and case reports were all eligible for inclusion. All included papers had neonates …
Contributors CAM: Reviewed literature, compiled manuscript and edited manuscript. MIO: Reviewed literature and contributed to manuscript. GA-J: Reviewed literature and contributed to manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.