AWHONN Practice Brief Number 8: Sudden Unexpected Postnatal Collapse in Healthy Term Newborns


  • In the first 2 hours after birth, all newborns in skin-to-skin contact and/or breastfeeding should be continuously monitored by qualified professional personnel, including nurses, nurse practitioners, physicians, and/or lactation consultants.
  • All healthy newborns with risk factors for sudden unexpected postnatal collapse (SUPC) should be frequently assessed during all skin-to-skin contact and breastfeeding sessions.
  • All caregivers should be taught safe positioning of the newborn to ensure airway protection.


Sudden unexpected postnatal collapse occurs in termor near-term (born at$37 weeks gestation) newborns who are healthy at birth, have 5-minute Apgar scores of 8 or more, and then experience cardiorespiratory collapse within the first week of life (Becher et al.,2012; Feldman-Winter et al., 2016; Herlenius &Kuhn, 2013; Miyazawa et al., 2019; Monnelly &Becher, 2018). Sudden unexpected postnatal collapse occurs when a spontaneously breathing newborn unexpectedly and suddenly becomes limp, pale orcyanotic, bradycardic, unresponsive, apneic, and/or hascardiac and/or respiratory failure and requires cardiopulmonary resuscitation (Becher et al., 2012;Herlenius & Kuhn, 2013; Poets et al., 2011). In a 2013review of 398 cases of SUPC reported in 26 articles published in English, French, and Spanish, Herleniusand Kuhn found that when a defined timeframe was reported, one-third of cases occurred in the first 2hours after birth, one-third occurred 24 hours afterbirth, and one-third occurred in the first 7 days afterbirth (Herlenius & Kuhn 2013). The incidence of SUPC in the United States is unknown. However, in2017, the World Health Organization reported that SUPC within the first 2 hours after birth was estimated to occur in between 1.6 and 5 cases per 100,000 live births with death rates of 0 to 1.1 per 100,000 live births.Sudden unexpected postnatal collapse can be synonymous with asphyxiation (Becher et al., 2012),suffocation, strangulation (Mollborg et al., 2015), an apparent life threatening event, or a brief resolved unexplained event (Tieder et al., 2016). The most common cause of SUPC is positional occlusion of the newborn’s airway (Becher et al., 2012); however, the cause may also be related to previously unknown newborn pathophysiology. Breastfeeding (Bass et al.,2016; Feldman-Winter et al., 2016; Friedman et al.,2015) and skin-to-skin contact (Bass et al., 2018;Herlenius & Kuhn, 2013; Ludington-Hoe & Morgan,2014) have been associated with SUPC