NURSES’ KNOWLEDGE OF SUDDEN UNEXPECTED POSTNATAL COLLAPSE (SUPC) AND SAFE NEWBORN POSITIONING

New York State as well as many other states have high rates of sudden unexpected infant death because of SUPC (Lambert et al., 2018). Global rates of SUPC have been reported as ranging from 2.6 to 133 cases per 100,000 live births (Feldman-Winter & Goldsmith, 2016). Sudden unexpected postnatal collapse happens when a spontaneously breathing newborn unexpectedly becomes apneic and needs cardiopulmonary resuscitation. The most commonly used definition of SUPC, is a newborn who had a 5-minute Apgar score of eight or more out of a total of ten, who then experiences cardiorespiratory collapse from five minutes post-birth through the first seven days post-birth during SSC and/or breastfeeding (Herlenius & Kuhn, 2013; Pejovic & Herlenius, 2013). Bass et al. (2018) reported the definition of SUPC as a newborn with an Apgar score of seven or more at ten minutes who collapses suddenly. Due to a variability in the Apgar score criterion that is part of the definition and variability in the timing of the SUPC’s occurrence, a uniform definition of SUPC has not yet been determined (Ludington-Hoe, Morrison-Wilford, DiMarco, & Lotas, 2018). Thus, the incidence of SUPC varies widely because of NURSES’ KNOWLEDGE OF SUPC AND SAFE NB POSITIONING 3 different definitions, varying inclusion and exclusion criteria of newborns who experience SUPC, and the lack of standardized reporting (Davanzo et al., 2015). In a series of cases described by Pejovic & Herlenius (2013), one-third of SUPC events occurred in the first two hours of life, one-third between two and twenty-four hours post-birth, and the final third between one and seven days post-birth. Risk factors for SUPC (e.g., maternal fatigue, primiparity, distractions, maternal obesity and newborn side-lying beside mother) have been identified (Garofalo et al., 2018; Ludington-Hoe & Morgan, 2014; Rodriguez, Hageman & Pellerite, 2018). Sudden unexpected postnatal collapse can occur when the newborn is held in SSC, breastfeeding (Gnigler et al., 2013; Herlenius & Kuhn, 2013; Pejovic & Herlenius, 2013), or when swaddled and being held by anyone (Becher et al., 2012). Because of the possibility of newborn deaths and morbidity, recommendations have been made for continuous bedside monitoring of the newborn by professional personnel throughout hospitalization (Feldman-Winter & Goldsmith, 2016). In conjunction with continuous bedside monitoring, further recommendations have been made for professional personnel to educate parents who are with or holding a newborn, particularly during the first week of the newborn’s life, on how to safely position newborns to prevent SUPC (Feldman-Winter & Goldsmith, 2016; Ludington-Hoe & Morgan, 2014). Problem and Purpose A need for professional nursing education about safe newborn positioning, especially during holding, exists, similar to other emerging nursing care practices (Goswami et al., 2018). For example, 200 nurses needed education in New York NURSES’ KNOWLEDGE OF SUPC AND SAFE NB POSITIONING 4 University (NYU) Langone Health to reduce the incidence of SUPC (Imossi, Barber, Fava & Gauthier, 2018) as did professional staff in Christiana Healthcare System in Delaware that reported a decrease in SUPCs from five to zero (Pearlman, Igboechi & Paul, 2017). Another testimony to the need for education is a recent report of a task force in the University Health System in Illinois that organized an educational program to teach staff how to educate parents about proper, distraction-free positioning of their newborns to prevent SUPC (Garofalo et al., 2018). Validati