Sudden and unexpected and near death during the early neonatal period: a multicenter study

Background: To investigate the incidence, clinical presentation and possible etiologies or risk factors of early onset of sudden and unexpected death or near-miss.

Methods: From 2001 to 2005, a retrospective analysis of observational database of neonates who were younger than one week old without any risk factors at five tertiary medical centers. The demographic data, clinical manifestations, laboratory data and possible etiologies were retrospectively collected and analyzed.

Results: Seventeen neonates presumed to be healthy at birth encountered early near death in five medical centers in Taipei city. The mean gestation age (GA) was 38.5 ± 1.2 weeks, mean birth body weight (BBW) was 2948.2 ± 327.8 gm. The median age at event was 26 hours old. Eleven patients were rooming-in babies with exclusive breast feeding. Seven patients (41.2%) died; seven patients (41.2%) survived with neurological sequelas, and the remaining three patients (17.6%) survived without complication. Possible causative factors included infection in two cases, urea cycle disorder in one case, hypertrophic cardiomyopathy in one case, hypocalcemia only in one case, hypocalcemia plus airway obstruction in one case, dehydration-related diseases in seven cases and unknown in 4 cases; there was no autopsy case.

Conclusion: More effort on promotion of autopsy to discover the underlying disease is necessary and helpful. To build up an alarm system or protocol for education and early detection is the basis to prevent this tragedy.