Article Text

Download PDFPDF
Guideline review: Sudden and unexpected postnatal collapse – BAPM framework
  1. Helen Cotton1,
  2. Elizabeth Osmond2
  1. 1 St Michael's Neonatal Unit, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
  2. 2 NICU, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
  1. Correspondence to Dr Helen Cotton, St Michael's Neonatal Unit, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS2 8EG, UK; helencotton1{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


Sudden unexpected postnatal collapse (SUPC) is a rare but devastating occurrence in seemingly well babies after birth. The exact incidence and indeed definition (Box 1) of SUPC varies widely, but is estimated to occur in 2.6–19 per 100 000 live births in the UK. Approximately one-third to one half of babies will die following SUPC. Post-asphyxial encephalopathy may occur in up to three quarters of those babies who do not have an underlying cause identified despite extensive investigation.

Box 1

Definition of SUPC as defined in the BAPM Framework1

  • Baby born at ≥35/40 gestation.

  • Well at birth with a 5 min Apgar score of ≥7.

  • Collapses suddenly within 7 days of birth from delivery (defined as being discovered in a state of cardiorespiratory compromise needing resuscitation with IPPV).

  • Either dies or goes onto require intensive care (with or without encephalopathy).

  • BAPM, The British Association of Perinatal Medicine; IPPV, intermittent positive pressure ventilation; SUPC, sudden unexpected postnatal collapse.

Information about the new framework

‘Sudden and Unexpected Postnatal Collapse: A BAPM Framework for Reducing Risk, Investigation and Management’ (Framework)1 (Box 2) was published in May 2022 in collaboration with the Healthcare Safety Investigation Branch and recommendations from their ‘National Learning Report on Neonatal Collapse alongside Skin-to-skin Contact’ published August 2020.2 The Framework aims to highlight the potential modifiable risks associated with SUPC and strategies which could be employed to help reduce them. The Framework also details suggested investigations which may help uncover the underlying diagnosis leading to SUPC, both for those that survive and those who die. It expands on the previous framework including discussion around parental support and therapeutic hypothermia (TH).

Box 2

Full link to the Framework1

Previous/related guideline(s)



  • Sudden unexpected death in infancy and childhood. Multiagency guidelines for care and investigation: The Royal College of Pathologists and the Royal College of Paediatrics and Child Health, 2016

Key issues the framework addresses

Risk reduction

Education and effective observation are key areas to consider, as SUPC may be preventable in many …

View Full Text


  • Twitter @bethosmond

  • 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 Commissioned; externally peer reviewed.