When a Healthy Newborn Suddenly Stops Breathing

A plain-language guide to two 2025 studies on preventing and treating sudden unexpected postnatal collapse

Very rarely, a baby who seemed perfectly well at birth suddenly stops breathing during the first hours or days of life. Doctors call this sudden unexpected postnatal collapse. Two studies published in 2025 looked at the two questions families care about most: can these events be spotted early enough to prevent harm, and does the cooling treatment used afterwards actually help?

Why babies are placed on their mother's chest in the first place

Almost everywhere in the world, a healthy newborn is now laid skin-to-skin on the mother's chest immediately after birth. This is not sentiment; it is evidence-based care. Reviews pooling many trials have found that early skin-to-skin contact helps babies breastfeed sooner and more successfully, keeps them warm, and settles them [1]. It is one of the most consistently recommended practices in newborn medicine, and nothing in the research described below argues against it.

What the research does show is that a very small number of babies run into trouble during exactly these first quiet hours. The medical term, sudden unexpected postnatal collapse — usually shortened to SUPC — describes a baby born after 35 weeks of pregnancy who appeared healthy and adapted normally after birth, but who then suddenly develops severe breathing and circulation problems and needs urgent resuscitation [2].

How doctors came to recognise this problem

For a long time these events were not counted separately. When a newborn who had seemed fine deteriorated in the first days, the death or injury was recorded alongside all other newborn deaths, and no one could say how often it happened or why. That changed when researchers in the United Kingdom ran a nationwide study specifically looking for collapses in apparently healthy newborns and found what they described as a missing group of deaths and near-deaths that ordinary statistics had never captured [3]. Similar work in the United States later showed that these collapses account for a small but real number of newborn deaths each year [4].

Once researchers began looking, patterns emerged. A German study comparing 31 affected babies with 93 unaffected ones found that when a baby collapsed with no other explanation, it was more than six times as likely to have been lying face-down or in another position where the airway could become blocked [5]. A large American analysis found that, compared with sudden infant deaths at older ages, these very early collapses were more often linked to first-time mothers, to swaddling, and to a parent falling asleep while feeding the baby [6]. None of these findings mean that any parent did something wrong. They describe a narrow, recognisable window — the first feed, the first hours, an exhausted parent, a baby whose face is not visible — in which a newborn's still-immature breathing control can fail silently.

Before this work, families and midwives faced the problem without a name, without an estimate of how often it happened, and without any agreed way to reduce the risk. The two studies at the centre of this article represent the current attempt to fill those gaps from both ends: prevention and treatment.

Study one: can continuous monitoring catch a collapse in time?

A group of doctors working in three community hospitals in the Piedmont region of northern Italy — in the towns of Ivrea, Ciriè and Chivasso — tried something unusual [7]. Between June 2023 and December 2024, they offered every newborn in their maternity units continuous wireless monitoring for the first 24 hours of life, starting from the moment the baby was placed on the mother's chest.

The equipment was deliberately unobtrusive: a small single-use sensor on the baby's foot, with no wires running to the bedside, sending heart rate and oxygen levels to a monitor outside the room. If something looked wrong, an alarm reached staff in about ten seconds. The team adjusted the alarm settings so the system would react to a genuinely slow heartbeat rather than to the constant small dips that happen whenever a newborn wriggles.

Out of more than 2,200 babies monitored, only two families chose not to take part. Staff reported that the sensor did not delay the first breastfeed, did not interrupt skin-to-skin contact, and did not get in the way of the usual newborn checks. Parents described it as reassuring, especially after long labours or caesarean births, because it allowed them to rest without feeling they had to keep watch every second.

The monitors picked up 40 concerning events. Two were collapses caught as they happened. In the first, a mother had fallen asleep while feeding, and the baby's face had become covered by her breast while a cap with a tight strap made things worse; staff arrived, removed the cap, and the baby recovered immediately. In the second, a baby born at 36 weeks slipped under the blankets against his sleeping mother at 20 hours of age and was found when his oxygen level dropped; gentle stimulation and a little extra oxygen were enough. Neither baby suffered lasting neurological harm. The alarms also uncovered three other problems that would otherwise have been found later — an infection, a bleed in the brain, and one unexplained pattern — and among 35 alarms for a slow heart rate, five turned out to be early infections.

The honest limitation is that this was a first demonstration, not a proper comparison. The researchers did not measure whether monitoring reduces deaths or disability, because they had no comparison group of unmonitored babies. That study is planned next.

Study two: does cooling help after a collapse?

When a baby's brain has been deprived of oxygen around the time of birth, standard treatment is to cool the whole body to about 33–34 °C for three days. This treatment is well proven for oxygen deprivation during labour and delivery, established by large trials including one run across 15 hospitals in a United States research network [8]. Because a sudden postnatal collapse also deprives the brain of oxygen, doctors began using cooling for these babies too — reasoning by analogy, without direct evidence.

A team from hospitals in Ravenna and Rimini, working with the University of Bologna, set out to check whether that analogy holds [9]. They searched five medical databases for every published report of cooling after sudden postnatal collapse and found 13 studies, published between 2011 and 2023 from Europe, North America, Asia and Australia. Together these described 148 babies who had collapsed, 70 of whom were cooled.

The picture that emerged was consistent in some ways and unsettled in others. Most collapses happened within the first two hours after birth, although some occurred as late as three days. Almost all happened during skin-to-skin contact or feeding, often with the baby face-down and without anyone watching closely, and first-time mothers were involved in nearly every report. Among the babies who were cooled, about one in ten died. Seizures were very common, affecting seven to nine out of every ten. Brain scans were abnormal in roughly half. Of the babies who survived and were followed up for at least a year, somewhere between half and two-thirds were developing normally.

The researchers' central conclusion, however, was about the quality of the evidence rather than the results. Almost all of the 13 studies were single case reports or small series. Hardly any compared cooled babies with similar babies who were not cooled. Follow-up was patchy and rarely used standard developmental tests. Judged by formal methods for rating medical evidence, the certainty was rated as very low for every outcome. Cooling appears feasible and does not seem to cause additional harm — but whether it genuinely improves outcomes after this particular kind of collapse remains unproven.

What this means for families

If you are expecting a baby, the practical takeaways are simple and reassuring. Skin-to-skin contact remains strongly recommended, and these events are rare. What matters is how those first hours are set up. Guidance developed specifically to keep breastfeeding promotion and collapse prevention working together suggests that the mother should be propped up at roughly a 45-degree angle rather than lying flat, that the baby's face should stay visible with nose and mouth clear, and that someone — a midwife, nurse, partner or family member — should be watching during the first skin-to-skin period and the first feed [10]. Professional nursing bodies have built these expectations into formal practice standards [11]. Small details genuinely matter: one carefully conducted trial in Spain found that simply changing how far the mother's bed was reclined changed how often babies' oxygen levels dipped during early skin-to-skin contact [12].

It is also entirely reasonable to say out loud that you are exhausted and want someone to hold or watch the baby while you sleep. Research consistently identifies the unsupervised, deeply tired first-time parent as the situation in which these collapses cluster [13] — not because those parents are careless, but because a newborn cannot yet reliably signal distress and a sleeping adult cannot hear silence.

What researchers are working on next

Two things are likely to change in the coming years. The Italian team is now comparing monitored babies with babies cared for before monitoring began, which should show whether continuous monitoring actually prevents harm rather than simply being acceptable to families. And because collapses are far too rare for a single hospital to study alone, researchers are calling for international registries in which every case is recorded the same way, with long-term follow-up, so that the question of whether cooling helps can finally be answered. Meanwhile, hospitals continue to refine practical prevention bundles — staff training, positioning standards, structured checks in the first hours — that require no new technology at all [14].

For now, the fairest summary is this: sudden postnatal collapse is rare, its risk factors are increasingly well understood and largely addressable through supervision and positioning, we are becoming better at detecting it quickly, and we still do not know for certain whether the treatment given afterwards changes the outcome. That is an uncomfortable truth, but it is the one the evidence supports — and it is why the first hours are watched as carefully as they are.

References

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  2. Herlenius E, Kuhn P. Sudden Unexpected Postnatal Collapse of Newborn Infants: A Review of Cases, Definitions, Risks, and Preventive Measures. Transl Stroke Res. 2013;4:236–247. doi:10.1007/s12975-013-0255-4 ↩
  3. Becher JC, Bhushan SS, Lyon AJ. Unexpected Collapse in Apparently Healthy Newborns — a Prospective National Study of a Missing Cohort of Neonatal Deaths and Near-Death Events. Arch Dis Child Fetal Neonatal Ed. 2012;97:F30–F34. doi:10.1136/adc.2010.208736 ↩
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  9. Cocchi E, Brighi A, Ancora G. Therapeutic Hypothermia in Sudden Unexpected Postnatal Collapse: Feasibility, Risks, and Long-Term Outcomes — A Systematic Review. Children (Basel). 2025;12(10):1422. doi:10.3390/children12101422 ↩
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