Fetal, neonatal, and infant death in central China (Hubei)

Abstract

Data based on forensic autopsy in neonates and infants in China are rare in the literature. The purpose of this study is to evaluate the characteristics of fetal, neonatal, and infant death and to determine the main cause of death among them. A retrospective analysis of fetal and infant forensic autopsies referred to the Tongji Forensic Medical Center (TFMC) in Hubei, central China, during a 16-year period between January 1999 and December 2014, was performed. In this period, there were 1111 males and 543 females; the total male-to-female ratio (MFR) was 2.05:1. There were 173 fetal and infant autopsies conducted, comprised of 43 fetal, 84 neonatal (<28 days) and 46 infant (4 weeks to 1 year) cases. The annual case number ranged from 5 in 2004 to 18 in 2014 (annual mean of 10.8). MFR was 1.75:1. About 94% of these deaths (163/173) resulted from natural causes, 6 cases (3.5%) were accidental deaths, and 4 (2.3%) resulted from homicide (4 abandoned babies). Among fetuses, the most common causes of death were placental and umbilical cord pathologies (28%, 12/43), followed by intrapartum asphyxia resulting from amniotic fluid aspiration (AFA) or meconium aspiration syndrome (MAS) (18.6%, 8/43), congenital malformation (14%, 6/43), and intrapartum infection (9.3%, 4/43). A majority of neonatal deaths (66.7%, 56/84) died within 24 hours of birth. The main causes of neonatal death were asphyxia resulting from AFA, MAS, or hyaline membrane disease, and congenital malformation. The main causes of infant (1–12 months) death were infectious diseases, including pneumonia, meningitis, and viral brainstem encephalitis. This study was the 1st retrospective analysis of autopsies of fetal, neonatal, and infant death in TFMC and central China. We delineate the common causes of early demise among cases referred for autopsy, and report a male preponderance in this population. Our data observed that placental and/or umbilical cord pathology, asphyxia due to AFA, and/or MAS, and pneumonia were the leading causes of fetal, neonatal, and infant death, respectively. And it can inform clinical practitioners about the underlying causes of some of the most distressing cases in their practices.

Medico-legal analysis of cases of children who died suddenly due to pneumonia undiagnosed in their lifetime

“…Therefore, additional staining, primarily immunohistochemical, is increasingly being used in post-mortem microscopic examinations worldwide [11,12]. Molecular examinations for the congenital basis of sudden death in Poland is still rarely performed, although it is known from the literature that it is an important supplement to traditional post-mortem diagnostics [13][14][15]. The literature describes cases of post-mortem detection by genetic testing of rare metabolic diseases, such as medium-chain acetyl-CoA dehydrogenase (MCAD) deficiency or cardiovascular diseases, such as arrhythmogenic right ventricular cardiomyopathy, Brugada syndrome and other ion channel disorders) [16].…”

“…For the forensic specialist, the problem of both the cause of the child's death and, not infrequently, the answer to the detailed inquiries of prosecutors' offices and courts in terms of the possibility of a so-called medical error remains to be resolved. Given the scarcity of literature reports and the lack of clear histopathological criteria for the diagnosis of both interstitial pneumonia in children and its possible forms, it is not uncommon for these opinions to be very difficult, and ultimately form the basis for decisions made by prosecutors' offices and courts against doctors accused of committing "medical malpractice" [13,17,18]. According to the literature, the etiologic agent responsible for the deaths of chil-Arch Med Sadowej Kryminol 2022; vol.…”

“…According to the literature, the etiologic agent responsible for the deaths of chil-Arch Med Sadowej Kryminol 2022; vol. 72 (4): 165-182 ratury i sądy wobec lekarzy obwinionych o popełnienie "błędu w sztuce lekarskiej" [13,17,18]. Zgodnie z danymi z piśmiennictwa, czynnik etiologiczny, który odpowiada za zgony dzieci w przebiegu chorób układu oddechowego, zwykle również pośmiertnie pozostaje niezidentyfikowany [19].…”

“…Dlatego coraz częściej na świecie w badaniach pośmiertnych mikroskopowych wykorzystuje się barwienia dodatkowe, przede wszystkim immunohistochemiczne [11,12]. Badania molekularne w kierunku wrodzonego podłoża nagłego zgonu w Polsce są jeszcze rzadko wykonywane, choć wiadomo z literatury, że stanowią istotne uzupełnienie tradycyjnej diagnostyki pośmiertnej [13][14][15]. W literaturze opisywane są przypadki wykrycia pośmiertnego przy pomocy badań genetycznych rzadkich chorób metabolicznych, np.…”

The news related to abandoned babies in newspapers: Retrospective analysis

“…"Buluntu/Terk bebek" konusunun çok boyutlu nedenleri olabilmektedir. Ermenistan'da çocuklar en çok "yoksulluk" ve "engelli olma" gibi iki nedenden dolayı terk edilirken; Ukrayna'da kiralık taşıyıcı annelik uygulamasına bağlı hasta ya da engelli doğacağı anlaşılan bebeği, taşıyıcı anneyi kiralayan ebeveynlerin terk ettiği; Çin'de ise fazla nüfusa bağlı tek çocuk politikasının sonucu istenmeyen cinsiyette doğan bebeğin terk edildiği bildirilmektedir (Deng, Wang, Zhou, Ren, & Liu, 2019;Erdem,2023;Martirosyan, 2019;Malcolmson,2020). Gazetelerde verilen bilgiler sınırlı olduğu için çalışmada bebek terk edilme nedenleri bilinememektedir.…”