Main diagnosis and cause of death in a neonatal intensive care unit: do clinicians and pathologists agree?

Abstract

Despite a high agreement rate in the main diagnoses, notable imprecisions were present regarding cause of death and antemortem overlooking of potentially fatal conditions, confirming the useful role of autopsy to verify clinical diagnoses and suggesting that differentiation between the main diagnosis and cause of death should be carried out in future studies.

Postmortem Examinations on Deceased Neonates: A Rarely Utilized Procedure in an African Referral Center

“…The high neonatal mortality rate of 22.9% recorded in this study, which occurred primarily in neonates who were 7 days old and younger, corresponds with previous reports in this African subregion [12,13]. Very few of the cases (0.8%) benefited from postmortem examination, which led to a massive loss of useful information regarding the possible causes of deaths that could have aided in the future management of babies with similar pathologies, as has been reported in earlier studies [3][4][5][6][7][8]. Obtaining written permission and consent was challenging because of religious beliefs and cultural influence, except for a few enlightened parents/caregivers who requested an autopsy to know the cause of death of their neonates [10].…”

“…The usefulness of autopsy in establishing the cause of death, ascertaining unrelated diagnoses, and assisting in the grieving process was also documented by other researchers [3,4]. Perinatal autopsy has been used as a gold standard in clinical practice and provides information for genetic counseling, which is useful in the management of future pregnancies [1–5]. In this study center, however, detailed placental examination; radiography; and chromosomal, genetic, and other sophisticated postmortem studies were not feasible because of the lack of cooperation by parents/caregivers and the lack of required facilities [10,12].…”

“…The information provided by these postmortem studies can significantly augment the knowledge base at the study center [1][2][3][4][5][6][7][8][9][10][11]14,16]. However, because postmortem study was not performed in the majority of cases, the causes of death were often neither confirmed nor refuted [3][4][5][9][10][11]14,15]. This lack of data constitutes a major drawback and a veritable source of lost vital information that is readily available in other cultural settings and more organized centers [6,8,9].…”

“…These insights have led to improvements in the standard of care, clinical outcome, and life expectancy of affected children. Even with the advent of modern sophisticated diagnostic facilities, postmortem examination remains the gold standard for correctly diagnosing many diseases and unraveling unexplained causes of death in neonates [4][5][6]. The beneficial effects of postmortem study include advising parents regarding the cause of death of their neonate, which may help them adjust to the stress of bereavement [3,7].…”

Chest X-ray: an examination that has been in use for centuries but is still essential, especially in the clinical management of newborns in the neonatal intensive care unit

“…The most common causes of admission to a neonatal intensive care unit (NICU) are prematurity and low birth weight, which collectively account for up to 69% of hospitalizations in referral NICUs, including those in Brazil 1 - 4 . Respiratory complications, notably respiratory distress syndrome of prematurity, are major causes of mortality in the NICU 3 , 4 .…”