Ten years of neonatal autopsies in tertiary referral centre: retrospective study

Abstract

Objectives To measure the neonatal autopsy rate at a tertiary referral centre and identify trends over the past decade. To identify factors that may influence the likelihood of consent being given for autopsy. To examine any discordance between diagnoses before death and at autopsy. Design Retrospective review of patients' records. Setting Tertiary neonatal referral centre affiliated to university. Outcome measures Sex, gestational age, birth weight, type of delivery, and length of stay in neonatal unit for baby. Maternal age, marital status, history of previous pregnancies, and details of who requested permission for autopsy. Concordance between diagnoses before death and at autopsy. Results An autopsy was performed in 209/314 (67%) cases. New information was obtained in 50 (26%) autopsies. In six (3%) cases this information was crucial for future counselling. In 145 (74%) there was complete concordance between the clinical cause of death and the findings at autopsy. From 1994 onwards the autopsy rate in the neonatal unit fell. The only significant factor associated with consent for autopsy was increased gestational age. Conclusions Important extra information can be gained at neonatal autopsies. This should help parents to make an informed decision when they are asked to give permission for their baby to have an autopsy. These findings are of particular relevance in view of the recent negative publicity surrounding neonatal autopsies and the general decline in the neonatal autopsy rate over the decade studied.

Maintaining high autopsy rates in a Canadian blood and marrow transplant program: preserving a diagnostic and research tool

“…2 Few other specialized services, however, have reported autopsy rates in excess of 30%. Rates of autopsy among ICU deaths at our hospital were also increased relative to the overall hospital rate but to a lesser degree than the HSCT program, perhaps reflecting the number and variety of different clinical services involved in the ICU.…”

“…7 Rates of post-mortem examinations have declined steadily in North America over the past few decades from 50% in the 1960s to approximately 10% or less in the 1990s. 1,8 Even highly specialized areas such as neonatal deaths, 2 cancer care 3 and heart disease 1 have failed to evade this downward trend in autopsy rates. Nevertheless, specialized clinical programs, such as hematopoietic stem cell transplantation (HSCT), are evolving rapidly and rely on strict quality control and feedback mechanisms to improve clinical outcomes.…”

What is the value of neonatal autopsy? Pathological and clinical correlation in 135 cases

“…The rate published in different developed countries ranges between 52% and 67% 1,2,6 whereas that in Argentina is below 15%. 3,4 There is wide consensus regarding the contributions made by neonatal autopsy to confirm clinical diagnosis and identify diseases and congenital malformations, 7-9 as well as its addition to medical education, 10 and its medical legal worth.…”

“…The disease is characterized by eczematous skin lesions a n d i n t e n s e p r u r i t u s t h a t o f t e n o c c u r i n early childhood but can also start or persist in adulthood. 1 Scoring systems have been developed for use in trials.…”

Clinical importance of neonatal autopsies Yenidoğan otopsilerinin klinik önemi

“…Seeking consent for performing an autopsy from the grieving parents can be difficult (4 neonatal autopsy has a particularly valuable role in the counseling of families after the loss of an infant as it can improve parental understanding, alleviate concerns over prenatal events and provide knowledge for research and teaching. Genetic conditions or obstetric factors of relevance to future pregnancies may also be identified (5). The purpose of this study was to measure the neonatal autopsy rate at a tertiary referral center and to examine any discordance between the diagnosis before death and at autopsy.…”