The Value of Neonatal Autopsies

Abstract

Autopsy was performed on 221 of the 223 neonatal deaths that occurred over a period of 3 years (1989-1991). Clinically active problems at the time of death were identified in a combined clinicopathological approach. Prematurity associated conditions accounted for 51 per cent of deaths. Autopsy alone gave the diagnosis in 22 per cent of cases, confirmed the clinically suspected diagnosis in 68 per cent of cases and in 9 per cent of cases it was non-contributory; 69 per cent of deaths were considered non-preventable in our centre.

Value of the Perinatal Autopsy: Critique

“…Table 1 shows the percentage of autopsies for which there were additional findings, whether these findings changed the main diagnosis or not, and which may have led to change in management or counseling. Additional findings were found in 22% [46,48,67] to 76% [52] of all autopsies, but this varied with the type of perinatal loss. In the stillbirths group the range was from 28% [4] to 75% [65].…”

“…In the stillbirths group the range was from 28% [4] to 75% [65]. For neonatal deaths it ranged from 22% [48] to 81% [8] and for the therapeutical terminations it ranged from 22% [4,67] to 49% [63]. Two articles only mention a category 1 percentage and almost no other information [50,55].…”

“…Definitions of 48 h postnatal [6,53] and (within) 1 year postnatal were used in eight articles [4,46,47,50,57,58]. Neonatal deaths within 1 month of neonatal age were used in three articles [48,52,54]. Other studies defined neonatal deaths as being from a certain age, but no cut-off was stated for the end of this period [51,56].…”

“…In nine articles the research was stated or implied as having been performed in a level 3 hospital [6,46 -49,51,53,54,68]. In three papers the research was performed in a level 2 hospital [48,56,65]. Five articles were reviews of regional practices and the levels of hospitals involved were not stated [4,[57][58][59]62].…”

“…Five articles were reviews of regional practices and the levels of hospitals involved were not stated [4,[57][58][59]62]. The degree of expertise of the pathologists who performed the autopsy was usually stated (Table 3) but was not specified in 11 reports [8,47,48,50,51,55,56,61,65,66,67]. Macroscopic and histologic examinations were performed whenever the autopsy protocol was described (Table 3).…”