The Persisting Value of Autopsies on Extremely Preterm Infants in the 21st Century

Abstract

An autopsy is performed with the primary objective of finding the definitive cause of death (COD). Historically, it was done to know more about the anatomical details and pathological findings of the diseases. Extremely preterm (EP) infants are infants born at less than 28 weeks of gestation. 1 According to the World Health Organization, more than 90% of EP babies born in low-income countries die within the first few days of life compared with less than 10% of EP babies in high-income settings. 2 In addition to the high mortality, the EP infants had poor neurodevelopmental outcome. 3 Among the causes of in-hospital mortality, necrotizing enterocolitis (NEC), respiratory distress syndrome, intraventricular hemorrhage (IVH), infections, and gastrointestinal causes are among the top. 4 Autopsy (postmortem) of preterm infants can provide vital information about the COD and the accuracy of antemortem clinical diagnosis. In the preterm infant, because clinical manifestations are often nonspecific, diagnostic errors like unintentionally delayed, wrong, or missed diagnoses could occur. An autopsy could help in these scenarios. It has been reported that frequently classical autopsies have revised the initial diagnosis. 5,6 However, conventional autopsy might have religious, social, and cultural reservations. Additionally, with technological advancement, an alternative could be offered to families.An autopsy could provide valuable information and contribute to determining the definitive COD in preterm infants. In a series of reports regarding the timing of death, 66% to 73% of preterm infants had died in less than 28 days of life. 5,6 Hoffsten et al. 5 looked at the incidence of autopsy in preterm infants between 2002 and 2018 and found that in 34.9% of the cases, CODs were revised by these autopsies. Interestingly, the revised CODs after autopsy included the expected problems of EP infants (NEC, IVH, etc.). Except for congenital anomalies and chromosomal abnormities (5.0%-9.9%), 5 most of the diagnoses (pneumothorax, IVH,