The Value of Neonatal Autopsy

Abstract

Background and Objective: Neonatal autopsy rates were in decline internationally at the end of the last century. Our objective was to assess the current value of neonatal autopsy in providing additional information to families and healthcare professionals. Methods: We conducted a review of neonatal autopsies performed in a tertiary perinatal centre over an 11-year period. Primary outcomes measured were the annual neonatal autopsy rates and concordance rates between clinical and autopsy diagnoses of the primary cause of death. Secondary outcomes were the clinical, genetic and audit value of the examinations. Findings were used to inform the consent process, and the effect this had on institutional post-mortem rates was assessed over the subsequent 5-year period. Results: There was a marked decline in the annual neonatal autopsy rate from 73% in 1994 to 48% in 2004. 164 cases met the inclusion criteria for review. Complete concordance for cause of death was reached in 91% of cases. Previously unsuspected or unconfirmed clinical conditions, other than the primary cause of death, were uncovered at autopsy in 85 cases. Detailed information on inheritable conditions was obtained in 45 cases. Findings with perceived ‘audit value’ for clinical practice were identified in 29 cases. The dissemination of this information to staff and families contributed to the stabilisation of the consent rate in the following 5-year period. Conclusion: Neonatal autopsy remains a valuable diagnostic tool as it provides critical clinical and audit information for healthcare professionals and families.

¿Cuál es el valor de la autopsia neonatal? Correlación anatomoclínica en 135 casos

“…3,4 Existe amplio consenso acerca de los aportes de la autopsia neonatal en la confirmación de los diagnósticos clínicos, en identificar afecciones y malformaciones congénitas [7][8][9] en su contribución a la educación médica, 10 así como también sobre su valor desde el punto de vista médico-legal.…”

Death, bereavement and randomised controlled trials (BRACELET): a methodological study of policy and practice in neonatal and paediatric intensive care trials

“…The causes of the deaths were usually based on clinical, rather than pathologist reports, as there has been a general decline in neonatal and paediatric autopsy rates over the last 20 years. [87][88][89] It is not surprising therefore that all of the trial investigators who completed the section of the questionnaire about post-mortem data reported that these data were not specifically collected as part of the trial protocol. Most PIC investigators (66.7%) reported that post-mortem data were unnecessary compared with less than half (47.8%) of NIC investigators.…”

Minimally invasive perinatal and pediatric autopsy with laparoscopically assisted tissue sampling: feasibility and experience of the MinImAL procedure

“…Postmortem examination can provide families with a cause of death following fetal demise or death of a neonate or infant, with information obtained from the autopsy contributing to the management of future pregnancies in up to 40% of cases. Autopsy also provides tissue for research into congenital disease, assists in comprehensive audit of obstetric practice, and offers a method of infectious disease surveillance in low‐ or middle‐income countries.…”