An evaluation of the autopsy following death in a level IV neonatal intensive care unit

J Paediatr Child Health. 1999 Apr;35(2):185-9. doi: 10.1046/j.1440-1754.1999.t01-1-00338.x.

Abstract

Objective: To ascertain the determinants of neonatal autopsy, define clinical errors in the causes of death, and elucidate the possible audit and genetic value of the autopsy following death in a Level IV neonatal intensive care unit (NICU).

Methods: A review and correlation of clinical and autopsy information in a case series of infants who died during the period 1991-97.

Results: Two hundred and twenty-nine of 4057 infants admitted to the NICU died and 91 (39.7%) underwent an autopsy. The underlying cause of death was significantly different in infants who had an autopsy compared with infants who did not (P = 0.02). The autopsy rate was higher for deaths from miscellaneous causes (52.9%), lethal malformation (46.8%) and infection (45.4%) than deaths from prematurity (25.9%) and asphyxia (19%). Clinical errors in the causes of death were found in 22% of the infants, and in 4.4% a change in management may have been curative or prolonged life. The autopsy had audit value in 26% of infants and genetic value for a single gene (Mendelian) disorder in 4.4%.

Conclusions: Although the autopsy following death in a Level IV NICU yields potentially useful information in more than one-third of cases, this does not seem sufficient to ensure a high neonatal autopsy rate.

MeSH terms

  • Australia
  • Autopsy / statistics & numerical data*
  • Cause of Death*
  • Cohort Studies
  • Confidence Intervals
  • Evaluation Studies as Topic
  • Female
  • Humans
  • Infant, Newborn
  • Infant, Newborn, Diseases / mortality*
  • Intensive Care Units, Neonatal / statistics & numerical data*
  • Male
  • Odds Ratio
  • Sensitivity and Specificity