522 NEONATAL AUTOPSY; AN INVESTMENT WITH A HIGH RATE OF RETURN

Abstract

The value of the autopsy in clinical medicine continues to be debated. While autopsy studies in adults have documented rates of 10-20% for missed or erroneous diagnoses, similar studies in neonates are lacking. In order to understand how frequently the neonatal autopsy provides useful information a study of all deaths in a level III NICU over a three-year period was carried out. Tabulation of confirmed diagnoses and clinically acttve problems at the time of death was done retrospectively for the ftrst two years and prospectively for the third year. These diagnoses were compared with the final anatomic diagnoses obtained from the autopsy report.Over the three-year period there were 112 deaths with autopsies performed in 73 cases (65%), A total of 38 significant findings, defined as conditions which were suspected, but unconfirmed (16) unsuspected (18) or erroneous diagnoses, (4) were noted in a total of 29 patients (29/73, 40%). These Included; congenital anomalies (13), infections (11), iatrogenic complications (5), and others (9). These findings were not confined to any particular birth weight group nor did age at death (<7 days, 7-28 days, >28 days) influence the likelihood of significant findings. This high rate of return more than justifies a continued high rate of neonatal autopsy.