Neonatal Autopsies: A 10-Year Review. 1607

Abstract

The aims of this study were to identify: 1.) trends in neonatal autopsy rates over the last decade, 2.) concordance between antemortem and postmortem diagnoses, and 3.) characteristics predicting yield of information on autopsy. All neonatal deaths between Jan. 1, 1984 and Dec. 31, 1993 were reviewed. Antemortem diagnoses were defined as those that were either established or considered sufficiently likely to have initiated specific treatment prior to death. Unexpected autopsy findings were divided into four classes: Class I - major diagnoses, which if detected before death, would have likely resulted in cure or prolonged survival; Class II - major diagnoses whose antemortem detection was unlikely to change the patient's outcome; Class III - minor diagnoses contributing to the cause of death; and Class IV - diagnoses unrelated to the patient's outcome. Autopsies were obtained in 296 (61%) of 487 neonatal deaths during the study period, There was a statistically significant decline in autopsy rates between the first five years (71%) and the latter five years (48%) of the study period (X2, p .05). Autopsies were more likely to reveal unexpected diagnoses in neonates of a gestational age of 29 to 36 weeks, and in those whose mothers had no prenatal care (X2; p=0.02, 0.0001, respectively). Also, infants who died within 6 hours of birth had a significantly higher incidence of Class I and Class II findings at autopsy (22%; 20/90) compared to infants who died between 6-24 hours (10.6%; 8/75) and those who died after 24 hours (5.3%; 7/131) [X2, p=0.03]. There was no relationship between new findings at autopsy and maternal age, infant gender, or antemortem imaging studies. This study indicates that although neonatal autopsy rates have declined significantly over the last ten years, they still provide information valuable in the care of critically ill neonates, especially those < 36 wks. gestation, and those who die within 6 hours of life.