Ten years of neonatal autopsies in tertiary referral centre: retrospective study

doi:10.1136/bmj.324.7340.761

BMJ 2002;324:761-763 ( 30 March )

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Ten years of neonatal autopsies in tertiary referral centre: retrospective study

Malcolm Brodlie, house officer in paediatric surgery, ^a Ian A Laing, consultant neonatologist, ^b Jean W Keeling, consultant paediatric pathologist, ^c Kathryn J McKenzie, consultant paediatric pathologist. ^c

^a Royal Hospital for Sick Children, Edinburgh EH9 1LW, ^b Neonatal Unit, Simpson Memorial Maternity Pavilion, Edinburgh EH3 9YW, ^c Department of Paediatric Pathology, Royal Hospital for Sick Children, Edinburgh

Correspondence to: Ian Laing Ian.Laing{at}ed.ac.uk

Objectives: To measure the neonatal autopsy rate at atertiary referral centre and identify trends over the past decade.To identify factors that may influence the likelihood of consentbeing given for autopsy. To examine any discordance between diagnosesbefore death and atautopsy.
Design: Retrospective review of patients'records.
Setting: Tertiary neonatal referral centre affiliatedtouniversity.
Outcome measures: Sex, gestational age, birth weight, type ofdelivery, and length of stay in neonatal unit for baby. Maternalage, marital status, history of previous pregnancies, and detailsof who requested permission for autopsy. Concordance between diagnosesbefore death and atautopsy.
Results: An autopsy was performed in 209/314 (67%)cases. New information was obtained in 50 (26%) autopsies. Insix (3%) cases this information was crucial for future counselling.In 145 (74%) there was complete concordance between the clinicalcause of death and the findings at autopsy. From 1994 onwardsthe autopsy rate in the neonatal unit fell. The only significantfactor associated with consent for autopsy was increased gestationalage.
Conclusions: Important extra information can be gainedat neonatal autopsies. This should help parents to make an informeddecision when they are asked to give permission for their babyto have an autopsy. These findings are of particular relevancein view of the recent negative publicity surrounding neonatalautopsies and the general decline in the neonatal autopsy rateover the decadestudied.

What is already known on this topic
The neonatal autopsy rate dropped in Illinois during the 10 years from 1984 to 1993

Over recent years there has been a large amount of negative publicity surrounding neonatal autopsies in the United Kingdom

What this study adds
Over a quarter of neonatal autopsies yielded new information; in 3% of cases this information was crucial

This finding is likely to be of use to bereaved parents who are asked to give permission for autopsy and provides a more positive perspective on the utility of neonatal autopsies

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