Presented at the Neonatal Society 2007 Summer Meeting.
Pattnayak S, Catford K, Curley A, Kelsall W
Addenbrookes Hospital NHS Foundation Trust, Cambridge CB2 2QQ, UK
Background: Neonatal autopsy has a valuable role in investigating the cause of death of newborn babies (1). It may help in the bereavement follow-up meetings with parents, and can aid the grieving process. Over recent years, there has been a worldwide declining trend in autopsy rates (2). In UK the “organ retention scandal” (3) has resulted in reluctance by clinicians to discuss post-mortems and the willingness of parents to consent to the procedure. The emergence of new diagnoses after autopsy is important (4).
Aim: To review the neonatal autopsy rate and to identify trends over a 10 year period covering these events, to identify the factors that may influence the consent for autopsy and also to examine the discordance between ante and post mortem diagnoses.
Methods: We performed a retrospective case note review of all deaths in a Tertiary Neonatal Intensive Care Unit (NICU). Cases were identified form the NICU data base and secretarial records. Group A included babies born between 1st January 1996 and 31st December 1999, and Group B babies born between 1st January 2000 and 31st December 2005. Data were analysed using SPSS v13. We used X2 test for discrete variables, Student’s t test and Mann Whitney test for numerical variables. P value of less than 0.05 was considered significant.
Results: There were 287 deaths over the study period, 268(93.4%) set of notes were reviewed. 22 cases were excluded from the study, as death occurred in other units. Each group had 123 neonatal deaths. The autopsy rates were 46% in Group A vs. 31% in Group B (p<0.02). Complete concordance between the clinical diagnoses was obtained in 75% in Group A vs. 48% in Group B. The detection of new diagnoses had increased from 25% to 52% between the groups (p=0.004). The detection of new diagnoses was more common in babies with gestation >28 weeks, birth weight >1000 grams and length of stay <7 days. There was no difference in maternal age, parity, mode and place of delivery between the groups. Consultants had requested consent for autopsy in 62.5% (group A), 84.2% (group B) of deaths (p=0.012). Documented involvement of junior doctors in the process of obtaining consenting for autopsy, attending the post mortem or in follow up counselling were negligible.
Conclusion: There has been a decline in the neonatal autopsy rate. The increased detection rate of new diagnoses in this study reinforces the importance of the post-mortem in clinical care. Training issues for junior doctors needs to be addressed.
References
1. Gordijn SJ. Pediatr Dev Pathol 2002; 5:408-8.
2. Kumar P. Arch Pediatr Adolesc Med 2000; 154:38-42.
3. Redfern M. The Royal Liverpool Children’s inquiry report. London: HSMO; 2001.
4. Goldman L. N Eng Med J 1983;308:1000-5.