title: An evaluation of the autopsy following death in a level IV neonatal intensive care unit.
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.
authors.affiliation: Department of Neonatology, Royal Alexandra Hospital for Children, Parramatta, New South Wales, Australia.
authors.forename: P
authors.initials: P
authors.lastname: Barr
authors.forename: R
authors.initials: R
authors.lastname: Hunt
mesh_terms: D001315:Australia; D001344:Autopsy / Q000706:statistics & numerical data*; D002423:Cause of Death; D015331:Cohort Studies; D016001:Confidence Intervals; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000401:mortality*; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D008297:Male; D016017:Odds Ratio; D012680:Sensitivity and Specificity