An evaluation of the autopsy following death in a level IV neonatal intensive care unit.
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.
Barr
P
P
Department of Neonatology, Royal Alexandra Hospital for Children, Parramatta, New South Wales, Australia.
Hunt
R
R
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