title: Changing patterns of infant death over the last 100 years: autopsy experience from a specialist children's hospital.
abstract: OBJECTIVE
  Infant mortality has undergone a dramatic reduction in the UK over the past century because of improvements in public health policy and medical advances. Postmortem examinations have been performed at Great Ormond Street Hospital for over 100 years, and analysis of cases across this period has been performed to assess changing patterns of infant deaths undergoing autopsy.
  
  
  METHODS
  Autopsy reports from 1909 and 2009 were examined. Age, major pathology and cause of death was reviewed from these cases and entered into an anonymized database. A subsequent comparative analysis was performed.
  
  
  METHODS
  All postmortems performed and reported at Great Ormond Street Hospital in 1909 and 2009.
  
  
  METHODS
  Infant deaths, aged 0-365 days, were identified and subsequently analysed for the two years.
  
  
  METHODS
  Comparative proportional analysis of postmortem findings from the two time periods.
  
  
  RESULTS
  Three-hundred and fifty-seven and 347 autopsy reports were identified from 1909 and 2009 including 178 and 128 infant deaths, respectively. The commonest cause of death in 1909 was infection (74%) compared to 20% of deaths in 2009. The most frequent final 'diagnosis' in 2009 was 'unexplained sudden unexpected infant death (SUDI)', despite a full postmortem including ancillary investigations. In contrast, there were no such cases recorded in 1909, but there were frequent deaths due to gastroenteritis and malnutrition together accounting for 16% of cases, compared to one case of gastroenteritis in 2009. Fifteen percent of 1909 cases had infections which are almost never fatal with appropriate treatment in 2009, including tuberculosis, diphtheria and syphilis. Congenital anomalies were detected with similar frequencies at both time points, (21% and 19% in 1909 and 2009, respectively).
  
  
  CONCLUSIONS
  In the UK, significant changes in patterns of pathology have occurred in paediatric autopsy cases performed at a single specialist centre. Fatal infections and malnutrition (both poverty-related) have reduced yet the incidence of congenital anomalies has remained similar.
authors.affiliation: UCL Institute of Child Health, London,  UK.
authors.forename: J W
authors.initials: JW
authors.lastname: Pryce
authors.forename: M A
authors.initials: MA
authors.lastname: Weber
authors.forename: M T
authors.initials: MT
authors.lastname: Ashworth
authors.forename: Sea
authors.initials: S
authors.lastname: Roberts
authors.forename: M
authors.initials: M
authors.lastname: Malone
authors.forename: N J
authors.initials: NJ
authors.lastname: Sebire
mesh_terms: D001344:Autopsy / Q000266:history; D002423:Cause of Death; D000013:Congenital Abnormalities / Q000266:history; D005759:Gastroenteritis / Q000266:history / Q000401:mortality*; D049673:History, 20th Century; D049674:History, 21st Century; D006761:Hospitals / Q000266:history; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000266:history / Q000639:trends*; D007231:Infant, Newborn; D007239:Infections / Q000266:history / Q000401:mortality*; D044342:Malnutrition / Q000266:history / Q000401:mortality*; D015995:Prevalence; D013398:Sudden Infant Death / Q000453:epidemiology*; D006113:United Kingdom / Q000453:epidemiology