Autopsy study of pediatric deaths

Pattern of deaths in paediatric population- An autopsy based study done at a tertiary care hospital in New Delhi

The study was done retrospectively at Lady Hardinge Medical College, New Delhi to assess the pattern of Paediatric deaths among total paediatric autopsies conducted from year 2019-2021. All Deaths among the individuals less than 18 years of age were studied and statistical analysis was done. During the three-year study period from year 2019-2021, 41.2% were females and 58.8% were males in total 17 paediatric autopsies conducted in the year 2019. 60% female, 40% male among total 15 cases in the year 2020 and 58.3% female, 41.7% male among total 12 cases of paediatric autopsies conducted in the year 2021. On distribution of number of cases in a particular year of study as per the manners of paediatric autopsy cases conducted from year 2019-2021, 40% accidental deaths were recorded in 2019 and 2020 each. The accidental deaths were recorded in 20% cases in the year 2021 among total cases of paediatric autopsy done. Total number of homicidal deaths recorded was 50%, 12.5% and 37.5% in 2019, 2020 and 2021, respectively. The natural cause of death was in 38.5% cases in the year 2019; 46.2% and 15.4% were died of natural cause in the 2020 and 2021, respectively. Total number of suicidal deaths recorded was 25% in 2019 and 2020 each year and 50% in 2021. Out of total number of cases 23% and 21% were having history of hospital deaths and fall from height, respectively. Out of the total cases of paediatric autopsy done 16% cases each were died due to asphyxia deaths and septic shock. The cerebral damage was cause of death in 14% cases and 11% cases each were died of craniocerebral damage and haemorrhagic shock. The bilateral pneumonitis was cause of death in 7% cases and 5% cases each were died of strangulation, aspiration pneumonia, poisoning.

A study of spectrum of pulmonary pathology and expression of thyroid transcription factor-1 during neonatal period

Context

Neonatal period is the single most hazardous period of life. The major causes of neonatal death are prematurity and respiratory distress syndrome. We report a series of neonatal autopsies in our Neonatal Intensive Care Unit with special emphasis on pulmonary pathology. The spectrum of pathological changes in the lungs and thyroid transcription factor-1 (TTF-1) expression was studied in detail with reference to its spatial distribution.

Aims

This study aims to analyze the causes of neonatal death with special attention to pulmonary pathology along with associated histopathological changes in lungs. We also evaluated the expression of TTF-1 at different levels of the airway.

Materials and Methods

After taking consent and anthropometric measurements, autopsy was performed. Weights of all organs were taken, and histological sections were examined under hematoxylin and eosin stain. TTF-1 immunostaining was done on lung sections. Localization of TTF-1 was evaluated at the intrapulmonary level of terminal bronchioles (TBs), distal bronchioles, and alveoli.

Results

We performed a series of 25 autopsies in neonates. In our series, most of the neonates were preterm (64%), had low birth weight (44%), and died within the first 7 days of life (80%). Majority (60%) of the neonates died due to pulmonary causes, followed by septicemia (24%), congenital anomalies (12%), and birth injury (4%). Among the respiratory causes, hyaline membrane disease (HMD) was diagnosed in maximum number of cases (32%), followed by pneumonia (12%) and pulmonary hemorrhage (12%). The TTF-1 expression in TBs, distal airways, and alveoli was significantly reduced or absent in cases of HMD compared to the control group.

Conclusions

In this study, we observed that HMD is the most common cause of perinatal death among respiratory disorders, and in this disease, the expression of TTF-1 is significantly reduced in TBs, distal airways, and alveoli compared to the control group.

Infections in a Children's Hospital autopsy population

We reviewed our Children's Hospital autopsies (1986-2009, 3-8 year groups) to determine the contribution of infections/inflammation to death and trends over time. Infections were categorized as (1) underlying cause of death, (2) mechanism of death complicating another underlying cause of death, (3) contributing (4) agonal or (5) incidental. Of 608 autopsies (44% of deaths), 401 had 691 infections (66%, 1.72 infections/infected child). In categories 1-5, there were 85 (12.3%), 237(34.3%), 231 (33.4%), 82 (11.9%) and 56(8.1%) infections. Leading infections include bronchopneumonia (188), sepsis (144- Enterococcus most common with 22), meningitis (35- Streptococcus pneumoniae most common with 10), pneumonitis (33), peritonitis (29). Sepsis declined in 2002-2009, attributed to fluid resuscitation standardization. Meningitis declined after 1993, and may be partially attributed to vaccines (Hemophilus influenza, Streptococcus pneumoniae). Despite advances in anti-microbial therapy, 66% of pediatric autopsies had inflammatory lesions, predominately as the mechanism or contributing factor rather than the underlying cause of death.

Postmortem examinations on deceased neonates: a rarely utilized procedure in an African referral center

Postmortem examination remains the gold standard for the correct diagnosis of many diseases and for unraveling unexplained causes of death. This paper reports on the poor utilization of autopsy services and encourages parents/caregivers and practitioners to perform postmortem examinations on deceased neonates in sub-Saharan Africa. In a retrospective study, the records of 1093 neonates (653 males and 440 females, ratio 1.5∶1) who died at the University of Benin Teaching Hospital and who were brought to the mortuary between 2006 and 2010 were reviewed to determine the utilization of and factors influencing postmortem examination. Sixty-two percent of the neonates died within the 1st week of life, and only 9 (0.8%) underwent a postmortem examination. Findings in the 9 postmortem studies performed on 7 males and 2 females provided additional information on the causes of death. The religious beliefs that neonates should not be subjected to postmortem study and beliefs that dead neonates are taboo and a punishment by the gods for past wrongdoings influenced 511 (46.8%) parents/caregivers to refuse postmortem analysis. The practitioners did not request postmortem study in 281 (25.7%) of the cases. The utilization of postmortem examination was marginal in this setting. We advocate the need for public enlightenment campaigns to modify the attitudes of parents/caregivers toward the postmortem study of deceased neonates. Policies should be formulated to mandate postmortem examinations of deceased neonates to enhance insight into neonatal disease, unravel unexplained causes of death, and improve the standard of neonatal care in this subregion.

How the pediatric autopsy yields valuable information in a vertically integrated health care system

CONTEXT

Although autopsy rates have declined significantly in recent decades, studies continue to validate the autopsy as an important source of clinically relevant information, a teaching tool, and a quality assurance measure. A recent review of autopsy series showed a decline in the number of serious errors likely to have affected clinical outcome detected at autopsy during the past 46 years, with a current major error rate of 8.4% to 24.4%.

OBJECTIVE

Our hypothesis was that the pediatric autopsy would uncover a significant number of major unexpected findings at the high end of the spectrum predicted by a recent review. This study assesses the unexpected findings at a pediatric hospital whose autopsy service handles both in-house (tertiary care) and referral (mostly perinatal) cases for a vertically integrated health care system.

DESIGN

Data were analyzed from an autopsy effectiveness report completed for all autopsies performed in 2000. The data from this series include concordance of premortem and postmortem diagnoses, with the autopsy considered the criterion standard. The autopsy effectiveness report also provided logistic information, such as problems with consents, medical records, specimen identification, and prosection.

SETTING

Pediatric autopsies were performed by members of the Pediatric Pathology Division in a freestanding children's hospital in the Intermountain West of the United States with a large rural catchment area. This hospital is part of a large health maintenance organization serving the surrounding urban and rural areas.

PATIENTS

A sample of all in-house and referral autopsies for the year 2000 was examined.

MAIN OUTCOME MEASURE

The percentage of cases with a major or minor diagnostic discrepancy or unexpected pathologic finding using the autopsy as the criterion standard.

RESULTS

The overall autopsy rate was 40% (39 hospital autopsies and 15 forensic autopsies per 135 total deaths) and was 32% excluding forensic cases. Twenty-two additional referral autopsies from outside institutions were performed. Of 61 autopsies, 12 (20%) revealed a major diagnostic discrepancy or unexpected pathologic finding, 17 (28%) had a minor unexpected finding or additional diagnosis, 41 (67%) clarified the differential diagnosis, 46 (75%) confirmed or verified a major diagnosis, and 21 (34%) provided information regarding treatment effects. Additionally, 3 (5%) had problems with identification, and 12 (20%) had problems with consent, all of which were resolved prior to initiation of the autopsy.

CONCLUSIONS

These data confirm the value of the pediatric autopsy in a children's hospital and a vertically integrated health care system. It is an important medical and quality assurance procedure for assessing the accuracy of diagnoses, clarifying differential diagnoses, yielding unexpected findings, and providing feedback regarding therapeutic outcomes.