Clinicopathological features of fatal cardiomyopathy in childhood: an autopsy series

Reference ranges for organ weights of infants at autopsy: results of >1,000 consecutive cases from a single centre

Background

Infancy is the most common period for childhood death, including both neonatal deaths from obstetric or medical complications and sudden unexpected infant deaths. The weighing of organs at autopsy is an established process and is recommended in current protocols. However, minimal contemporary data is available regarding reference ranges for organ weights of infants.

Methods

Organ weight data for consecutive infant autopsies over a 14 year period performed at a single tertiary centre, including >1,000 cases, were examined in order to provide up to date reference ranges across this age range, using linear regression modelling and the standard LMS method.

Results

1,525 infant autopsies were analysed, of which 1,190 were subsequently used in the creation of linear regression models prior to performance of the LMS method. Organ weight charts were produced for the 5th, 25th, 50th, 75th and 95th centiles for the heart, lungs, liver, spleen, kidneys, pancreas, thymus gland and adrenal glands.

Conclusion

This study provides the largest single centre contemporary dataset of infant autopsies allowing provision of up-to-date ‘normal’ ranges for all major organ weights across this age range.

Toddler Fatalities: The Terrible Twos

The majority of childhood deaths investigated by medical examiners and coroners are under the age of one, and medical examiners and coroners are well-versed in the challenges involved in investigating these fatalities. As infants mature to toddlers, there is a paradigm shift with a decrease in both the number of fatalities and the number of undetermined causes of death. A subset of these, however, remain undetermined, causing frustration for both the parents and medical examiner/coroner. In an effort to facilitate a differential diagnosis in these cases, death certificate data from the New York City Office of Chief Medical Examiner for deaths from one to four years of age over a five year period was examined. Of the 230 deaths investigated by the New York City Office of Chief Medical Examiner, the manner was natural in 39%, accident in 32%, homicide in 19%, therapeutic complication in 5%, and undetermined in 5%. Diligent scene investigation and a thorough histologic examination are key components to the investigation. While the lack of a cause of death in a portion of these undetermined deaths is due to limits in current postmortem techniques, a differential diagnosis for these deaths should include channelopathies, seizure disorders, and accidental injuries involving asphyxial mechanisms and inadvertent drug/toxin ingestion.