1
|
Lakhani J, Mack C, Kunyk D, Kung J, van Manen M. Considerations for Practice in Supporting Parental Bereavement in the Neonatal Intensive Care Unit-a Systematic Review. J Palliat Care 2024; 39:138-160. [PMID: 36846871 PMCID: PMC10960324 DOI: 10.1177/08258597231158328] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND Parental bereavement after the death of an infant in a neonatal intensive care unit (NICU) is a complex and nuanced experience. Support from healthcare practitioners can have a significant impact on bereavement experiences in the short- and long-term. Although several studies exist exploring parental perceptions of their experience of loss and bereavement, there has not been a recent review of beneficial practices and common themes in the current literature. OBJECTIVE This review synthesizes empirical research to identify considerations that ought to guide the caregiving practices of healthcare professionals to support parental bereavement. SETTINGS/SUBJECTS Data was collected from studies identified in MEDLINE, Embase, and CINAHL. The search was limited to English-language studies describing parental bereavement in the NICU population from January 1990 to November 2021. RESULTS Of 583 studies initially identified, 47 studies of varying geographic locations were included in this review. Various themes surrounding healthcare support in parental bereavement were identified including ensuring the opportunity for parents to spend time caring for their child, understanding their perception of infant suffering, recognizing the impact of communication experiences with healthcare providers, and offering access to alternative means of support, all of which have been described as suboptimal. Parents generally want the opportunity to say goodbye to their infant in a private and safe space, be supported through their decision-making and be offered bereavement follow-up after loss. CONCLUSION This review identifies methods of support in parental bereavement based on first-hand parental experiences and routine implementation of these strategies may be beneficial in supporting parents through their bereavement after the loss of a baby in the NICU.
Collapse
Affiliation(s)
- Jenna Lakhani
- University of Alberta, Stollery Children's Hospital, Edmonton, Canada
| | - Cheryl Mack
- University of Alberta, Stollery Children's Hospital, Edmonton, Canada
| | | | | | - Michael van Manen
- University of Alberta, Stollery Children's Hospital, John Dossetor Health Ethics Centre, Edmonton, Canada
| |
Collapse
|
2
|
Gupta N, Langeh N, Sharma A, Mridha A, Jana M, Barwad A, Mani K, Dadhwal V, Kumar A, Deka D, Kabra M. Minimally invasive autopsy in the evaluation of fetal malformations and stillbirths: A feasibility study. Birth Defects Res 2024; 116:e2280. [PMID: 38087877 DOI: 10.1002/bdr2.2280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 09/30/2023] [Accepted: 11/26/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND Minimally invasive autopsy (MIA) using post-mortem magnetic resonance imaging with ancillary investigations is reported as accurate as conventional autopsy. This study assesses MIA's feasibility and accuracy compared to conventional autopsy. METHOD MIA and/or conventional autopsy were performed on malformed fetuses (14-20 weeks gestation) and stillbirths (>20 weeks gestation), with/without malformation. Concordance in diagnostic accuracy (95% confidence interval [CI]) and agreement (Kappa coefficient [k]) were assessed in malformed cases where both MIA and autopsy were conducted. RESULTS We enrolled 200 cases, including 100 malformed fetuses (<20 weeks) and 100 stillbirths (with/without malformations). Concordance of 97.3% was observed between MIA and autopsy in 156 malformed cases. The overall diagnostic accuracy of MIA was 96.04%. CONCLUSION While conventional autopsy remains the gold standard, MIA is feasible in tertiary care settings. It can be considered a potential alternative for post-mortem assessment, particularly in settings with limited facility of conventional autopsy and parental refusal.
Collapse
Affiliation(s)
- Neerja Gupta
- Department of Pediatrics, Division of Genetics, AIIMS, New Delhi, India
| | - Nitika Langeh
- Department of Pediatrics, Division of Genetics, AIIMS, New Delhi, India
| | - Aparna Sharma
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Asit Mridha
- Department of Pathology, AIIMS, New Delhi, India
| | - Manisha Jana
- Department of Radiodiagnosis, AIIMS, New Delhi, India
| | | | | | - Vatsla Dadhwal
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Atin Kumar
- Department of Radiodiagnosis, AIIMS, New Delhi, India
| | - Dipika Deka
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Madhulika Kabra
- Department of Pediatrics, Division of Genetics, AIIMS, New Delhi, India
| |
Collapse
|
3
|
Ahsan N, Malik FA, Mughis W, Jabeen R, Mehboob S, Allana R, Quratulain S, Jamal S, Paganelli CR, Goco N, Parlberg L, Omer SB, Kazi AM. Postmortem minimally invasive tissue sampling in communities: exploring perceptions of families, funeral workers, religious and community leaders and healthcare providers from Pakistan. BMC Health Serv Res 2023; 23:1402. [PMID: 38093318 PMCID: PMC10720140 DOI: 10.1186/s12913-023-10438-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Minimally invasive tissue sampling (MITS) has increasingly been used to improve the diagnosis of disease and identification of the cause of death, particularly in underserved areas. However, there are multiple barriers to accessing those who die within the community, our study aimed to explore the perceptions and insights of community members and healthcare providers regarding the feasibility of implementing MITS in community settings. METHODS A qualitative exploratory study was conducted. A total of twenty one in-depth interviews were conducted with deceased infants' parents, elders of the family, religious leaders, community leaders, and funeral workers. Focus group discussions were conducted with health care providers (n = 14) in two peri-urban slum areas of Karachi, Pakistan. The duration of this study was from August to October 2020. Data was analyzed using thematic analysis and was coded and merged into categories forming eight major themes. RESULTS In general, participants viewed minimally invasive tissue sampling (MITS) as beneficial for improving child health, though some had concerns about disrespecting the deceased during sample collection. Misinformation, fear of needles, and medical procedures were major barriers to MITS implementation. To enhance acceptance, community and religious leaders suggested using religious rulings, obtaining parental consent, ensuring confidentiality, and increasing efforts of community engagement. Community healthcare providers, along with funeral workers, recommended providing community members with grief counseling to increase study participation. Besides concerns about sampling interfering with respect for the decease, community members also raised concerns about misinformation. Further, participants provided feedback on the design and appearance of the mobile van used to collect MITS samples from children under the age of five. CONCLUSION This study is critical for understanding the challenges associated with implementation of community-based MITS sampling in Pakistan. Integrating the use of a mobile van for sample collection, grief counseling along with community engagement sessions and advocacy will help address community-based misinformation and develop community trust.
Collapse
Affiliation(s)
- Nazia Ahsan
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Fauzia Aman Malik
- Yale School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Waliyah Mughis
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Rawshan Jabeen
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Shaheen Mehboob
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Raheel Allana
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Syeda Quratulain
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Saima Jamal
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Christina R Paganelli
- Social, Statistical and Environmental Sciences, RTI International, Research Triangle Park, Seattle Washington, NC, USA
| | - Norman Goco
- Social, Statistical and Environmental Sciences, RTI International, Research Triangle Park, Seattle Washington, NC, USA
| | - Lindsay Parlberg
- Social, Statistical and Environmental Sciences, RTI International, Research Triangle Park, Seattle Washington, NC, USA
| | - Saad B Omer
- Yale Institute for Global Health, Yale University, New Haven, Connecticut, USA
| | - Abdul Momin Kazi
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
| |
Collapse
|
4
|
Sreenivas A, Jaihind Jothikaran TA, Lewis L, Mathew M. Community perceptions of postmortem examination and minimally invasive tissue sampling in neonates:a qualitative study in South India. BMC Pregnancy Childbirth 2023; 23:804. [PMID: 37990299 PMCID: PMC10664656 DOI: 10.1186/s12884-023-06123-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/11/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Postmortem examination is the gold standard for establishing the cause of death. Minimally Invasive Tissue Sampling (MITS) of organs is a novel approach that can be used as an alternative to postmortem examination. In this study, the community perceptions in two states in South India towards neonatal postmortem and the acceptance towards the MITS technique is studied. METHODS In-depth interviews were conducted among the participants from Kerala and Karnataka to understand the perception towards postmortem and the acceptance of the novel MITS technique. The interviews were audio recorded, and a thematic analysis was done to identify the overarching themes and codes. RESULTS The knowledge and attitude of participants on conventional and MITS postmortem techniques, reasons for refusal, and the need for raising awareness were identified in the study. Participants favored the MITS techniques as it was less disfiguring and less time-consuming. The major concerns for refusal of conventional postmortem were that the procedure was disfiguring, time-consuming, and caused emotional stress to the parents. CONCLUSIONS Participants favored the MITS approach over conventional postmortem as it caused less disfigurement and was conducive to the religious practice of burial of the body.
Collapse
Affiliation(s)
- Athira Sreenivas
- Department of Pathology, Centre for Foetal and Perinatal Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Teddy Andrews Jaihind Jothikaran
- Department of Social and Health Innovation, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Leslie Lewis
- Department of Pediatrics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Mary Mathew
- Department of Pathology, Centre for Foetal and Perinatal Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| |
Collapse
|
5
|
O'Keefe H, Shenfine R, Brown M, Beyer F, Rankin J. Are non-invasive or minimally invasive autopsy techniques for detecting cause of death in prenates, neonates and infants accurate? A systematic review of diagnostic test accuracy. BMJ Open 2023; 13:e064774. [PMID: 36609326 PMCID: PMC9827258 DOI: 10.1136/bmjopen-2022-064774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 12/04/2022] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To assess the diagnostic accuracy of non-invasive or minimally invasive autopsy techniques in deaths under 1 year of age. DESIGN This is a systematic review of diagnostic test accuracy. The protocol is registered on PROSPERO. PARTICIPANTS Deaths from conception to one adjusted year of age. SEARCH METHODS MEDLINE (Ovid), EMBASE (Ovid), CINAHL (EBSCO), the Cochrane Library, Scopus and grey literature sources were searched from inception to November 2021. DIAGNOSTIC TESTS Non-invasive or minimally invasive diagnostic tests as an alternative to traditional autopsy. DATA COLLECTION AND ANALYSIS Studies were included if participants were under one adjusted year of age, with index tests conducted prior to the reference standard.Data were extracted from eligible studies using piloted forms. Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies-2. A narrative synthesis was conducted following the Synthesis without Meta-Analysis guidelines. Vote counting was used to assess the direction of effect. MAIN OUTCOME MEASURES Direction of effect was expressed as percentage of patients per study. FINDINGS We included 54 direct evidence studies (68 articles/trials), encompassing 3268 cases and eight index tests. The direction of effect was positive for postmortem ultrasound and antenatal echography, although with varying levels of success. Conversely, the direction of effect was against virtual autopsy. For the remaining tests, the direction of effect was inconclusive.A further 134 indirect evidence studies (135 articles/trials) were included, encompassing 6242 perinatal cases. The addition of these results had minimal impact on the direct findings yet did reveal other techniques, which may be favourable alternatives to autopsy.Seven trial registrations were included but yielded no results. CONCLUSIONS Current evidence is insufficient to make firm conclusions about the generalised use of non-invasive or minimally invasive autopsy techniques in relation to all perinatal population groups.PROSPERO registration numberCRD42021223254.
Collapse
Affiliation(s)
- Hannah O'Keefe
- NIHR Innovation Observatory, Newcastle University, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Rebekka Shenfine
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Melissa Brown
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona Beyer
- NIHR Innovation Observatory, Newcastle University, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
6
|
Groenendaal F, Nikkels PGJ. Autopsy in a neonatal intensive care unit: do we still need it in 2022? J Pediatr (Rio J) 2022; 98:442-443. [PMID: 35609639 PMCID: PMC9510792 DOI: 10.1016/j.jped.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/06/2022] [Indexed: 12/02/2022] Open
Affiliation(s)
- Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands.
| | - Peter G J Nikkels
- Department of Pathology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| |
Collapse
|
7
|
Mathew M, Lewis L, Sreenivas A, Purkayastha J. Cause of Death in Neonates With Neurological Insults in the Neonatal Intensive Care Unit: Insights From A MITS Pilot Study. Clin Infect Dis 2021; 73:S408-S414. [PMID: 34910168 PMCID: PMC8672737 DOI: 10.1093/cid/ciab857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Minimally invasive tissue sampling (MITS) of organs has been used as an alternative to complete diagnostic autopsy in countries where refusal for autopsy in newborns is common for sociocultural reasons. There is a paucity of literature regarding the diagnostic utility of MITS of the brain after death in neonates with neurological insults, especially in India. Methods This was a prospective, preliminary single-center tertiary care hospital study in India, focused specifically on MITS of the brain after neonatal death as a diagnostic tool to identify the various neurological insults. All neonatal deaths with neurological symptoms occurring within the first 30 days of life were enrolled, irrespective of the suspected clinical diagnosis. Results Sixteen neonates were enrolled after death for MITS of the brain, performed for diagnostic purposes, during the study period from February 2020 to March 2021. Their gestational ages ranged from 26 to 38 weeks. All neonates had either a history of seizures and/or respiratory distress or clinical evidence of sepsis and were on ventilator support. Histopathology in all 16 neonates showed evidence of anoxia, with or without reactive astrogliosis or microgliosis. In 5 neonates with cranial ultrasound evidence of brain hemorrhage, MITS of the brain showed intraventricular hemorrhage, subdural hemorrhage, or intraparenchymal white matter microhemorrhages. Premortem blood culture–proven sepsis was seen in 9 neonates. In all cases (100%), MITS had a good diagnostic yield and was useful to establish the neurological insult in the brain. Conclusions MITS of the brain provides an accurate and adequate diagnosis and can be an alternative to complete diagnostic autopsy for establishing the cause of death due to neurological insults, especially in low-resource settings where obtaining consent for more invasive procedure is often challenging.
Collapse
Affiliation(s)
- Mary Mathew
- Department of Pathology, Centre for Foetal and Perinatal Pathology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Leslie Lewis
- Department of Pediatrics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Athira Sreenivas
- Department of Pathology, Centre for Foetal and Perinatal Pathology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Jayashree Purkayastha
- Department of Pediatrics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| |
Collapse
|
8
|
Munguambe K, Maixenchs M, Anselmo R, Blevins J, Ordi J, Mandomando I, Breiman RF, Bassat Q, Menéndez C. Consent to minimally invasive tissue sampling procedures in children in Mozambique: A mixed-methods study. PLoS One 2021; 16:e0259621. [PMID: 34748582 PMCID: PMC8575303 DOI: 10.1371/journal.pone.0259621] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/22/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Minimally invasive tissue sampling (MITS), also named minimally invasive autopsy is a post-mortem method shown to be an acceptable proxy of the complete diagnostic autopsy. MITS improves the knowledge of causes of death (CoD) in resource-limited settings. Its implementation requires understanding the components of acceptability, including facilitators and barriers in real-case scenarios. METHODS We undertook a mixed-methods analysis comparing anticipated (hypothetical scenario) and experienced (real-case scenario) acceptability of MITS among relatives of deceased children in Mozambique. Anticipated acceptability information was obtained from 15 interviews with relatives of deceased children. The interview focus was on whether and why they would allow the procedure on their dead child in a hypothetical scenario. Experienced acceptability data were obtained from outcomes of consent requested to relatives of 114 deceased children during MITS implementation, recorded through observations, clinical records abstraction and follow-up informal conversations with health care professionals and semi-structured interviews with relatives. RESULTS Ninety-three percent of relatives indicated that they would hypothetically accept MITS on their deceased child. A key reason was knowing the CoD to take preventive actions; whereas the need to conform with the norm of immediate child burial, the secrecy of perinatal deaths, the decision-making complexity, the misalignment between MITS' purpose and traditional values, lack of a credible reason to investigate CoD, and the impotency to resuscitate the deceased were identified as potential points of hesitancy for acceptance. The only refusing respondent linked MITS to a perception that sharing results would constitute a breach of confidentiality and the lack of value attached to CoD determination. Experienced acceptability revealed four different components: actual acceptance, health professionals' hesitancy, relatives' hesitancy and actual refusal, which resulted in 82% of approached relatives to agree with MITS and 79% of cases to undergo MITS. Barriers to acceptability included, among others, health professionals' and facilities' unpreparedness to perform MITS, the threat of not burying the child immediately, financial burden of delays, decision-making complexities and misalignment of MITS' objectives with family values. CONCLUSIONS MITS showed high anticipated and experienced acceptability driven by the opportunity to prevent further deaths. Anticipated acceptability identified secrecy, confidentiality and complex decision-making processes as barriers, while experienced acceptability revealed family- and health facility-level logistics and practical aspects as barriers. Health-system and logistical impediments must also be considered before MITS implementation. Additionally, the multiple components of acceptability must be taken into account to make it more consistent and transferrable.
Collapse
Affiliation(s)
- Khátia Munguambe
- Centro de Investigação em Saúde de Manhiça (CISM), Cambeve, Maputo, Mozambique
- Faculdade de Medicina, Universidade Eduardo Mondlane (UEM), Maputo, Mozambique
| | - Maria Maixenchs
- Centro de Investigação em Saúde de Manhiça (CISM), Cambeve, Maputo, Mozambique
- Barcelona Institute for Global Health/ Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Rui Anselmo
- Centro de Investigação em Saúde de Manhiça (CISM), Cambeve, Maputo, Mozambique
| | - John Blevins
- Emory Global Health Institute, Emory University, Atlanta, Georgia, United States of America
| | - Jaume Ordi
- Barcelona Institute for Global Health/ Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- Department of Pathology, Hospital Clinic- Universitat de Barcelona, Barcelona, Spain
| | - Inácio Mandomando
- Centro de Investigação em Saúde de Manhiça (CISM), Cambeve, Maputo, Mozambique
- Instituto Nacional de Saúde (INS), Ministério da Saúde, Maputo, Mozambique
| | - Robert F. Breiman
- Emory Global Health Institute, Emory University, Atlanta, Georgia, United States of America
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça (CISM), Cambeve, Maputo, Mozambique
- Barcelona Institute for Global Health/ Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- Institución Catalana de Investigación y Estudios Avanzados (ICREA), Barcelona, Spain
- Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Clara Menéndez
- Centro de Investigação em Saúde de Manhiça (CISM), Cambeve, Maputo, Mozambique
- Barcelona Institute for Global Health/ Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| |
Collapse
|
9
|
Lewis C, Hutchinson JC, Riddington M, Hill M, Arthurs OJ, Fisher J, Wade A, Doré CJ, Chitty LS, Sebire NJ. Minimally invasive autopsy for fetuses and children based on a combination of post-mortem MRI and endoscopic examination: a feasibility study. Health Technol Assess 2020; 23:1-104. [PMID: 31461397 DOI: 10.3310/hta23460] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Less invasive perinatal and paediatric autopsy methods, such as imaging alongside targeted endoscopy and organ biopsy, may address declining consent rates for traditional autopsy, but their acceptability and accuracy are not known. OBJECTIVES The aims of this study were to provide empirical data on the acceptability and likely uptake for different types of autopsy among key stakeholders (study 1); and to analyse existing autopsy data sources to provide estimates of the potential efficacy of less invasive autopsy (LIA) and its projected utility in clinical practice (study 2). REVIEW METHODS Study 1: this was a mixed-methods study. Parents were involved in research design and interpretation of findings. Substudy 1: a cross-sectional survey of 859 parents who had experienced miscarriage, termination of pregnancy for fetal anomaly, stillbirth, infant or child death, and interviews with 20 responders. Substudy 2: interviews with 25 health professionals and four coroners. Substudy 3: interviews with 16 religious leaders and eight focus groups, with 76 members of the Muslim and Jewish community. Study 2: a retrospective analysis of national data in addition to detailed information from an existing in-house autopsy database of > 5000 clinical cases that had undergone standard autopsy to determine the proportion of cases by clinical indication group for which tissue sampling of specific internal organs significantly contributed to the diagnosis. RESULTS Substudy 1: 91% of participants indicated that they would consent to some form of LIA, 54% would consent to standard autopsy, 74% to minimally invasive autopsy (MIA) and 77% to non-invasive autopsy (NIA). Substudy 2: participants viewed LIA as a positive development, but had concerns around the limitations of the technology and de-skilling the workforce. Cost implications, skills and training requirements were identified as implementation challenges. Substudy 3: religious leaders agreed that NIA was religiously permissible, but MIA was considered less acceptable. Community members indicated that they might consent to NIA if the body could be returned for burial within 24 hours. Study 2: in 5-10% of cases of sudden unexplained death in childhood and sudden unexplained death in infants, the final cause of death is determined by routine histological sampling of macroscopically normal organs, predominantly the heart and lungs, and in this group routine histological sampling therefore remains an important aspect of investigation. In contrast, routine histological examination of macroscopically normal organs rarely (< 0.5%) provides the cause of death in fetal cases, making LIA and NIA approaches potentially highly applicable. LIMITATIONS A key limitation of the empirical research is that it is hypothetical. Further research is required to determine actual uptake. Furthermore, because of the retrospective nature of the autopsy data set, findings regarding the likely contribution of organ sampling to final diagnosis are based on extrapolation of findings from historical autopsies, and prospective data collection is required to validate the conclusions. CONCLUSIONS LIA is viable and acceptable (except for unexplained deaths), and likely to increase uptake. Further health economic, performance and implementation studies are required to determine the optimal service configuration required to offer this as routine clinical care. FUNDING The National Institute for Health Research Health Technology Assessment programme.
Collapse
Affiliation(s)
- Celine Lewis
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Genetics and Genomic Medicine, University College London Great Ormond Street Institute of Child Health, London, UK
| | - John C Hutchinson
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust and Institute of Child Health/University College London, London, UK
| | - Megan Riddington
- Department of Psychological Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Melissa Hill
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Genetics and Genomic Medicine, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Owen J Arthurs
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - Angie Wade
- Institute of Child Health; Population, Policy and Practice, University College London, London, UK
| | - Caroline J Doré
- Comprehensive Clinical Trials Unit, University College London, London, UK
| | - Lyn S Chitty
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Genetics and Genomic Medicine, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Neil J Sebire
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust and Institute of Child Health/University College London, London, UK
| |
Collapse
|
10
|
Kilcullen M, Kandasamy Y, Watson D, Cadet-James Y. Decisions to consent for autopsy after stillbirth: Aboriginal and Torres Strait Islander women's experiences. Aust N Z J Obstet Gynaecol 2019; 60:350-354. [PMID: 31591716 DOI: 10.1111/ajo.13052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 08/05/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND The stillbirth rate for Australian Aboriginal and Torres Strait Islander infants is twice that for non-Indigenous infants. Autopsy is the gold standard for fetal investigation; however, parental consent is often not given. There is little research investigating the drivers of parents' decision-making for autopsy after stillbirth. AIMS The current study explored the reasons why Aboriginal and Torres Strait Islander women did or did not give permission to autopsy after stillbirth. MATERIALS AND METHODS Five Aboriginal and/or Torres Strait Islander women participated in semi-structured interviews. Thematic analysis was conducted within a phenomenological framework. RESULTS Five themes were identified as reasons for giving permission - to find out why the baby died; to confirm diagnosis; to understand future risk; to help others; and doubt about maternal causes. Four themes were identified as reasons for declining permission - not asked in a sensitive manner; not enough time to think; distress about the autopsy procedure; and unwilling to agree. There was a lack of acceptability of the lengthy timeframe for the availability of autopsy results as families usually wait between three and nine months. This lengthy waiting period negatively impacted upon families' health and wellbeing. CONCLUSIONS It is important for health professionals to understand the factors that parents consider when giving permission for autopsy after stillbirth. It is hoped that an increase in autopsy rate will enhance the understanding of the causes of stillbirth and ultimately decrease the stillbirth rate for Aboriginal and Torres Strait Islander families.
Collapse
Affiliation(s)
- Meegan Kilcullen
- College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia
| | - Yogavijayan Kandasamy
- Department of Neonatology, The Townsville Hospital, Townsville, Queensland, Australia.,Mothers and Babies Research Centre, Hunter Medical Research Institute, John Hunter Hospital, The University of Newcastle, Newcastle, New South Wales, Australia.,College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - David Watson
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.,Department of Obstetrics and Gynaecology, The Townsville Hospital, Townsville, Queensland, Australia
| | - Yvonne Cadet-James
- Indigenous Research and Education Centre, James Cook University, Townsville, Queensland, Australia.,Apunipima Cape York Health Council, Bungalow, Queensland, Australia
| |
Collapse
|
11
|
Factors Influencing Acceptance of Post-Mortem Examination of Children at a Tertiary Care Hospital in Nairobi, Kenya. Ann Glob Health 2019; 85. [PMID: 31276331 PMCID: PMC6634467 DOI: 10.5334/aogh.2504] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Clinical autopsies are not often part of routine care, despite their role in clarifying cause of death. In fact, autopsy rates across the world have declined and are especially low in sub-Saharan Africa. OBJECTIVES We set out to identify factors associated with acceptance of pediatric autopsies among parents of deceased children less than five years old, and examined local preferences for minimally invasive tissue sampling (MITS) procedures during post-mortem (PM) examinations. METHODS From December 2016 to September 2017, we contacted 113 parents/next of kin who had been previously approached to consent to a PM examination of their deceased child as part of a Kenyan study on cause of death. Interviews occurred up to three years after the death of their child. FINDINGS Seventy-three percent (83/113) of eligible study participants were enrolled, of whom 62/83 (75%) had previously consented to PM examination of their child. Those who previously consented to PM had higher levels of education, were more likely employed, and had more knowledge about certain aspects of autopsies than non-consenters. The majority (97%) of PM consenters did so because they wanted to know the cause of death of their child, and up to a third believed autopsy studies helped advance medical knowledge. Reasons for non-consent to PM examination included: parents felt there was no need for further examination (29%) or they were satisfied with the clinical diagnosis (24%). Overall, only 40% of study participants would have preferred MITS procedures to conventional autopsy. However, 81% of autopsy non-consenters would have accepted PM examination if it only involved MITS techniques. CONCLUSION There is potential to increase autopsy rates by strengthening reasons for acceptance and addressing modifiable reasons for refusals. Although MITS procedures have the potential to improve autopsy acceptance rates, they were not significantly preferred over conventional autopsies in our study population.
Collapse
|
12
|
Abstract
OBJECTIVES The acceptability of traditional postmortem examination to bereaved families, coupled with a misguided professional view about their limited utility, has led to decrease in this ultimate investigation. Research recurrently demonstrates that postmortem examination provides clinically relevant information despite ever-improving diagnostic techniques. This review examines postmortem examination for children who die in PICU-whether consented or nonconsented (legally mandated). It explores how such investigations might provide useful information and suggests that PICU and pathology teams work together to provide information for bereaved families to either enable them to consent to postmortem interventions or understand necessary forensic processes. Newer technologies such as postmortem imaging and laparoscope-assisted/ultrasound-guided tissue sampling are reviewed, with the hope that greater acceptability to families may lead to a welcome resurgence in postmortem information for clinicians, tempered by realization that widespread acceptance of their equivalence to standard techniques by most forensic services is awaited. DATA SOURCES Literature review. STUDY SELECTION Journal articles describing practices in pediatric and adult postmortem examination. DATA EXTRACTION Not available. DATA SYNTHESIS Not available. CONCLUSIONS The PICU team have a duty to help bereaved parents understand what postmortem investigations are available, or might be mandated, after the death of their child. A thoughtful, unhurried, and compassionate discussion should be arranged with expert pathology teams and any specialists who have cared for the child to explain how investigations can provide information about what is involved-including availability and suitability of newer techniques. This should include information about when a child's body, organs, or tissues will be available for the funeral, necessary legal procedures and how and when results will be explained to them.
Collapse
|
13
|
Shruthi M, Gupta N, Jana M, Mridha AR, Kumar A, Agarwal R, Sharma R, Deka D, Gupta AK, Kabra M. Conventional vs virtual autopsy with postmortem MRI in phenotypic characterization of stillbirths and fetal malformations. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 51:236-245. [PMID: 28295775 DOI: 10.1002/uog.17468] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 01/25/2017] [Accepted: 02/28/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To compare virtual autopsy using postmortem magnetic resonance imaging (MRI) with conventional autopsy with respect to phenotypic characterization of stillbirths and malformed fetuses, and acceptability to parents. METHODS This was a prospective diagnostic evaluation study, conducted from June 2013 to June 2015, including stillbirths and pregnancies terminated owing to fetal malformation at ≥ 20 weeks' gestation, for which parental consent to both conventional autopsy and postmortem MRI was obtained. Cases of maternal and obstetric cause of fetal demise were excluded. Whole-body postmortem MRI (at 1.5 T) was performed prior to conventional autopsy. Taking conventional autopsy as the diagnostic gold standard, postmortem MRI findings alone, or in conjunction with other minimally invasive prenatal and postmortem investigations, were assessed and compared for diagnostic accuracy. RESULTS Parental consent for both conventional autopsy and postmortem MRI was obtained in 52 cases of which 43 were included in the analysis. In 35 (81.4%) cases, the final diagnosis based on virtual autopsy with postmortem MRI was in agreement with that of conventional autopsy. With conventional autopsy as the reference standard, sensitivity, specificity, positive and negative predictive values of postmortem MRI were, respectively: 77.7%, 99.8%, 97.4% and 98.0% for whole-body assessment; 93.1%, 99.0%, 87.1% and 99.5% for the nervous system; 61.0%, 100.0%, 100.0% and 96.7% for the cardiovascular system; 91.1%, 100.0%, 100.0% and 98.0% for the pulmonary system; 80.6%, 99.8%, 96.7% and 98.7% for the abdomen; 96.2%, 99.7%, 96.2% and 99.7% for the renal system; and 66.7%, 100.0%, 100.0% and 97.2% for the musculoskeletal system. Virtual autopsy was acceptable to 96.8% of families as compared with conventional autopsy to 82.5%. CONCLUSIONS Virtual autopsy using postmortem MRI and other minimally invasive investigations can be an acceptable alternative to conventional autopsy when the latter is refused by the parents. Postmortem MRI is more acceptable to parents and can provide additional diagnostic information on brain and spinal cord malformations. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- M Shruthi
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - N Gupta
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - M Jana
- Department of Radio Diagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - A R Mridha
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - A Kumar
- Department of Radio Diagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - R Agarwal
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - R Sharma
- Department of Radio Diagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - D Deka
- Fetal Medicine Division, Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - A K Gupta
- Department of Radio Diagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - M Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
14
|
Shelmerdine SC, Hutchinson JC, Sebire NJ, Jacques TS, Arthurs OJ. Post-mortem magnetic resonance (PMMR) imaging of the brain in fetuses and children with histopathological correlation. Clin Radiol 2017; 72:1025-1037. [PMID: 28821323 DOI: 10.1016/j.crad.2017.07.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 06/19/2017] [Accepted: 07/17/2017] [Indexed: 11/29/2022]
Abstract
Post-mortem magnetic resonance (PMMR) imaging is rapidly emerging as an alternative, "less invasive", and more widely accepted investigative approach for perinatal deaths in the UK. PMMR has a high diagnostic accuracy for congenital and acquired fetal neuropathological anomalies compared to conventional autopsy, and is particularly useful when autopsy is non-diagnostic. The main objectives of this review are to describe and illustrate the range of common normal and abnormal central nervous system (CNS) findings encountered during PMMR investigation. This article covers the standard PMMR sequences used at our institution, normal physiological post-mortem findings, and a range of abnormal developmental and acquired conditions. The abnormal findings include diseases ranging from neural tube defects, posterior fossa malformations, those of forebrain and commissural development as well as neoplastic, haemorrhagic, and infectious aetiologies. Neuropathological findings at conventional autopsy accompany many of the conditions we describe, allowing readers to better understand the underlying disease processes and imaging appearances.
Collapse
Affiliation(s)
- S C Shelmerdine
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - J C Hutchinson
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - N J Sebire
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - T S Jacques
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - O J Arthurs
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Imaging and Biophysics, UCL Great Ormond Street Institute of Child Health, London, UK.
| |
Collapse
|
15
|
Andruszkow J, Weichert W, Braunschweig T, Knüchel-Clarke R, Erlmeier F. [Fetal autopsies : Relic or still a gold standard?]. DER PATHOLOGE 2017; 38:438-447. [PMID: 28741114 DOI: 10.1007/s00292-017-0324-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Fetal autopsy rates are decreasing in Western countries although post-mortem examinations render important information for the parents concerning the cause of abortion and risk of recurrence in future pregnancies. OBJECTIVE The intention of the presented study was to analyze the development of fetal autopsies in Germany during the last decade and to review accessible information obtained by fetal autopsy. MATERIAL AND METHODS Reports of fetal autopsies conducted in two German university Institutes of pathology between 2005 and 2014 were evaluated retrospectively. Demographic data and the correlation between clinical diagnoses and autopsy findings were assessed. In addition, differences between spontaneous and induced cases of abortion and differences between the institutes were also documented. RESULTS Overall, 428 fetal autopsies were performed, whereby the number of autopsies decreased by 24.2% during the study period. Of the examined fetuses 29.7% were induced abortions which as expected exhibited different malformations compared to cases of spontaneous abortion (p < 0.001). There was no evidence of a malformation or other cause of death in 27.1% of the cases and 95.7% of these abortions occurred spontaneously. A discrepancy between clinical and autopsy findings was evident in 6.8% of cases and 3.5% of the autopsy examinations revealed at least one additional malformation compared to the prenatal clinical data. CONCLUSION Despite improvements in prenatal diagnostics, fetal autopsies remain an important diagnostic tool even today contributing additional information in a considerable number of cases potentially revising clinical diagnoses.
Collapse
Affiliation(s)
- J Andruszkow
- Institut für Pathologie, Uniklinikum der RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland.
| | - W Weichert
- Institut für Pathologie, Technische Universität München, München, Deutschland.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Heidelberg, Deutschland
| | - T Braunschweig
- Institut für Pathologie, Uniklinikum der RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - R Knüchel-Clarke
- Institut für Pathologie, Uniklinikum der RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - F Erlmeier
- Institut für Pathologie, Technische Universität München, München, Deutschland
| |
Collapse
|
16
|
Lewis C, Hill M, Arthurs OJ, Hutchinson C, Chitty LS, Sebire NJ. Factors affecting uptake of postmortem examination in the prenatal, perinatal and paediatric setting. BJOG 2017; 125:172-181. [PMID: 28190300 PMCID: PMC5763339 DOI: 10.1111/1471-0528.14600] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2017] [Indexed: 11/30/2022]
Abstract
Background Postmortem examination is the single most useful investigation in providing information to parents about why their baby or child died. Despite this, uptake remains well below the recommended 75%. Objective To address the question ‘what are the barriers and motivators to perinatal, prenatal and paediatric PM examination?’ Search strategy Key databases including Pubmed and CINAHL; Cochrane library, websites of relevant patient organisations, hand search of key journals, first and last authors and references. Selection criteria Peer‐reviewed qualitative, quantitative or mixed methods research examining factors affecting uptake or decline of perinatal or paediatric postmortem examination. Data collection and analysis Narrative synthesis; findings were compared across studies to examine interrelations. Main results Seven major themes describing barriers to postmortem uptake were identified: dislike of invasiveness, practicalities of the procedure, organ retention issues, protective parenting, communication and understanding, religion and culture and professional or organisational barriers. Six major themes related to factors which facilitated parental consent were identified: desire for information, contributing to research, coping and well‐being, respectful care, minimally invasive options, and policy and practice. There were a number of themes in the literature that reflected best practice. Conclusion Findings highlight the need for better health professional education and the fact some concerns may be mitigated if less invasive methods of postmortem were routinely available. New consent packages and codes of practice may have a positive impact on perception of examination after death. The landscape is changing; further research is necessary to assess the impact on postmortem uptake rates. Tweetable abstract Systematic review to explore the barriers and motivators to perinatal, prenatal and paediatric postmortem examination. Systematic review to explore the barriers and motivators to perinatal, prenatal and paediatric postmortem examination.
Collapse
Affiliation(s)
- C Lewis
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,UCL Institute of Child Health, Great Ormond Street Institute of Child Health, London, UK
| | - M Hill
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,UCL Institute of Child Health, Great Ormond Street Institute of Child Health, London, UK
| | - O J Arthurs
- UCL Institute of Child Health, Great Ormond Street Institute of Child Health, London, UK.,Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - C Hutchinson
- UCL Institute of Child Health, Great Ormond Street Institute of Child Health, London, UK.,Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - L S Chitty
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,UCL Institute of Child Health, Great Ormond Street Institute of Child Health, London, UK
| | - N J Sebire
- UCL Institute of Child Health, Great Ormond Street Institute of Child Health, London, UK.,Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| |
Collapse
|
17
|
Heltne U, Dyregrov A, Dyregrov K. Death scene investigation: parents’ experiences. SCANDINAVIAN JOURNAL OF FORENSIC SCIENCE 2017. [DOI: 10.1515/sjfs-2016-0009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
This article presents the results of a study undertaken to evaluate how parents experience voluntary Death Scene Investigation (DSI) in their homes. In total, 35 parents were interviewed using semi-structured qualitative interview guidelines developed for this project. These focused on the parents’: 1) appraisal of information provided prior to the DSI and motivation for participating in the study, 2) experience of, and reactions to the DSI, and 3) thoughts and reactions following the DSI. The evaluation shows that performing a DSI is an important part of providing good care for bereaved parents following Sudden Infant Death Syndrome. If such an investigation is undertaken by professionals with extensive professional knowledge and experience in meeting bereaved parents in an empathic and caring manner, it can be a positive experience for parents, and help support them in coping with the painful death of their infant.
Collapse
Affiliation(s)
- Unni Heltne
- Center for Crisis Psychology, Bergen, Norway
| | - Atle Dyregrov
- Center for Crisis Psychology, Bergen, Norway
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen
| | - Kari Dyregrov
- Center for Crisis Psychology, Bergen, Norway
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Norway
| |
Collapse
|
18
|
Whole-Body MRI Virtual Autopsy Using Diffusion-weighted Imaging With Background Suppression (DWIBS) at 3 T in a Child Succumbing to Chordoma. J Pediatr Hematol Oncol 2017; 39:133-136. [PMID: 28060123 DOI: 10.1097/mph.0000000000000759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND We report the use of diffusion-weighted imaging with background suppression (DWIBS) in pediatric virtual magnetic resonance imaging (MRI) autopsy of a child who succumbed to chordoma. CASE DESCRIPTION A 10-year-old girl who succumbed to relapse of a chordoma underwent whole-body virtual MRI autopsy 12 hours postmortem with short Tau inversion recovery (STIR) and DWIBS on 3 T, which demonstrated the primary mass, local and cardiac invasion, and metastatic disease to the thorax, abdomen, head/neck, and musculoskeletal system. CONCLUSIONS Postmortem virtual MRI autopsy including DWIBS successfully demonstrated the transthoracic spread of chordoma and invasion of the heart, resulting in blood-borne metastases. Motion and respiratory artifact were not factors during virtual autopsy using DWIBS on 3 T, making ideal use of this technology.
Collapse
|
19
|
Widmann R, Caduff R, Giudici L, Zhong Q, Vogetseder A, Arlettaz R, Frey B, Moch H, Bode PK. Value of postmortem studies in deceased neonatal and pediatric intensive care unit patients. Virchows Arch 2016; 470:217-223. [DOI: 10.1007/s00428-016-2056-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 11/03/2016] [Accepted: 12/08/2016] [Indexed: 10/20/2022]
|
20
|
Battersby C, Longford N, Mandalia S, Costeloe K, Modi N. Incidence and enteral feed antecedents of severe neonatal necrotising enterocolitis across neonatal networks in England, 2012-13: a whole-population surveillance study. Lancet Gastroenterol Hepatol 2016; 2:43-51. [PMID: 28404014 DOI: 10.1016/s2468-1253(16)30117-0] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 09/12/2016] [Accepted: 09/15/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Necrotising enterocolitis is a neonatal gastrointestinal inflammatory disease with high mortality and severe morbidity. This disorder is growing in global relevance as birth rates and survival of babies with low gestational age improve. Population data are scant and pathogenesis is incompletely understood, but enteral feed exposures are believed to affect risk. We aimed to quantify the national incidence of severe necrotising enterocolitis, describe variation across neonatal networks, and investigate enteral feeding-related antecedents of severe necrotising enterocolitis. METHODS We undertook a 2-year national surveillance study (the UK Neonatal Collaborative Necrotising Enterocolitis [UKNC-NEC] Study) of babies born in England to quantify the burden of severe or fatal necrotising enterocolitis confirmed by laparotomy, leading to death, or both. Data on all liveborn babies admitted to neonatal units between Jan 1, 2012, and Dec 31, 2013, were obtained from the National Neonatal Research Database. In the subgroup of babies born before a gestational age of 32 weeks, we did a propensity score analysis of the effect of feeding in the first 14 postnatal days with own mother's milk, with or without human donor milk and avoidance of bovine-origin formula, or milk fortifier, on the risk of developing necrotising enterocolitis. FINDINGS During the study period, 118 073 babies were admitted to 163 neonatal units across 23 networks, of whom 14 678 were born before a gestational age of 32 weeks. Overall, 531 (0·4%) babies developed severe necrotising enterocolitis, of whom 247 (46·5%) died (139 after laparotomy). 462 (3·2%) of 14 678 babies born before a gestational age of 32 weeks developed severe necrotising enterocolitis, of whom 222 (48·1%) died. Among babies born before a gestational age of 32 weeks, the adjusted network incidence of necrotising enterocolitis ranged from 2·51% (95% CI 1·13-3·60) to 3·85% (2·37-5·33), with no unusual variation from the adjusted national incidence of 3·13% (2·85-3·42), despite variation in feeding practices. The absolute risk difference for babies born before a gestational age of 32 weeks who received their own mother's milk within 7 days of birth was -0·88% (95% CI -1·15 to -0·61; relative risk 0·69, 95% CI 0·60 to 0·78; number needed to treat to prevent one case of necrotising enterocolitis 114, 95% CI 87 to 136). For babies who received no compared with any bovine-origin products within 14 days of birth, the absolute risk difference was -0·65% (-1·01 to -0·29; relative risk 0·61, 0·39 to 0·83; number needed to treat 154, 99 to 345). We were unable to assess the effect of human donor milk as use was low. INTERPRETATION Early feeding of babies with their own mother's milk and avoidance of bovine-origin products might reduce the risk of necrotising enterocolitis, but the absolute reduction is small. Owing to the rarity of severe necrotising enterocolitis, international collaborations are needed for adequately powered preventive trials. FUNDING National Institute for Health Research.
Collapse
Affiliation(s)
- Cheryl Battersby
- Neonatal Data Analysis Unit, Imperial College London, London, UK
| | - Nick Longford
- Neonatal Data Analysis Unit, Imperial College London, London, UK
| | | | - Kate Costeloe
- Neonatal Unit, Barts and the London School of Medicine and Dentistry, Homerton Hospital, London, UK
| | - Neena Modi
- Neonatal Data Analysis Unit, Imperial College London, London, UK.
| | | |
Collapse
|
21
|
Maixenchs M, Anselmo R, Zielinski-Gutiérrez E, Odhiambo FO, Akello C, Ondire M, Zaidi SSH, Soofi SB, Bhutta ZA, Diarra K, Djitèye M, Dembélé R, Sow S, Minsoko PCA, Agnandji ST, Lell B, Ismail MR, Carrilho C, Ordi J, Menéndez C, Bassat Q, Munguambe K. Willingness to Know the Cause of Death and Hypothetical Acceptability of the Minimally Invasive Autopsy in Six Diverse African and Asian Settings: A Mixed Methods Socio-Behavioural Study. PLoS Med 2016; 13:e1002172. [PMID: 27875532 PMCID: PMC5119724 DOI: 10.1371/journal.pmed.1002172] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 10/11/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The minimally invasive autopsy (MIA) is being investigated as an alternative to complete diagnostic autopsies for cause of death (CoD) investigation. Before potential implementation of the MIA in settings where post-mortem procedures are unusual, a thorough assessment of its feasibility and acceptability is essential. METHODS AND FINDINGS We conducted a socio-behavioural study at the community level to understand local attitudes and perceptions related to death and the hypothetical feasibility and acceptability of conducting MIAs in six distinct settings in Gabon, Kenya, Mali, Mozambique, and Pakistan. A total of 504 interviews (135 key informants, 175 health providers [including formal health professionals and traditional or informal health providers], and 194 relatives of deceased people) were conducted. The constructs "willingness to know the CoD" and "hypothetical acceptability of MIAs" were quantified and analysed using the framework analysis approach to compare the occurrence of themes related to acceptability across participants. Overall, 75% (379/504) of the participants would be willing to know the CoD of a relative. The overall hypothetical acceptability of MIA on a relative was 73% (366/504). The idea of the MIA was acceptable because of its perceived simplicity and rapidity and particularly for not "mutilating" the body. Further, MIAs were believed to help prevent infectious diseases, address hereditary diseases, clarify the CoD, and avoid witchcraft accusations and conflicts within families. The main concerns regarding the procedure included the potential breach of confidentiality on the CoD, the misperception of organ removal, and the incompatibility with some religious beliefs. Formal health professionals were concerned about possible contradictions between the MIA findings and the clinical pre-mortem diagnoses. Acceptability of the MIA was equally high among Christian and Islamic communities. However, in the two predominantly Muslim countries, MIA acceptability was higher in Mali than in Pakistan. While the results of the study are encouraging for the potential use of the MIA for CoD investigation in low-income settings, they remain hypothetical, with a need for confirmation with real-life MIA implementation and in populations beyond Health and Demographic Surveillance System areas. CONCLUSIONS This study showed a high level of interest in knowing the CoD of a relative and a high hypothetical acceptability of MIAs as a tool for CoD investigation across six distinct settings. These findings anticipate potential barriers and facilitators, both at the health facility and community level, essential for local tailoring of recommendations for future MIA implementation.
Collapse
Affiliation(s)
- Maria Maixenchs
- Centro de Investigação em Saúde da Manhiça, Maputo, Mozambique
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Rui Anselmo
- Centro de Investigação em Saúde da Manhiça, Maputo, Mozambique
| | | | - Frank O. Odhiambo
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Clarah Akello
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Maureen Ondire
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - S. Shujaat H. Zaidi
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sajid Bashir Soofi
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Zulfiqar A. Bhutta
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kounandji Diarra
- Centre pour le Développement des Vaccins (CVD-Mali), Bamako, Mali
| | - Mahamane Djitèye
- Centre pour le Développement des Vaccins (CVD-Mali), Bamako, Mali
| | | | - Samba Sow
- Centre pour le Développement des Vaccins (CVD-Mali), Bamako, Mali
| | | | - Selidji Todagbe Agnandji
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Bertrand Lell
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Mamudo R. Ismail
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Carla Carrilho
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Jaume Ordi
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Clara Menéndez
- Centro de Investigação em Saúde da Manhiça, Maputo, Mozambique
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Quique Bassat
- Centro de Investigação em Saúde da Manhiça, Maputo, Mozambique
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Khátia Munguambe
- Centro de Investigação em Saúde da Manhiça, Maputo, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- * E-mail:
| |
Collapse
|
22
|
Banerjee J, Kaur C, Ramaiah S, Roy R, Aladangady N. Factors influencing the uptake of neonatal bereavement support services - Findings from two tertiary neonatal centres in the UK. BMC Palliat Care 2016; 15:54. [PMID: 27357123 PMCID: PMC4928251 DOI: 10.1186/s12904-016-0126-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 06/20/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research on perinatal bereavement services is limited. The aim of the study was to compare the uptake of bereavement support services between two tertiary neonatal units (NNU), and to investigate influencing factors. METHOD The medical and bereavement records of all neonatal deaths were studied from January 2006 to December 2011. Data collected included parent and baby characteristics, mode of death, consent for autopsy and bereavement follow-up. The categorical data were compared by chi-square or Fisher's exact test and continuous data by Wilcoxon signed-rank test; a multivariable regression analysis was performed using STATA 12.0. RESULTS The neonatal deaths of 297 babies (182 in NNU1 and 115 in NNU2) with full datasets were analysed. Baby characteristics were similar between units except for lower median gestational age in NNU1 (p = 0.03). Significantly more NNU1 parents were non-Caucasian (p < 0.01), from lower socio-economic status (p = 0.01) and had previous stillbirth/miscarriage (p = 0.03). More babies had care withdrawn in NNU2 (p < 0.01). A significantly higher proportion of parents from NNU1 (61 %) attended bereavement follow-up compared to NNU2 (34 %; p < 0.01). On multivariable analysis, significantly more parents who were married or co-habiting (p = 0.02) and consented for an autopsy (p = 0.01) attended bereavement services. CONCLUSION Uptake of bereavement services varied between the two NNUs, which could be due to differences in the ethnic and socio-economic mix of the population. Significantly more parents who were married or co-habiting, or consented for autopsy, attended bereavement follow up services.
Collapse
Affiliation(s)
- Jayanta Banerjee
- Neonatal Unit, Homerton University Hospital NHS Foundation Trust, Homerton Row, London, E9 6SR, United Kingdom.,Centre for Paediatrics, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Neonatal Unit, Imperial College Healthcare NHS Trust, London, UK
| | - Charanjit Kaur
- Neonatal Unit, Homerton University Hospital NHS Foundation Trust, Homerton Row, London, E9 6SR, United Kingdom
| | - Sridhar Ramaiah
- Neonatal Unit, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Rahul Roy
- Neonatal Unit, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Narendra Aladangady
- Neonatal Unit, Homerton University Hospital NHS Foundation Trust, Homerton Row, London, E9 6SR, United Kingdom. .,Centre for Paediatrics, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK. .,Department of Paediatrics, SDM Medical College and Hospitals, Dharwad, India.
| |
Collapse
|
23
|
Judge-Kronis L, Hutchinson J, Sebire N, Arthurs O. Consent for paediatric and perinatal postmortem investigations: Implications of less invasive autopsy. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.jofri.2015.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
24
|
Zamir A, Arthurs OJ, Hagen CK, Diemoz PC, Brochard T, Bravin A, Sebire NJ, Olivo A. X-ray phase contrast tomography; proof of principle for post-mortem imaging. Br J Radiol 2015; 89:20150565. [PMID: 26612467 DOI: 10.1259/bjr.20150565] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To demonstrate the feasibility of using X-ray phase-contrast tomography to assess internal organs in a post-mortem piglet model, as a possible non-invasive imaging autopsy technique. METHODS Tomographic images of a new-born piglet were obtained using a free-space propagation X-ray phase-contrast imaging setup at a synchrotron (European Synchrotron Radiation Facility, Grenoble, France). A monochromatic X-ray beam (52 keV) was used in combination with a detector pixel size of 46 × 46 µm(2). A phase-retrieval algorithm was applied to all projections, which were then reconstructed into tomograms using the filtered-back projection algorithm. Images were assessed for diagnostic quality. RESULTS Images obtained with the free-space propagation setup presented high soft-tissue contrast and sufficient resolution for resolving organ structure. All of the main body organs (heart, lungs, kidneys, liver and intestines) were easily identified and adequately visualized. In addition, grey/white matter differentiation in the cerebellum while still contained within the skull was shown. CONCLUSION The feasibility of using X-ray phase-contrast tomography as a post-mortem imaging technique in an animal model has been demonstrated. Future studies will focus on translating this experiment to a laboratory-based setup. ADVANCES IN KNOWLEDGE Appropriate image processing and analysis enable the simultaneous visualization of both soft- and hard-tissue structures in X-ray phase-contrast images of a complex, thick sample.
Collapse
Affiliation(s)
- Anna Zamir
- 1 Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Owen J Arthurs
- 2 Great Ormond Street Hospital for Children NHS Foundation Trust, London UK.,3 Institute of Child Health, University College London, London, UK
| | - Charlotte K Hagen
- 1 Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Paul C Diemoz
- 1 Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | | | - Alberto Bravin
- 4 European Synchrotron Radiation Facility, Grenoble, France
| | - Neil J Sebire
- 2 Great Ormond Street Hospital for Children NHS Foundation Trust, London UK.,3 Institute of Child Health, University College London, London, UK
| | - Alessandro Olivo
- 1 Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| |
Collapse
|
25
|
Arthurs OJ, Thayyil S, Pauliah SS, Jacques TS, Chong WK, Gunny R, Saunders D, Addison S, Lally P, Cady E, Jones R, Norman W, Scott R, Robertson NJ, Wade A, Chitty L, Taylor AM, Sebire NJ. Diagnostic accuracy and limitations of post-mortem MRI for neurological abnormalities in fetuses and children. Clin Radiol 2015; 70:872-80. [PMID: 26050535 DOI: 10.1016/j.crad.2015.04.008] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 03/04/2015] [Accepted: 04/13/2015] [Indexed: 10/23/2022]
Abstract
AIM To compare the diagnostic accuracy of non-invasive cerebral post-mortem magnetic resonance imaging (PMMRI) specifically for cerebral and neurological abnormalities in a series of fetuses and children, compared to conventional autopsy. MATERIALS AND METHODS Institutional ethics approval and parental consent was obtained. Pre-autopsy cerebral PMMRI was performed in a sequential prospective cohort (n = 400) of fetuses (n = 277; 185 ≤ 24 weeks and 92 > 24 weeks gestation) and children <16 years (n = 123) of age. PMMRI and conventional autopsy findings were reported blinded and independently of each other. RESULTS Cerebral PMMRI had sensitivities and specificities (95% confidence interval) of 88.4% (75.5 to 94.9), and 95.2% (92.1 to 97.1), respectively, for cerebral malformations; 100% (83.9 to 100), and 99.1% (97.2 to 99.7) for major intracranial bleeds; and 87.5% (80.1 to 92.4) and 74.1% (68 to 79.4) for overall brain pathology. Formal neuropathological examination was non-diagnostic due to maceration/autolysis in 43/277 (16%) fetuses; of these, cerebral PMMRI imaging provided clinically important information in 23 (53%). The sensitivity of PMMRI for detecting significant ante-mortem ischaemic injury was only 68% (48.4 to 82.8) overall. CONCLUSIONS PMMRI is an accurate investigational technique for identifying significant neuropathology in fetuses and children, and may provide important information even in cases where autolysis prevents formal neuropathological examination; however, PMMRI is less sensitive at detecting hypoxic-ischaemic brain injury, and may not detect rarer disorders not encountered in this study.
Collapse
Affiliation(s)
- O J Arthurs
- Paediatric Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK; UCL Institute of Child Health, London, UK.
| | - S Thayyil
- Perinatal Neurology and Neonatology, Imperial College London, London, UK
| | - S S Pauliah
- Perinatal Neurology and Neonatology, Imperial College London, London, UK
| | - T S Jacques
- Department of Histopathology, UCL Institute of Child Health & Great Ormond Street Hospital for Children, London, UK
| | - W K Chong
- Paediatric Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK; UCL Institute of Child Health, London, UK
| | - R Gunny
- Paediatric Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK; UCL Institute of Child Health, London, UK
| | - D Saunders
- Paediatric Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK; UCL Institute of Child Health, London, UK
| | - S Addison
- Perinatal Neurology and Neonatology, Imperial College London, London, UK
| | - P Lally
- Perinatal Neurology and Neonatology, Imperial College London, London, UK
| | - E Cady
- Medical Physics and Bioengineering, University College London Hospitals NHS Foundation Trust, London, UK
| | - R Jones
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK; Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - W Norman
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK; Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - R Scott
- Department of Histopathology, University College London Hospital NHS Trust, UK
| | - N J Robertson
- Academic Neonatology, UCL Institute for Women's Health, London, UK
| | - A Wade
- Paediatric Epidemiology and Biostatistics Unit, UCL Institute of Child Health, London, UK
| | - L Chitty
- Genetics and Genomic Medicine, UCL Institute of Child Health, London, UK; Clinical Genetics, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; UCLH NHS Foundation Trusts, London, UK
| | - A M Taylor
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK; Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - N J Sebire
- UCL Institute of Child Health, London, UK; Department of Histopathology, UCL Institute of Child Health & Great Ormond Street Hospital for Children, London, UK
| | | |
Collapse
|
26
|
Arthurs OJ, Taylor AM, Sebire NJ. Indications, advantages and limitations of perinatal postmortem imaging in clinical practice. Pediatr Radiol 2015; 45:491-500. [PMID: 25274468 PMCID: PMC4381094 DOI: 10.1007/s00247-014-3165-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 07/01/2014] [Accepted: 08/20/2014] [Indexed: 11/29/2022]
Abstract
Just as there is a range of paediatric imaging techniques available during life, a similar repertoire is available as part of the foetal and perinatal postmortem examination. In this article, we review the literature regarding the diagnostic utility of postmortem radiography, US, CT and MRI in this clinical setting. There is limited direct evidence on the diagnostic utility of any of these techniques, apart from postmortem MRI, which when combined with other noninvasive investigations, has been shown to be highly sensitive and specific for many foetal postmortem diagnoses. The main disadvantages of postmortem MRI include the longer duration of imaging, the need for appropriate training in the interpretation of normal postmortem changes, and possible non-diagnostic imaging examinations in early gestation foetuses. As less-invasive autopsy becomes increasingly available, the true utility of these techniques will evolve, and clinical guidelines for maximal diagnostic yield can be developed.
Collapse
Affiliation(s)
- Owen J. Arthurs
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH UK ,Institute of Child Health, University College London, London, UK
| | - Andrew M. Taylor
- Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK ,Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK
| | - Neil J. Sebire
- Institute of Child Health, University College London, London, UK ,Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| |
Collapse
|
27
|
Addison S, Arthurs OJ, Thayyil S. Post-mortem MRI as an alternative to non-forensic autopsy in foetuses and children: from research into clinical practice. Br J Radiol 2014; 87:20130621. [PMID: 24288400 DOI: 10.1259/bjr.20130621] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Although post-mortem MRI (PMMR) was proposed as an alternative to conventional autopsy more than a decade ago, the lack of systematic validation has limited its clinical uptake. Minimally invasive autopsy (MIA) using PMMR together with ancillary investigations has now been shown to be as accurate as conventional autopsy in foetuses, newborns and infants and is particularly useful for cerebral, cardiac and genitourinary imaging. Unlike conventional autopsy, PMMR provides a permanent three-dimensional auditable record, with accurate estimation of internal organ volumes. MIA is becoming highly acceptable to parents and professionals, and there is widespread political support and public interest in its clinical implementation in the UK. In the short to medium term, it is desirable that a supraregional network of specialist centres should be established to provide this service within the current National Health Service framework.
Collapse
Affiliation(s)
- S Addison
- Perinatal Neurology and Neonatology, Imperial College London, London, UK
| | | | | |
Collapse
|
28
|
Garstang J, Griffiths F, Sidebotham P. What do bereaved parents want from professionals after the sudden death of their child: a systematic review of the literature. BMC Pediatr 2014; 14:269. [PMID: 25319926 PMCID: PMC4287432 DOI: 10.1186/1471-2431-14-269] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 10/03/2014] [Indexed: 12/02/2022] Open
Abstract
Background The death of a child is a devastating event for parents. In many high income countries, following an unexpected death, there are formal investigations to find the cause of death as part of wider integrated child death review processes. These processes have a clear aim of establishing the cause of death but it is less clear how bereaved families are supported. In order to inform better practice, a literature review was undertaken to identify what is known about what bereaved parents want from professionals following an unexpected child death. Methods This was a mixed studies systematic review with a thematic analysis to synthesize findings. The review included papers from Europe, North America or Australasia; papers had to detail parents’ experiences rather than professional practices. Results The review includes data from 52 papers, concerning 4000 bereaved parents. After a child has died, parents wish to be able to say goodbye to them at the hospital or Emergency Department, they would like time and privacy to see and hold their child; parents may bitterly regret not being able to do so. Parents need to know the full details about their child’s death and may feel that they are being deliberately evaded when not given this information. Parents often struggle to obtain and understand the autopsy results even in the cases where they consented for the procedure. Parents would like follow-up appointments from health care professionals after the death; this is to enable them to obtain further information as they may have been too distraught at the time of the death to ask appropriate questions or comprehend the answers. Parents also value the emotional support provided by continuing contact with health-care professionals. Conclusion All professionals involved with child deaths should ensure that procedures are in place to support parents; to allow them to say goodbye to their child, to be able to understand why their child died and to offer the parents follow-up appointments with appropriate health-care professionals. Electronic supplementary material The online version of this article (doi:10.1186/1471-2431-14-269) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Joanna Garstang
- Division of Mental Health and Wellbeing, Warwick Medical School, Coventry CV4 7AL, UK.
| | | | | |
Collapse
|
29
|
Sands' learning outcomes for consent taker training: Seeking consent/authorisation for a hospital post mortem examination of a baby. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.jnn.2013.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
30
|
Rüegger CM, Bartsch C, Martinez RM, Ross S, Bolliger SA, Koller B, Held L, Bruder E, Bode PK, Caduff R, Frey B, Schäffer L, Bucher HU. Minimally invasive, imaging guided virtual autopsy compared to conventional autopsy in foetal, newborn and infant cases: study protocol for the paediatric virtual autopsy trial. BMC Pediatr 2014; 14:15. [PMID: 24438163 PMCID: PMC3897955 DOI: 10.1186/1471-2431-14-15] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 01/17/2014] [Indexed: 11/23/2022] Open
Abstract
Background In light of declining autopsy rates around the world, post-mortem MR imaging is a promising alternative to conventional autopsy in the investigation of infant death. A major drawback of this non-invasive autopsy approach is the fact that histopathological and microbiological examination of the tissue is not possible. The objective of this prospective study is to compare the performance of minimally invasive, virtual autopsy, including CT-guided biopsy, with conventional autopsy procedures in a paediatric population. Methods/Design Foetuses, newborns and infants that are referred for autopsy at three different institutions associated with the University of Zurich will be eligible for recruitment. All bodies will be examined with a commercial CT and a 3 Tesla MRI scanner, masked to the results of conventional autopsy. After cross-sectional imaging, CT-guided tissue sampling will be performed by a multifunctional robotic system (Virtobot) allowing for automated post-mortem biopsies. Virtual autopsy results will be classified with regards to the likely final diagnosis and major pathological findings and compared to the results of conventional autopsy, which remains the diagnostic gold standard. Discussion There is an urgent need for the development of alternative post-mortem examination methods, not only as a counselling tool for families and as a quality control measure for clinical diagnosis and treatment but also as an instrument to advance medical knowledge and clinical practice. This interdisciplinary study will determine whether virtual autopsy will narrow the gap in information between non-invasive and traditional autopsy procedures. Trial Registration ClinicalTrials.gov: NCT01888380
Collapse
|
31
|
Baker JN, Windham JA, Hinds PS, Gattuso JS, Mandrell B, Gajjar P, West NK, Hammarback T, Broniscer A. Bereaved parents' intentions and suggestions about research autopsies in children with lethal brain tumors. J Pediatr 2013; 163:581-6. [PMID: 23433673 PMCID: PMC3664241 DOI: 10.1016/j.jpeds.2013.01.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 10/24/2012] [Accepted: 01/08/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine bereaved parents' perceptions about participating in autopsy-related research and to elucidate their suggestions about how to improve the process. STUDY DESIGN A prospective multicenter study was conducted to collect tumor tissue by autopsy of children with diffuse intrinsic pontine glioma. In the study, parents completed a questionnaire after their child's death to describe the purpose for, hopes (ie, desired outcomes of), and regrets about their participation in autopsy-related research. Parents also suggested ways to improve autopsy-related discussions. A semantic content analytic method was used to analyze responses and identify themes within and across parent responses. RESULTS Responses from 33 parents indicated that the main reasons for participating in this study were to advance medical knowledge or find a cure, a desire to help others, and choosing as their child would want. Parents hoped that participation would help others or help find a cure as well as provide closure. Providing education/anticipatory guidance and having a trusted professional sensitively broach the topic of autopsy were suggestions to improve autopsy discussions. All parents felt that study participation was the right decision, and none regretted it; 91% agreed that they would make the choice again. CONCLUSION Because autopsy can help advance scientific understanding of the disease itself and because parents reported having no regret and even cited benefits, researchers should be encouraged to continue autopsy-related research. Parental perceptions about such studies should be evaluated in other types of pediatric diseases.
Collapse
Affiliation(s)
- Justin N Baker
- Division of Quality of Life and Palliative Care; Departments of Pediatric Medicine and Oncology, St. Jude Children’s Research Hospital
| | - Jennifer A Windham
- Patient Care Services – Social Work; St. Jude Children’s Research Hospital
| | - Pamela S Hinds
- Department of Nursing Research and Quality Outcomes; Children’s National Medical Center
| | - Jami S Gattuso
- Division of Nursing Research; Department of Pediatric Medicine, St. Jude Children’s Research Hospital
| | - Belinda Mandrell
- Division of Nursing Research; Department of Pediatric Medicine, St. Jude Children’s Research Hospital
| | - Poorna Gajjar
- Division of Nursing Research; Department of Pediatric Medicine, St. Jude Children’s Research Hospital
| | - Nancy K West
- Division of Nursing Research; Department of Pediatric Medicine, St. Jude Children’s Research Hospital
| | - Teresa Hammarback
- Division of Nursing Research; Department of Pediatric Medicine, St. Jude Children’s Research Hospital
| | - Alberto Broniscer
- Division of Neuro-oncology; Department of Oncology, St. Jude Children’s Research Hospital
| |
Collapse
|
32
|
Abstract
End-of-life decisions are always stressful for families and professionals. As the decades pass, ethics and the law both change, even in one society, and cannot always provide perfect choices for each individual patient. Conflict should rarely arise in the neonatal unit. High-quality communication and compassion should allow professionals and families to build a team approach to the care of their child, even when the infant is imperilled. Each unit should have structures in place to deal with conflict, and every senior professional must be trained in conflict resolution so that the care of the family is outstanding.
Collapse
|
33
|
Horey D, Flenady V, Heazell AEP, Khong TY. Interventions for supporting parents' decisions about autopsy after stillbirth. Cochrane Database Syst Rev 2013:CD009932. [PMID: 23450611 DOI: 10.1002/14651858.cd009932.pub2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Stillbirth remains one of the least understood areas of infant death and accurate data on the causes of stillbirth are the cornerstone of stillbirth prevention. An autopsy examination remains the gold standard post-mortem investigation for stillbirth. However, decisions about post-mortem investigations, particularly autopsy are difficult. The purpose of this review is to examine the effectiveness of methods to help parents who have experienced a stillbirth decide whether to have post-mortem investigations, including whether to have an autopsy performed. OBJECTIVES The primary objectives were a) to examine the effectiveness of interventions to support parents' decisions about autopsy consent after a stillbirth on outcomes for parents, and b) to determine autopsy rates. Secondary objectives were to identify issues related to the acceptability of any interventions to parents and the feasibility of their implementation. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (29 October 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 10), MEDLINE (1966 to 24 July 2012) and EMBASE (1980 to 24 July 2012), Current Controlled Trials metaRegister (mRCT) (18 September 2012) and the WHO International Clinical Trials Registry Platform Search Portal (ICTRP) (18 September 2012). We also searched the websites of the Stillbirth and Neonatal Death Charity (SANDS) and International Stillbirth Alliance (ISA) (18 September 2012) and then subsequently searched the websites of all the ISA member organisations. SELECTION CRITERIA Randomised controlled trials (RCTs) of interventions designed specifically to support parents who have experienced a stillbirth make decisions about their options for post-mortem investigations including all investigations after stillbirth compared with usual care. DATA COLLECTION AND ANALYSIS Two review authors independently screened citations against the selection criteria. MAIN RESULTS No studies meeting the review inclusion criteria were identified. A search of 40 websites associated with supporting parents who experience stillbirth also found little reference to, or information about autopsy or other post-mortem examinations. AUTHORS' CONCLUSIONS Support for parents making decisions about autopsy or other post-mortem examinations after stillbirth must rely on the ad hoc knowledge and experience of those involved at the time.
Collapse
Affiliation(s)
- Dell Horey
- Faculty of Health Sciences, La Trobe University, Bundoora, Australia.
| | | | | | | |
Collapse
|
34
|
Van Loenhout RB, De Krijger RR, Van de Ven CP, Van der Horst IWJM, Beurskens LWJE, Tibboel D, Keijzer R. Postmortem biopsy to obtain lung tissue in congenital diaphragmatic hernia. Neonatology 2013; 103:213-7. [PMID: 23328121 DOI: 10.1159/000345921] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 11/08/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND The accrual of human tissues from autopsies for diagnostic and translational research has decreased significantly over the last decades. OBJECTIVES The objective of this study was to evaluate our experience with lung biopsy through a minithoracotomy as an alternative for obtaining postmortem tissue when full autopsy is refused in congenital diaphragmatic hernia (CDH) patients. METHODS Within 2 h of death we routinely asked parents for permission to perform an autopsy. Starting in 2001, parents who refused autopsy were asked permission for a postmortem lung biopsy. Pathology autopsy and biopsy reports were compared to clinical records. RESULTS Between 2001 and 2009, 46 patients died from CDH. Permission for autopsy was granted in 5 patients (11%). Of the remaining 41 patients, the parents of 15 (33%) agreed to postmortem lung biopsy. In all cases, additional findings were reported from the autopsy or biopsy, without changing the originally reported cause of death. In 1 case, we isolated fibroblasts from the lung biopsy using standardized cell culture techniques. Parents were able to take their child home with a minimal delay following biopsy. CONCLUSIONS Parents refusing a full autopsy frequently agree to postmortem organ biopsy. This approach should therefore be considered as a valuable alternative, when permission for full autopsy is declined, for obtaining human tissues for both diagnostic and research purposes and is potentially applicable to other anomalies.
Collapse
Affiliation(s)
- R B Van Loenhout
- Department of Pediatric Surgery, Sophia Children's Hospital, Erasmus MC, Rotterdam, The Netherlands
| | | | | | | | | | | | | |
Collapse
|
35
|
Horey D, Flenady V, Conway L, McLeod E, Yee Khong T. Decision influences and aftermath: parents, stillbirth and autopsy. Health Expect 2012; 17:534-44. [PMID: 22708659 DOI: 10.1111/j.1369-7625.2012.00782.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Stillbirth, among the most distressing experiences an adult may face, is also a time when parents must decide whether an autopsy or other post-mortem examinations will be performed on their infant. Autopsies can reveal information that might help explain stillbirth, yet little is known about how people make this difficult decision. OBJECTIVES This study examines the influences on decisions about autopsy after stillbirth among Australian parents. DESIGN The study involved secondary analysis of transcripts of three focus groups using qualitative content analysis. PARTICIPANTS AND SETTING Seventeen parents of 14 stillborn babies participated in consultations around the revision of a perinatal mortality audit guideline. RESULTS Parents shared the decision making. Four decision drivers were identified: parents' preparedness or readiness to make decisions; parental responsibility; concern for possible consequences of an autopsy and the role of health professionals. Each decision driver involved reasons both for and against autopsy. Two decision aftermath were also present: some parents who agreed to an autopsy were dissatisfied with the way the autopsy results were given to them and some parents who did not have an autopsy for their infant expressed some form of regret or uncertainty about the choice they made. CONCLUSIONS To make decisions about autopsy after stillbirth, parents need factual information about autopsy procedures, recognition that there might be fear of blame, an environment of trust, and health services and professionals prepared and skilled for difficult conversations.
Collapse
Affiliation(s)
- Dell Horey
- Research Fellow, Research Education and Development Unit, La Trobe University, Melbourne, Vic.Associate Professor, Mater Medical Research Institute, University of Queensland, Brisbane, QldState Coordinator, SANDS Queensland, Brisbane, QldFounder and Director, Stillbirth Foundation Australia, Sydney, NSWConsultant, SA Pathology at Women's and Children's Hospital, University of Adelaide, Adelaide, SAMember, Australian and New Zealand Stillbirth Alliance (ANZSA), Woolloongabba, Qld, Australia
| | | | | | | | | |
Collapse
|
36
|
Horey D, Flenady V, Heazell AEP, Khong TY. Interventions for supporting parents’ decisions about autopsy after stillbirth. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2012. [DOI: 10.1002/14651858.cd009932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
37
|
Breeze ACG, Statham H, Hackett GA, Jessop FA, Lees CC. Perinatal postmortems: what is important to parents and how do they decide? Birth 2012; 39:57-64. [PMID: 22369606 DOI: 10.1111/j.1523-536x.2011.00513.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Falling consent rates for postmortems, regardless of age of death, have been widely reported in recent years. The aim of this study was to explore parental attitudes to, and decision-making about, a perinatal postmortem after termination for fetal abnormality, late miscarriage, or stillbirth. METHODS A prospective self-completion questionnaire was given to 35 women and their partners. The participants had experienced second or third trimester pregnancy loss in a single fetal medicine and delivery unit in the United Kingdom and were making decisions about having a postmortem. They were asked to complete a questionnaire about their attitudes to, and expectations of, a perinatal postmortem. RESULTS Thirty-one questionnaires were received from parents of 17 babies (49% of those asked; 16 from mothers, 15 from fathers). Parents of nine babies (53%) said they would agree to a full postmortem, of three babies to a limited postmortem, and of four babies to an external examination only; one couple were undecided. The most important issues for the parents in this study that related to their decisions about a postmortem centered on the need for information, both for future planning and about what had happened. Moderately important issues related to altruism, which is, improving medical knowledge and helping other parents experiencing similar bereavement. Among the lowest scoring issues were potential barriers, such as concerns about cultural or religious acceptability of a postmortem, funeral delays, and what would happen to the baby's body. CONCLUSIONS Bereaved parents who participated in this study, where postmortem consent rates were relatively high, thought that their need for knowledge eclipsed assumed barriers when deciding whether or not to have a postmortem for their baby.
Collapse
Affiliation(s)
- Andrew C G Breeze
- Centre for Family Research, University of Cambridge, Free School Lane, Cambridge CB2 3RF, UK
| | | | | | | | | |
Collapse
|
38
|
Hickey L, Murphy A, Devaney D, Gillan J, Clarke T. The value of neonatal autopsy. Neonatology 2012; 101:68-73. [PMID: 21912185 DOI: 10.1159/000329094] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Accepted: 04/29/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVE Neonatal autopsy rates were in decline internationally at the end of the last century. Our objective was to assess the current value of neonatal autopsy in providing additional information to families and healthcare professionals. METHODS We conducted a review of neonatal autopsies performed in a tertiary perinatal centre over an 11-year period. Primary outcomes measured were the annual neonatal autopsy rates and concordance rates between clinical and autopsy diagnoses of the primary cause of death. Secondary outcomes were the clinical, genetic and audit value of the examinations. Findings were used to inform the consent process, and the effect this had on institutional post-mortem rates was assessed over the subsequent 5-year period. RESULTS There was a marked decline in the annual neonatal autopsy rate from 73% in 1994 to 48% in 2004. 164 cases met the inclusion criteria for review. Complete concordance for cause of death was reached in 91% of cases. Previously unsuspected or unconfirmed clinical conditions, other than the primary cause of death, were uncovered at autopsy in 85 cases. Detailed information on inheritable conditions was obtained in 45 cases. Findings with perceived 'audit value' for clinical practice were identified in 29 cases. The dissemination of this information to staff and families contributed to the stabilisation of the consent rate in the following 5-year period. CONCLUSION Neonatal autopsy remains a valuable diagnostic tool as it provides critical clinical and audit information for healthcare professionals and families.
Collapse
|
39
|
HOLSTE CAROLA, PILO CHRISTINA, PETTERSSON KARIN, RÅDESTAD INGELA, PAPADOGIANNAKIS NIKOS. Mothers’ attitudes towards perinatal autopsy after stillbirth. Acta Obstet Gynecol Scand 2011; 90:1287-90. [DOI: 10.1111/j.1600-0412.2011.01202.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
40
|
Sullivan J, Monagle P. Bereaved parents' perceptions of the autopsy examination of their child. Pediatrics 2011; 127:e1013-20. [PMID: 21402641 DOI: 10.1542/peds.2009-2027] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE In this study we explored parental views of their child's autopsy, their experiences with autopsy-related processes, and the impact of the examination on their grief. METHODS A survey design with a mailed questionnaire was used. The inclusion criteria were that an autopsy had been performed on the child and it was at least 3 months since his or her death. The questionnaire consisted of nonidentifying demographic details about the child, a standardized grief measure (parts A and B of the Texas Revised Inventory of Grief), and 28 questions with response sets and opportunities for comment. Fifty-three parents participated. RESULTS Our findings suggest a complexity of perceptions associated with pediatric autopsy examination. A distinction was identified between the informational and altruistic benefits of autopsy and its supportive qualities. Ninety percent of parents valued autopsy as a means of finding out why their child died, and 77% appreciated its contribution to medical knowledge. The general unequivocal helpfulness for bereaved parents commonly ascribed to autopsy examinations was not found. Parents expressed uncertainty about their perceptions of autopsy. Forty-one percent of the parents felt that it helped them live with their loss and 30% found it a comfort, whereas 42% of the parents felt that their child's autopsy examination added to their grief. The results underscore the necessity for open discussion with parents about the realities of what autopsy can offer them. CONCLUSIONS Our results add to the knowledge about the meaning of autopsy for grieving parents and challenge some current beliefs.
Collapse
Affiliation(s)
- Jane Sullivan
- Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville, Melbourne, Victoria 3052, Australia.
| | | |
Collapse
|
41
|
FLENADY V, MAHOMED K, ELLWOOD D, CHARLES A, TEALE G, CHADHA Y, JEFFERY H, STACEY T, IBIEBELE I, ELDER M, KHONG Y. Uptake of the Perinatal Society of Australia and New Zealand perinatal mortality audit guideline. Aust N Z J Obstet Gynaecol 2010; 50:138-43. [DOI: 10.1111/j.1479-828x.2009.01125.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
42
|
Sieswerda-Hoogendoorn T, van Rijn RR. Current techniques in postmortem imaging with specific attention to paediatric applications. Pediatr Radiol 2010; 40:141-52; quiz 259. [PMID: 20013258 PMCID: PMC2803260 DOI: 10.1007/s00247-009-1486-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Revised: 11/09/2009] [Accepted: 11/16/2009] [Indexed: 12/02/2022]
Abstract
In this review we discuss the decline of and current controversies regarding conventional autopsies and the use of postmortem radiology as an adjunct to and a possible alternative for the conventional autopsy. We will address the radiological techniques and applications for postmortem imaging in children.
Collapse
Affiliation(s)
- Tessa Sieswerda-Hoogendoorn
- Department of Radiology, Academic Medical Centre Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam Zuid-Oost, Netherlands
- Department of Pathology and Toxicology, Netherlands Forensic Institute, The Hague, Netherlands
| | - Rick R. van Rijn
- Department of Radiology, Academic Medical Centre Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam Zuid-Oost, Netherlands
- Department of Pathology and Toxicology, Netherlands Forensic Institute, The Hague, Netherlands
| |
Collapse
|
43
|
Green FHY, Keys E. In Reply. Arch Pathol Lab Med 2009. [DOI: 10.5858/133.4.510.b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Francis H. Y. Green
- Department of Pathology and Laboratory Medicine University of Calgary Calgary, Alberta, Canada T2N 4N1
| | - Elizabeth Keys
- Pathology and Laboratory Medicine Calgary Health Region Calgary, Alberta, Canada T2W 3N2
| |
Collapse
|
44
|
Abstract
Where possible, both parents should be present whenever bad news is broken. Professional calm and carefully chosen words are essential. Staff must be aware of cultural and religious beliefs of the family, and should be cognizant of linguistic and educational capabilities. The unexpected collapse and death of an infant is rare but is exceptionally demanding on communication skills. Time must be given for the family to ask questions, and staff should acknowledge the tragedy and the uncertainty, but should convey a determination to discover the truth for the family. A predictable deterioration allows staff and family to work together towards a "guided consensus" over future management. Compassionate care involves time, comfort and dignity for the child and parents. It is crucial for the family to receive empathetic support from senior nursing and medical staff. Mementoes may help the grieving process. Necropsy may also play an important role in allowing the families to rebuild their lives.
Collapse
Affiliation(s)
- Ian A Laing
- Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, UK.
| | | |
Collapse
|
45
|
Pavón Delgado A, Salinas Martín M, Losada Martínez A, Fontillón-Alberdi M, Núñez Solís J, Zamarriego Zubizarreta C. Valor de la autopsia en una unidad de cuidados intensivos neonatológicos. An Pediatr (Barc) 2008; 69:124-8. [DOI: 10.1157/13124890] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
46
|
Abstract
The subject of perinatal autopsy is not frequently seen in the literature. Perinatal loss, particularly stillbirth, frequently remains unexplained, despite current technology and diagnostic procedures. Parents may automatically refuse an autopsy, despite the potentially valuable information it could provide about the current pregnancy and subsequent pregnancies and despite the possible comfort the results could provide for relatives. Other reasons for declining an autopsy could be cultural or religious prohibitions. In addition, healthcare providers sometimes lack the knowledge of circumstances under which a postmortem examination is permitted, and fail to use culturally sensitive and culturally competent discussions about the reasons a postmortem examination is important and permissible. This purpose of this article is to provide information on selected cultural and religious groups to assist the nurse who is seeking consent for a perinatal autopsy.
Collapse
|
47
|
Abstract
The autopsy is now often regarded as of marginal use in modern clinical practice. In this Review we contend that the autopsy remains an important procedure with substantial, if largely underused, potential to advance medical knowledge and improve clinical practice. Many doctors lack familiarity with autopsy practices, and are insufficiently aware of the benefits for not only bereaved families but also present and future patients. In this Review, which has an international perspective, we consider the ascent and decline of the autopsy, the legal frameworks that govern its use, the value and potential pitfalls of alternatives to the conventional method, and the autopsy's role in undergraduate medical education. We also draw attention to the continuing ability of autopsies to improve the completeness and reliability of death certification, which is important for public-health strategies and for some bereaved families.
Collapse
Affiliation(s)
- Julian L Burton
- Academic Unit of Pathology, School of Medicine and Biomedical Sciences, University of Sheffield, Beech Hill Road, Sheffield S10 2RX, UK.
| | - James Underwood
- Academic Unit of Pathology, School of Medicine and Biomedical Sciences, University of Sheffield, Beech Hill Road, Sheffield S10 2RX, UK
| |
Collapse
|
48
|
Rose C, Evans M, Tooley J. Falling rates of perinatal postmortem examination: are we to blame? Arch Dis Child Fetal Neonatal Ed 2006; 91:F465. [PMID: 17056852 PMCID: PMC2672775 DOI: 10.1136/adc.2005.091314] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
49
|
Affiliation(s)
- Karen Kavanaugh
- Department of Maternal Child Nursing, University of Illinois, Chicago College of Nursing, USA.
| | | |
Collapse
|
50
|
Elder DE, Zuccollo JM, Stanley TV. Neonatal death after hypoxic ischaemic encephalopathy: does a postmortem add to the final diagnoses? BJOG 2005; 112:935-40. [PMID: 15957995 DOI: 10.1111/j.1471-0528.2005.00608.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Case review after fatal perinatal asphyxia may have medicolegal implications. Accurate diagnosis of cause of death is therefore essential. OBJECTIVE To determine consent rate and utility of autopsy after fatal grade III hypoxic ischaemic encephalopathy (HIE) presumed to be secondary to birth asphyxia. DESIGN A retrospective clinical review from January 1995 to December 2002. SETTING Regional tertiary referral neonatal unit, Wellington, New Zealand. POPULATION Inclusion criteria were gestation >/=37 weeks, resuscitation after delivery and clinical course of grade III HIE. Exclusions were a recognised major lethal malformation. METHODS Review of clinical records including the autopsy report. MAIN OUTCOME MEASURES Consent for autopsy, change in diagnosis after autopsy. RESULTS Twenty-three infants died during the time period with a major diagnosis of grade III HIE. Three did not meet inclusion criteria. Of the remaining 20, 11 were female. Median gestation at birth was 40 weeks (range 38-42 weeks) and median birth weight was 3568 g (range 2140-4475 g). In 8/17 of the infants for whom length and head measurements were available, the Ponderal Index suggested intrauterine growth retardation. The 16/20 infants had an autopsy. Four of these were Coroner's cases giving an autopsy rate of 80% with a rate by consent of 60%. In 10 (62.5%) infants, significant new information was added to the clinical diagnoses. CONCLUSIONS Neonatal HIE is a symptom rather than a final clinical diagnosis. A full autopsy is required to fully explore the reasons for fatal neonatal HIE and may provide information that is important medicolegally.
Collapse
Affiliation(s)
- Dawn E Elder
- Department of Paediatrics, Wellington School of Medicine and Health Sciences, Otago University, Wellington South, New Zealand
| | | | | |
Collapse
|