BJOG : an international journal of obstetrics and gynaecology · 2005
Neonatal death after hypoxic ischaemic encephalopathy: does a postmortem add to the final diagnoses?
СтатьяНазвание и аннотация: Перевод в очереди
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Elder Dawn E, Zuccollo Jane M, Stanley Thorsten V
Аннотация
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.
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.