Clinical aspects of neonatal death and autopsy

An autopsy carried out by a trained perinatal pathologist can provide parents and professionals with new information about the cause of a baby's death. It is extremely stressful for parents to be asked for autopsy authorisation. The request is also very demanding for the staff. The rates of neonatal autopsy have been declining since 1990 and, almost certainly, the adverse publicity surrounding the Alder Hey enquiry precipitated a further fall in authorisation rates. Only a re-establishment of trust between parents and professionals can reverse this trend. This trust is founded on excellent perinatal communication and clinical care. The child's death must be managed in the most empathetic way, with an understanding of bereavement and the grief support required. If the parents and professionals work together as a team, the parents should sense the commitment of staff to their family. They may then be more likely to understand the importance of autopsy and to provide authorisation.