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Updated: Aug 17, 2026
The Hypoxic Ischemic Encephalopathy Model of Perinatal Ischemia
Published on: November 19, 2008
Neonatal death after hypoxic ischaemic encephalopathy: does a postmortem add to the final diagnoses?
Dawn E Elder1, Jane M Zuccollo, Thorsten V Stanley
1Department of Paediatrics, Wellington School of Medicine and Health Sciences, Otago University, Wellington South, New Zealand.
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.
