Autopsy in a Neonatal Intensive Care Unit: pathological and clinical agreement

Area of Science:

• Perinatal Medicine
• Pathology
• Medical Ethics

Background:

• Neonatal mortality remains a significant concern in tertiary care settings.
• Accurate diagnosis is crucial for effective patient management and family counseling.
• Autopsy plays a vital role in verifying clinical diagnoses and uncovering underlying causes of death.

Purpose of the Study:

• To determine neonatal autopsy rates at a tertiary hospital in southern Brazil.
• To assess the concordance between premortem clinical diagnoses and postmortem autopsy findings.
• To evaluate the impact of autopsy findings on patient management and genetic counseling.

Main Methods:

• Retrospective review of all neonatal autopsies over a 10-year period.
• Calculation of autopsy consent rates and analysis of agreement using modified Goldman criteria.
• Statistical analysis including linear regression to assess trends in autopsy rates.

Main Results:

• Out of 382 neonatal deaths, autopsy consent was obtained for 73 (19.1%).
• Complete agreement between clinical and autopsy diagnoses was observed in 65.8% of cases.
• Autopsies revealed additional significant findings in 34.2% of cases, influencing genetic counseling and potentially patient management.

Conclusions:

• Neonatal autopsies, despite low consent rates, offer valuable insights into causes of death and complement clinical diagnoses.
• Autopsy findings significantly contribute to understanding neonatal mortality and provide essential information for bereaved families.
• The study highlights the continued importance of neonatal autopsies in clinical practice and research.