Neuropathologic findings and age-related differences in Finnish pediatric medico-legal autopsies

Neuropathological examination plays a critical role in medico-legal cause-of-death investigation, especially in determining the cause and manner of death in pediatric autopsies. Although a comprehensive neuropathological examination is recommended, limited data exists of the diagnostic yield of neuropathology consultations in such cases. This retrospective register-based study reviewed Finnish pediatric medico-legal autopsies from 2016 to 2022 involving full neuropathological examination performed by a neuropathologist, with a focus on age-related differences in consultation rates, themes, and diagnostic findings. Data were retrieved from the medico-legal cause-of-death investigation documents, and included background characteristics, neuropathologic diagnoses, and causes and manners of death. A total of 118 pediatric medico-legal autopsies with a neuropathology consultation were performed during the study period. The consultation rate was highest among infants (aged <1 year; 45.6%), compared to early childhood (aged 1-10 years; 23.0%) and late childhood (aged 11-18 years; 6.2%). Traumatic brain injury was the most frequent consultation theme overall (33.9%), while the frequency of epilepsy-related consultations increased with age. Hypoxic-ischaemic neuronal injury constituted the commonest finding, with an overall prevalence of 43.2%. Findings associated with childhood epilepsy were more prevalent in early and late childhood, with epilepsy accounting for 15.2% of deaths in the latter group. Positive diagnostic findings were uncommon among infants, consistent with a high proportion of cases (42.1%) classified as sudden infant death syndrome. These findings provide forensic pathologists with age-specific diagnostic insights, supporting more targeted resource use and neuropathology consultation practices.