Postmortem examination after deaths in neonatal units in England and Wales, 2017-2022: a national observational study

Postmortem (PM) examination can be valuable after a baby's death, providing information about the cause of death and support for families. However, worldwide trends indicate declining neonatal PM rates. We aimed to analyse trends in PM offer and completion after deaths in neonatal units.

We used data from the National Neonatal Research Database on deaths in neonatal units in England, Wales and the Isle of Man (2017-2022). We used regression models to estimate rates of PM offer and completion and their association with selected clinical, socio-demographic and service-related variables. We report the relative risk (RR), with a p value <0.05 considered statistically significant.

PM offer and completion rates ranged from 56% to 62% and 15% to 18%, respectively. Compared with extremely preterm infants, term infants had higher PM completion rates (RR 2.25, 95% CI 1.94 to 2.62, p<0.001). PM completion was less likely for babies of Asian (RR 0.58, 95% CI 0.46 to 0.72, p<0.001) or black mothers (RR 0.78, 95% CI 0.60 to 0.99, p=0.04) when compared with babies of white mothers. Babies of mothers in the country's least deprived decile were more likely to have a PM completed (RR 1.38, 95% CI 1.04 to 2.48, p=0.04), in comparison with the most deprived centile.

This national study provides a near-contemporaneous perspective on neonatal PM and adds to existing evidence of low rates. These data indicate the need to address the root causes of variation in PM completion to ensure equity in the care of families after a neonatal death.