A neuropathologic analysis of neonatal deaths occurring in a single neonatal unit over a 20-year period

This study presents an overview of 2515 consecutive autopsies performed on newborn infants who died during the first 28 days of life at The Hospital for Sick Children, Toronto, during the period 1970-89. The infants were grouped into two categories according to their gestational age, then subdivided into groups of early (0-6 days) and late (7-28 days) neonatal death. Trends in the occurrence of neuropathologic observation were documented. For each 5-year period and each gestational group, the following diagnoses were recorded: hypoxic-ischemic neuronal changes, periventricular leukomalacia, infarction, kernicterus, meningitis, and hemorrhage (subependymal, parenchymal, choroidal). Over these 20 years, our results show that death in preterm infants decreased because of a drop in the incidence of subependymal hemorrhage/intraventricular hemorrhage, kernicterus, and meningitis but increased in term infants as a result of a higher frequency of hypoxic-ischemic neuronal necrosis and choroid plexus hemorrhage.