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Observational Study
. 2021 Jul 8;11(1):14156.
doi: 10.1038/s41598-021-93358-7.

The value of autopsy in preterm infants at a Swedish tertiary neonatal intensive care unit 2002-2018

Alice Hoffsten  1 , Laszlo Markasz  1   2 , Katharina Ericson  3 , Leif D Nelin  1   4 , Richard Sindelar  5   6
Affiliations
Observational Study

The value of autopsy in preterm infants at a Swedish tertiary neonatal intensive care unit 2002-2018

Alice Hoffsten et al. Sci Rep. .

Abstract

Reliable data on causes of death (COD) in preterm infants are needed to assess perinatal care and current clinical guidelines. In this retrospective observational analysis of all deceased preterm infants born < 37 weeks' gestational age (n = 278) at a Swedish tertiary neonatal intensive care unit, we compared preliminary COD from Medical Death Certificates with autopsy defined COD (2002-2018), and assessed changes in COD between two periods (period 1:2002-2009 vs. period 2:2011-2018; 2010 excluded due to centralized care and seasonal variation in COD). Autopsy was performed in 73% of all cases and was more than twice as high compared to national infant autopsy rates (33%). Autopsy revised or confirmed a suspected preliminary COD in 34.9% of the cases (23.6% and 11.3%, respectively). Necrotizing enterocolitis (NEC) as COD increased between Period 1 and 2 (5% vs. 26%). The autopsy rate did not change between the two study periods (75% vs. 71%). We conclude that autopsy determined the final COD in a third of cases, while the incidence of NEC as COD increased markedly during the study period. Since there is a high risk to determine COD incorrectly based on clinical findings in preterm infants, autopsy remains a valuable method to obtain reliable COD.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Annual incidence of NEC as cause of death from 2002 to 2018.
Figure 2
Figure 2
(a) Distribution in percent of causes of death at various time intervals (0–24 h; 1–6 days; 7–28 days; > 28 days) during Period 1 and Period 2. *p < 0.05; significant change between Period 1 and Period 2 within each time interval. Congenital, congenital anomalies; Respiratory, respiratory causes; IVH, intraventricular hemorrhage; Infection, infection with septicemia; NEC, necrotizing enterocolitis. See Table 4 for further categorization of causes of death. (b) Distribution in percent of causes of death at various degrees of immaturity (gestational age < 28 weeks, 28–31 weeks and 32–36 weeks) during Period 1 and Period 2. *p < 0.05; significant change between Period 1 and Period 2 within each degree of immaturity. GA; gestational age; Congenital, congenital anomalies; Respiratory, respiratory causes; IVH, intraventricular hemorrhage; Infection, infection with septicemia; NEC, necrotizing enterocolitis. See Table 4 for further categorization of causes of death.
Figure 3
Figure 3
Inclusion of participants, data extraction and period division.
See this image and copyright information in PMC

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