Diagnostic utility of autopsy in a university hospital in Iran.

OBJECTIVE: The objective of this study were to evaluate the diagnostic utility of the autopsy in University hospital in Tehran, Iran. METHODS: In this retrospective descriptive-analytic survey during a six years period from 1998 to 2003, autopsies in the Bahrami Children Hospital, a teriary care hospital in Tehran, were studied. The clinical and autopsy diagnoses were compared and categorized as follows: 1. Change (clinical and autopsy diagnoses discordant), 2. Add (significant unexpected findings noted on the autopsy, although the clinical diagnosis was not altered), 3. Confirm (clinical and autopsy diagnosis concordant), 4. Autopsy inconclusive. RESULTS: Eighty four autopsies were studied. Out of 350 neonatal deaths in the period, autopsy was performed in 74 neonates (21%) and of 249 under 5 year deaths (except neonates) autopsy was performed in only 10 cases (4%). In 61 cases (73%) the autopsy diagnoses confirmed the clinical diagnosis, in 10 cases (12%) it changed the clinical diagnosis, in 11 cases (13%) it significantly added to the clinical diagnosis and in 2 cases (2%) it was inconclusive. CONCLUSION: This study demonstrated that neonatal and infantile autopsy continued to provide clinically useful data in 25% of cases and remains an invaluable tool in pediatric medicine.

Neonatal nosocomial infections in Bahrami Children Hospital.

OBJECTIVE: Nosocomial infections are one of the most important causes of mortality and morbidity in hospitals. These are major public health problems worldwide, but particularly in developing countries. These infections have the most common frequency in pediatric hospitals-especially in neonatal wards- second to burn hospitals. In the present study, neonatal nosocomial infections have been reviewed in Bahrami Children Hospital from fall of 1999 through fall of 2004. METHODS: Nosocomial infected patients were defined as all patients who were neither infected not were in incubation period at the admission time and had positive culture after third day of admission. The incidence of nosocomial infections computed as infections per 100 hospital discharges and infections per 100 hospital days. Chi square test was used for comparison of rates. RESULTS: Fifty-two patients had been diagnosed having nosocomial infections. NICU (Neonatal Intensive Care Unit) showed the highest portion of infections (40%) followed by neonatal surgery ward (35%) and neonates ward (25%). Frequencies of nosocomial infection by site were as follows: eyes (27%), septicemia, surgical wounds and location of drain or catheter (each one 21%), CSF (7%) and urinary (2%). The most common pathogenic organisms were Enterobacter (27%), aurues Staphilococcus (21%), Klebsiella (18%), E.coli (14%) and epidermis Staphilococcus (9%). Total number of hospitalized patients was 5990 and total number of hospitalized days was 39,095 in the five years. Infections per 100 hospital discharges and 100 hospital days by service were as follows, respectively: NICU (2.9, 0.26), neonatal surgery (1.7, 0.18) and neonates (0.3, 0.06). The differences were significantly meaningful (p value< 0.001). CONCLUSION: These findings provide useful information for future surveillance in association with prevention programs. Subsequently, surveillance should be focused on high-risk patients in intensive care unit and/or who have undergone surgery and invasive procedures.