[Value of autopsy in a neonatal intensive care unit]. / Valor de la autopsia en una unidad de cuidados intensivos neonatológicos.

OBJECTIVES: 1) To identify the profile of the cases requested for autopsy; 2) to analyze the clinocopathological discordance; 3) to investigate predictive factors for unsuspected clinically relevant diagnoses. PATIENTS AND METHOD: All autopsies performed between January 1999 and December 2005 in a tertiary neonatal intensive care unit, were retrospectively reviewed. Clinicopathological concordance was assessed independently by two neonatologists and two pathologists, according to a modification of the Goldman classification. A comparison was made between newborns who had an autopsy performed and those who did not and predictive factors for unsuspected findings were investigated. RESULTS: During the study period, there were 309 deaths, and autopsies were performed in 128 (41.4 %) of these cases. Autopsies were more common in newborns who had gestational age > 36 weeks (p < 0.001), birthweight > 1500 g (p < 0.001) and congenital defects (p < 0.007). However, the probability that the autopsy was granted decreased with increasing death age (p < 0.016). Unsuspected diagnoses were observed in 49.2 % of the autopsies, being a major finding in 21.1 % of the cases. A clinicopathological discordance involving the prognosis was found in four cases (3.1 %). Relevant unsuspected findings could not be predicted from the ante-mortem clinical diagnosis, gestational age, birthweight, sex, and death age. CONCLUSION: The autopsy remains the "gold standard" method to reveal major and unsuspected diagnoses and there is no substitute for it. Postmortem examination should be requested systematically in every neonatal death. However, several factors such as gestational age, birthweight, presence of congenital defects and death age, influence the likelihood of autopsy being granted.

Valor de la autopsia en una unidad de cuidados intensivos neonatológicos / Value of autopsy in a neonatal intensive care unit

Objetivos: Conocer el perfil de los casos sometidos a autopsia, analizar la discrepancia clinicopatológica e investigar los factores predictivos de un rendimiento alto. Pacientes y método: Se estudiaron retrospectivamente todas las autopsias practicadas en una unidad de cuidados intensivos neonatológicos de tercer nivel entre enero de 1999 y diciembre de 2005. De manera independiente, dos patólogos y dos neonatólogos establecieron la concordancia clinicopatológica según la clasificación de Goldman modificada. Se compararon los neonatos sometidos a autopsia con los que no lo fueron, y se investigaron los factores predictivos de hallazgos insospechados. Resultados: Se practicaron 128 autopsias (41,4 %) en 309 fallecimientos ocurridos durante el período de estudio. Las necropsias se realizaron con más frecuencia en los recién nacidos mayores de 36 semanas de edad gestacional (p < 0,001), peso superior a 1.500 g (p < 0,001) y con malformación (p < 0,007). Sin embargo, la probabilidad de que se concediera la autopsia decreció cuanto mayor era la edad del paciente fallecido (p < 0,016). Se observaron diagnósticos insospechados en el 49,2 % de las necropsias, siendo relevantes en el 21,1 %. En 4 casos (3,1 %) existió una discrepancia clinicopatológica con implicaciones en el pronóstico. No fue posible predecir los hallazgos insospechados relevantes en función del diagnóstico clínico ante mortem, la edad gestacional, el peso al nacer, el sexo y la edad en el momento del fallecimiento. Conclusión: La autopsia continúa siendo el método de referencia e insustituible para demostrar diagnósticos insospechados y relevantes. La necropsia debe solicitarse de manera sistemática ante toda muerte neonatal. Sin embargo, factores como la edad gestacional, el peso de nacimiento, la presencia de malformaciones y la edad de fallecimiento influyen en la probabilidad de ser concedida

Objectives: 1) To identify the profile of the cases requested for autopsy; 2) to analyze the clinocopathological discordance; 3) to investigate predictive factors for unsuspected clinically relevant diagnoses. Patients and method: All autopsies performed between January 1999 and December 2005 in a tertiary neonatal intensive care unit, were retrospectively reviewed. Clinicopathological concordance was assessed independently by two neonatologists and two pathologists, according to a modification of the Goldman classification. A comparison was made between newborns who had an autopsy performed and those who did not and predictive factors for unsuspected findings were investigated. Results: During the study period, there were 309 deaths, and autopsies were performed in 128 (41.4 %) of these cases. Autopsies were more common in newborns who had gestational age > 36 weeks (p < 0.001), birthweight > 1500 g (p < 0.001) and congenital defects (p < 0.007). However, the probability that the autopsy was granted decreased with increasing death age (p < 0.016). Unsuspected diagnoses were observed in 49.2 % of the autopsies, being a major finding in 21.1 % of the cases. A clinicopathological discordance involving the prognosis was found in four cases (3.1 %). Relevant unsuspected findings could not be predicted from the ante-mortem clinical diagnosis, gestational age, birthweight, sex, and death age. Conclusion: The autopsy remains the "gold standard" method to reveal major and unsuspected diagnoses and there is no substitute for it. Postmortem examination should be requested systematically in every neonatal death. However, several factors such as gestational age, birthweight, presence of congenital defects and death age, influence the likelihood of autopsy being granted

Enfermedad de Kawasaki neonatal grave / Severe neonatal Kawasaki disease

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