The causes of morbidity and mortality among infants born at term.

Previous studies have reported on the pathologic spectrum of perinatal mortality; however, in our opinion, the problems pertaining to the term newborn have not been emphasized sufficiently. We reviewed the autopsies of all term infants up to 2 months of age in a ten-year period (July 1975 to July 1985). These 342 patients comprised 20% of all pediatric autopsies. The patients were grouped according to cause of death in the following categories: congenital anomalies (59%); infection (10%); perinatal injury, including meconium aspiration (9%); maternal-placental problems (11%); and miscellaneous (5%). In 4% of the cases, mainly stillbirths, the cause of death was unclear. Of the congenital anomalies, the cardiovascular system was most affected (57%). Hyaline membrane disease and intraventricular hemorrhage, usually frequent in series involving many preterm patients, were seldom seen. This study emphasizes the different pathologic spectrum of mortality between premature and term newborns.

Victim factor correlates of traumatic infant death in South Carolina.

In South Carolina over a nine-year period, the adjusted odds that infants who died of injuries had been of low birth weight were 2.65:1 as compared to a live-born control group. The odds that injury victims were black were 1.84:1 as compared to control subjects. For victims of accidents only, the odds ratio for low birth weight was 2.37, and for black race, 1.61. For victims of homicide, the odds ratio for low birth weight was 6.15, and for black race, 4.76. Male sex, high birth order, low Apgar score, and the presence of a congenital anomaly were not significant infant risk factors by multifactorial analyses.

Surgical and conservative management of esophageal perforation.

A series of patients with esophageal injuries was reviewed to evaluate the role of conservative management of these injuries. Between 1962 and 1978, we treated 108 esophageal injuries. In 74 percent of the cases, the injury was probably iatrogenic. Foreign bodies were the most frequent cause of noniatrogenic esophageal injury. Sixty-eight patients underwent surgery, while the remaining 40 patients received conservative treatment. Of 11 deaths in the series, eight occurred among the surgically treated group. Methods of treatment are discussed, and illustrative cases presented.

The medicolegal investigation of operating room associated deaths.

For those medicolegal investigative systems charged by statute with the responsibility of investigating and examining known or suspected iatrogenic deaths--whether in a perioperative or operative situation, or in some other relationship to medical intervention--there is usually little doubt that these types of investigations constitute the most difficult, often perplexing, and far-reaching investigation, examination, and reporting problems of any of the types of cases referred. Much of this difficulty derives from the changing attitude of the public at large, including the medical and the legal community. In the United States, as recently as 15 years ago, the loss of life or injury subsequent to a therapeutic or operative procedure, with rare exception, was accepted virtually as an act of God.