“NEONATAL AUTOPSIES IN A NIGERIAN TERTIARY REFERRAL CENTRE”: A ONE YEAR PROSPECTIVE STUDY IN UNIVERSITY OF CALABAR TEACHING HOSPITAL

Abstract

Introduction: The word autopsy is derived from the Greek word 'autopsia' meaning to see
for oneself. Neonatal death was defined as death occurring within the first 28days of life.
Autopsy has contributed to medical care by establishing the cause of death, assisting in
determining the manner of death, comparing the ante mortem and postmortem findings.
Despite the importance of autopsy; there has been a worldwide decline in the neonatal
autopsy rate. The aim of the study is to carry out a prospective histopathological evaluation
of neonatal autopsies in a Nigerian tertiary referral centre with the following objectives: To
identify the trends in neonatal autopsy in UCTH, Calabar, to identify the common causes of
neonatal mortality as well as their frequencies in UCTH, Calabar, to determine the rate at
which autopsies detect important, clinically missed diagnoses and to determine the
concordance between ante mortem and postmortem diagnosis.
Methods: This prospective study was performed over a one year period (1stJune 2012, to
30th June 2013) in the department of pathology, UCTH. Ethical approval from the hospital
ethical committee and written informed consent from parents were obtained prior to autopsy.
Data were obtained from medical records department, registry of child births, neonatal
deaths, and autopsies in the past one decade in department of pathology, UCTH (2004-2013)
for trend analysis, as well as from fifty-three (53) neonatal autopsies which were performed
using standard techniques including internal and external examinations and followed by
histopathological examination. A modification of the Goldman Criteria used to classify
diagnostic error.

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Results: In the one-year prospective study of 53 neonatal autopsies, male : female ratio was
1: 0.83 and mean age at death was 6.5 + 7.3 days, ranging from 1 to 28 days, with a little
less than one-fifth (10) i.e. 18.9% dying within 24 hours and one-half (26) i.e. 49.1%, dying
within 2-7 days of life, respectively. In this study, the commonest cause of neonatal death
was severe birth asphyxia seen in 10 cases (18.9%), followed by kernicterus in 6
cases(11.3%), birth trauma seen in 6 cases(11.3%), congenital heart disease seen in 5 cases(
9.4%), and prematurity seen in 5 cases( 9.4%). Birth injury6(50%), Congenital heart disease
5(41.7%) and Intracranial haemorrhage 4(33.3%) were always being missed clinically. The
ante mortem and postmortem causes of deaths were similar for 16 cases and dissimilar for
37 cases of neonatal autopsies, yielding a concordance rate of 30.2%, and a discordance rate
of 69.8%. In the 10-year trend analysis, there were a total of 22, 916 deliveries with male:
female ratio of 1:0.95 and 1,136 neonatal deaths. Autopsy was performed in 86(7.57%) of
cases. During this period, total neonatal autopsy rate (NAR) was found to be 7.57, ranging
from 0.84% in 2004 to 26 % in 2013.
Conclusion: The study confirms the usefulness of neonatal autopsy in ascertaining the
definitive cause of death. Low Neonatal autopsy rate in the centre was also noted with
gradual improvement in the study period. There was a low concordance rate of 30.2% with
diagnosis of congenital heart disease, intracranial haemorrhage and Birth trauma which were
commonly missed by the clinicians.