Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Inter-center variation in autopsy practices among regional neonatal intensive care units (NICUs)

Journal of Perinatology volume 41, pages 2820–2825 (2021)Cite this article

Subjects

Abstract

Objective

To characterize infants who underwent autopsy in regional neonatal intensive care units (NICUs) and examine inter-center variability in autopsy completion.

Study design

Retrospective cohort study of infants who died between 2010 and 2016 from 32 participating hospitals in the Children’s Hospital Neonatal Database (CHND). Maternal/infant demographics and hospital stay data were collected, along with autopsy rates by center, year, and region. Data analysis utilized bivariate and multivariable statistics.

Result

Of 6299 deaths, 1742 (27.7%) completed autopsy. Infants who underwent autopsy had higher median birth weight (2 124 g vs. 1 655 g) and gestational age (34 vs. 32 weeks). No differences were seen in sex, length of stay, or primary cause of death. Marked inter-center variability was observed, with 17-fold adjusted difference (p < 0.001) in autopsy rates.

Conclusion

Patient characteristics do not account for variability in autopsy practices across regional NICUs. Factors such as provider practices and parental preferences should be investigated.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to the full article PDF.

USD 39.95

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Autopsy rates as a percentage of deaths in regional NICUs by year.
Fig. 2: Adjusted odds ratio of autopsy by center. Centers deidentified and placed in ascending order by odds ratio.

Similar content being viewed by others

References

  1. Ely DM, Driscoll AK. Infant Mortality in the United States, 2017: Data From the Period Linked Birth/Infant Death File. Natl Vital Stat Rep. 2019;68:1–20.

    PubMed  Google Scholar 

  2. Feudtner C, Feinstein JA, Satchell M, Zhao H, Kang TI. Shifting place of death among children with complex chronic conditions in the United States, 1989-2003. JAMA. 2007;297:2725–32.

    Article  CAS  Google Scholar 

  3. Custer JW, Winters BD, Goode V, Robinson KA, Yang T, Pronovost PJ, et al. Diagnostic errors in the pediatric and neonatal ICU: a systematic review. Pediatr Crit Care Med. 2015;16:29–36.

    Article  Google Scholar 

  4. Brodlie M, Laing IA, Keeling JW, McKenzie KJ. Ten years of neonatal autopsies in tertiary referral centre: retrospective study. BMJ. 2002;324:761–3.

    Article  Google Scholar 

  5. Kabra NS, Udani RH. Correlation between clinical diagnoses at the time of death and autopsy findings in critically sick neonates at a regional neonatal intensive care unit in India. J Trop Pediatr. 2001;47:295–300.

    Article  CAS  Google Scholar 

  6. Leadbetter KZ, Vesoulis ZA, White FV, Schmidt RE, Khanna G, Shimony JS, et al. The role of post-mortem MRI in the neonatal intensive care unit. J Perinatol. 2017;37:98–103.

    Article  CAS  Google Scholar 

  7. Straumanis JP. The autopsy: still valuable in the 21st century for identifying diagnostic errors. Pediatr Crit Care Med. 2015;16:79–80.

    Article  Google Scholar 

  8. Nese N, Bulbul Y. Diagnostic value of perinatal autopsies: analysis of 486 cases. J Perinat Med. 2018;46:175–81.

    Article  Google Scholar 

  9. Sullivan J, Monagle P. Bereaved parents’ perceptions of the autopsy examination of their child. Pediatrics. 2011;127:e1013–20.

    Article  Google Scholar 

  10. Blokker BM, Weustink AC, Hunink MGM, Oosterhuis JW. Autopsy rates in the Netherlands: 35 years of decline. PLoS One. 2017;12:e0178200.

    Article  Google Scholar 

  11. Burton JL, Underwood J. Clinical, educational, and epidemiological value of autopsy. Lancet. 2007;369:1471–80.

    Article  Google Scholar 

  12. Tsitsikas DA, Brothwell M, Chin Aleong JA, Lister AT. The attitudes of relatives to autopsy: a misconception. J Clin Pathol. 2011;64:412–4.

    Article  Google Scholar 

  13. Khong TY. Improving perinatal autopsy rates: who is counseling bereaved parents for autopsy consent? Birth. 1997;24:55–7.

    Article  CAS  Google Scholar 

  14. Murthy K, Dykes FD, Padula MA, Pallotto EK, Reber KM, Durand DJ, et al. The Children’s Hospitals Neonatal Database: an overview of patient complexity, outcomes and variation in care. J Perinatol. 2014;34:582–6.

    Article  CAS  Google Scholar 

  15. Fry JT, Matoba N, Datta A, DiGeronimo R, Coghill CH, Natarajan G, et al. Center, Gestational Age, and Race Impact End-of-Life Care Practices at Regional Neonatal Intensive Care Units. J Pediatr. 2020;217:e1.

    Article  Google Scholar 

  16. Bureau USC Census Regions and Divisions of the United States 2019 [updated April 22, 2019. Available from: https://www2.census.gov/geo/pdfs/maps-data/maps/reference/us_regdiv.pdf.

  17. Bureau USC MEDIAN HOUSEHOLD INCOME IN THE PAST 12 MONTHS (IN 2013 INFLATION-ADJUSTED DOLLARS). In: Office USCBsACS, editor. 2013.

  18. American Academy of Pediatrics Committee on F, Newborn. Levels of neonatal care. Pediatrics. 2012;130:587–97.

    Article  Google Scholar 

  19. VanMarter LJ, Taylor F, Epstein MF. Parental and physician-related determinants of consent for neonatal autopsy. Am J Dis Child. 1987;141:149–53.

    CAS  PubMed  Google Scholar 

  20. Kumar P, Angst DB, Taxy J, Mangurten HH. Neonatal autopsies: a 10-year experience. Arch Pediatr Adolesc Med. 2000;154:38–42.

    CAS  PubMed  Google Scholar 

  21. Hickey L, Murphy A, Devaney D, Gillan J, Clarke T. The value of neonatal autopsy. Neonatology. 2012;101:68–73.

    Article  Google Scholar 

  22. Shojania KG, Burton EC. The vanishing nonforensic autopsy. N Engl J Med. 2008;358:873–5.

    Article  CAS  Google Scholar 

  23. Cartlidge PH, Dawson AT, Stewart JH, Vujanic GM. Value and quality of perinatal and infant postmortem examinations: cohort analysis of 400 consecutive deaths. BMJ. 1995;310:155–8.

    Article  CAS  Google Scholar 

  24. Mjornheim B, Rosendahl A, Eriksson LC, Takman C. Attitudes of Nurses and Physicians About Clinical Autopsy in Neonatal and Adult Hospital Care: A Survey in Sweden. Nurs Res. 2015;64:264–71.

    Article  Google Scholar 

  25. McPhee SJ, Bottles K, Lo B, Saika G, Crommie D. To redeem them from death. Reactions of family members to autopsy. Am J Med. 1986;80:665–71.

    Article  CAS  Google Scholar 

  26. Rose C, Evans M, Tooley J. Falling rates of perinatal postmortem examination: are we to blame? Arch Dis Child Fetal Neonatal Ed. 2006;91:F465.

    Article  CAS  Google Scholar 

  27. Gordijn SJ, Erwich JJ, Khong TY. Value of the perinatal autopsy: critique. Pediatr Dev Pathol. 2002;5:480–8.

    Article  Google Scholar 

  28. Elder DE, Zuccollo JM. Autopsy after death due to extreme prematurity. Arch Dis Child Fetal Neonatal Ed. 2005;90:F270–2.

    Article  CAS  Google Scholar 

  29. Durning S, Cation L. The educational value of autopsy in a residency training program. Arch Intern Med. 2000;160:997–9.

    Article  CAS  Google Scholar 

  30. Swinton CH, Weiner J, Okah FA. The neonatal autopsy: can it be revived? Am J Perinatol. 2013;30:739–44.

    Article  Google Scholar 

  31. Mercier CE, Dunn MS, Ferrelli KR, Howard DB, Soll RF. Vermont Oxford Network EIF-USG. Neurodevelopmental outcome of extremely low birth weight infants from the Vermont Oxford network: 1998-2003. Neonatology. 2010;97:329–38.

    Article  Google Scholar 

  32. Verhagen AA, Janvier A, Leuthner SR, Andrews B, Lagatta J, Bos AF, et al. Categorizing neonatal deaths: a cross-cultural study in the United States, Canada, and The Netherlands. J Pediatr. 2010;156:33–7.

    Article  Google Scholar 

  33. Weiner J, Sharma J, Lantos J, Kilbride H. How infants die in the neonatal intensive care unit: trends from 1999 through 2008. Arch Pediatr Adolesc Med. 2011;165:630–4.

    Article  Google Scholar 

  34. Assaad MA, Lapointe A, Thivierge E, Janvier A. Mortality and Morbidity rounds in neonatology: Providers’ experiences and perspectives. Acta Paediatr. 2021;110:2737–44.

  35. Carter BS, Guthrie SO. Utility of morbidity and mortality conference in end-of-life education in the neonatal intensive care unit. J Palliat Med. 2007;10:375–80.

    Article  Google Scholar 

Download references

Acknowledgements

We are indebted to the institutions that serve the infants and their families, and these institutions also have invested in and continue to participate in the Children’s Hospital’s Neonatal Database (CHND). A full list is located in the Supplementary Information.

Funding

This study was conducted without specific funding support

Author information

Author notes

  1. A list of members and their affiliations appears in the Supplementary Information.

Authors and Affiliations

  1. Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, and Division of Neonatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA

    Ankur Datta, Nana Matoba, Karna Murthy & Jessica T. Fry

  2. Department of Pediatrics, Indiana University, Indianapolis, IN, and Division of Neonatology, Riley Hospital for Children, Indianapolis, IN, USA

    Jason Z. Niehaus

  3. Department of Pediatrics, University of Missouri - Kansas City, Detroit, MI, and Division of Neonatology, Children’s Mercy Hospital, Kansas City, MO, USA

    Julie Weiner

  4. Children’s Hospitals Association, Overland Park, KS, USA

    Isabella Zaniletti

  5. Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, and Division of Neonatology, Nemours/AI duPont Hospital for Children, Wilmington, DE, USA

    Kevin M. Sullivan

  6. Department of Pediatrics, University of Washington, Seattle, WA, and Division of Neonatology, Seattle Children’s Hospital, Seattle, WA, USA

    Robert DiGeronimo

  7. Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, and Division of Neonatology, Children’s of Alabama, Birmingham, AL, USA

    Carl H. Coghill

  8. Department of Pediatrics, Wayne State University, Detroit, MI, and Division of Neonatology, Children’s Hospital of Michigan, Detroit, MI, USA

    Girija Natarajan

  9. Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, and Division of Neonatology, Children’s Hospital of Wisconsin, Milwaukee, WI, USA

    Steven R. Leuthner

  10. Department of Pediatrics, The Ohio State College of Medicine, Columbus, OH, and Division of Neonatology, Nationwide Children’s Hospital, Columbus, OH, USA

    Amy Brown Schlegel

  11. Department of Pediatrics, University of California at Irvine, Irvine, CA, and Division of Neonatology, Children’s Hospital of Orange County, Orange, CA, USA

    Anita Shah

Authors
  1. Ankur Datta
    View author publications

    Search author on:PubMed Google Scholar

  2. Jason Z. Niehaus
    View author publications

    Search author on:PubMed Google Scholar

  3. Julie Weiner
    View author publications

    Search author on:PubMed Google Scholar

  4. Isabella Zaniletti
    View author publications

    Search author on:PubMed Google Scholar

  5. Nana Matoba
    View author publications

    Search author on:PubMed Google Scholar

  6. Kevin M. Sullivan
    View author publications

    Search author on:PubMed Google Scholar

  7. Robert DiGeronimo
    View author publications

    Search author on:PubMed Google Scholar

  8. Carl H. Coghill
    View author publications

    Search author on:PubMed Google Scholar

  9. Girija Natarajan
    View author publications

    Search author on:PubMed Google Scholar

  10. Steven R. Leuthner
    View author publications

    Search author on:PubMed Google Scholar

  11. Amy Brown Schlegel
    View author publications

    Search author on:PubMed Google Scholar

  12. Anita Shah
    View author publications

    Search author on:PubMed Google Scholar

  13. Karna Murthy
    View author publications

    Search author on:PubMed Google Scholar

  14. Jessica T. Fry
    View author publications

    Search author on:PubMed Google Scholar

Consortia

Children’s Hospital Neonatal Consortium (CHNC)

  • Karna Murthy

Contributions

A.D., J.N., and J.W. wrote the manuscript. I.Z. provided statistical analysis and methodological review. All authors designed the project, reviewed the data, edited the manuscript, and approved the final submitted version.

Corresponding author

Correspondence to Ankur Datta.

Ethics declarations

Competing interests

Dr. Murthy is a Board member and Chair of the CHNC (Kansas City, MO). Dr. Zaniletti is an employee of Children’s Hospitals Association, Inc (Overland Park, KS). The other authors report no conflicts of interest relevant to this article and have no financial relationships relevant to this article to disclose.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Datta, A., Niehaus, J.Z., Weiner, J. et al. Inter-center variation in autopsy practices among regional neonatal intensive care units (NICUs). J Perinatol 41, 2820–2825 (2021). https://doi.org/10.1038/s41372-021-01286-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Version of record:

  • Issue date:

  • DOI: https://doi.org/10.1038/s41372-021-01286-1

Search

Advanced search

Quick links