A post mortem is the medical examination that helps us understand what has happened when someone dies. For a baby, the post mortem should be carried out by a pathologist with specialist knowledge and experience of carrying out post mortems on babies.
All parents should be offered a post mortem by senior staff at the hospital soon after their baby is stillborn. But fewer than half of all bereaved parents agree (consent) to this investigation. Parents find the decision extremely difficult for many reasons, and may think they won’t find out anything new about their baby’s death. In fact, around four out of ten post mortems of babies provide significant additional information. But it’s also true that the cause of death will be identified in only around two out of every ten ‘unexplained’ stillbirths in which the baby appeared to have developed and grown normally.
Although pathologists follow professional guidelines for post mortems on babies, there is no agreed system for recording the information. The way that pathologists report their findings varies, so it is hard to compare reports from different pathology departments. The inconsistencies also make it hard to use post mortem information in research.
WHAT IS THE PROJECT TRYING TO ACHIEVE?
This study is developing a database using information from more than 1000 previously performed post mortems (all unidentifiable). The information is being reviewed, categorised and recorded in a useful way so that data between departments and pathologists can be usefully compared.
This study aims to provide better understanding of which investigations are useful in helping us understand why babies die, and what research is likely to give us the most helpful information in the future.
1,065 post mortems have been reviewed. For each baby, the clinical information and post mortem findings have been put onto a specially designed research database. This has allowed the researchers to identify some patterns and also to see which investigations are the most helpful. Overall, a definite cause of death has been established for 393 babies, and 296 deaths remain entirely unexplained, with no apparent cause. Some abnormality was seen in 376 deaths; the abnormalities were mostly affecting the placenta, but it wasn’t clear how the baby had been affected. The results are currently being looked at in more detail.
WHO IS CONDUCTING THE RESEARCH?
The Principal Investigator on the project is Professor Neil Sebire, Great Ormond Street Hospital & Institute of Child Health UCL London, Professor of Paediatric Pathology. His team comprises:
- Dr J Pryce, Clinical Research Associate in Paediatric Pathology GOSH/ICH
- Dr S Levine, Consultant in Paediatric Pathology St George’s Hospital, London
- Dr F Jessop, Consultant in Paediatric Pathology and Addenbrookes Hospital, Cambridge
- Prof G Smith, Professor of Obstetrics, Cambridge
The work is taking place at Department of Histopathology, Great Ormond Street Hospital and Institute of Child Heath.
This is a 2 year project running from 2013 to 2015. First results were presented at the Fetal Growth conference in 2015, and the results are due to be published in early 2016.
1. Pryce JW, Weber MA, Heales S, Krywawych S, Ashworth MT, Klein NJ, Sebire NJ. Postmortem tandem mass spectrometry profiling for detection of infection in unexpected infant death. Forensic Sci Med Pathol. 2012 Jan 14. PubMed PMID: 22246957.
2. Pryce JW, Paine SM, Weber MA, Harding B, Jacques TS, Sebire NJ. Role of routine neuropathological examination for determining cause of death in sudden unexpected deaths in infancy (SUDI). J Clin Pathol. 2011 Dec 1. PubMed PMID: 22135027.
3. Pathak S, Lees CC, Hackett G, Jessop F, Sebire NJ. Frequency and clinical significance of placental histological lesions in an unselected population at or near term. Virchows Arch. 2011 Dec;459(6):565-72. Epub 2011 Oct 27. PMID: 22038509.
4. Weber MA, Risdon RA, Ashworth MT, Malone M, Sebire NJ. Autopsy findings of co-sleeping-associated sudden unexpected deaths in infancy: Relationship between pathological features and asphyxial mode of death. J Paediatr Child Health. 2011 Oct 21. doi: 10.1111/j.1440-1754.2011.02228.x. PubMed PMID: 22017395