New diagnoses found at autopsy in extremely preterm infants dying before 28 days of age
| GA (weeks) | BW (g) | Age at death (days) | Main clinical diagnoses | New diagnoses at Autopsy | Significant change | Main cause of death |
|---|---|---|---|---|---|---|
| GA, Gestational age; BW, birth weight; IVH, intraventricular haemorrhage; NEC, necrotising enterocolitis; PVH, periventricular haemorrhage; PVL, periventricular leucomalacia; HMD, hyaline membrane disease; PIE, pulmonary interstitial emphysema; TPN, total parenteral nutrition; PPROM, prolonged preterm rupture of membranes. | ||||||
| 25 | 470 | 15 | Lung disease with ongoing air leak. Asphyxial episode with pneumothorax. Presumed tracheal injury | Pulmonary haemorrhage. Pneumonia: right middle lobe. Cerebral cortical haemorrhage. Tracheal injury established | No | Iatrogenic: tracheal laceration |
| 22 | 445 | <1 | Extreme prematurity. No active resuscitation. Twin | Meckel’s diverticulum | No | Extreme prematurity: no active treatment |
| 22 | 585 | <1 | Extreme prematurity. No active resuscitation. Twin of above infant | Evidence of perinatal asphyxia | Yes | Extreme prematurity with perinatal asphyxia: no active treatment |
| 25 | 550 | 8 | Bilateral cystic kidneys. Lung disease. Renal failure | Unilateral renal agenesis. Multicystic dysplastic kidney. Congenital pneumonia (renal ultrasound misinterpreted) | Yes | Congenital renal anomaly: absent kidney |
| 27 | 880 | 8 | Resolving lung disease. Collapse day 8 | Long line perforation of right atrium with S epidermidis sepsis | Yes | Iatrogenic: long-line perforation |
| 25 | 680 | 4 | Fetal ventriculomegaly. Bilateral severe IVH. Hypovolaemic collapse | Congenital pneumonia. Multiorgan ischaemic changes | No | Perinatal infection |
| 23 | 475 | 10 | Resolving lung disease. Bilateral grade 3 IVH. ? NEC | Candida septicaemia with bowel perforation and cerebral abscess. Traumatic perforation of stomach | Yes | Postnatal Infection |
| 26 | 670 | 5 | Lung disease. Major pulmonary haemorrhage | Germinal matrix and subarachnoid haemorrhage. Periventricular leucomalacia | No | Pulmonary haemorrhage |
| 24 | 650 | <1 | Clinical lung hypoplasia | Previous bowel perforation | No | Pulmonary hypoplasia |
| 23 | 576 | <1 | Failure to resuscitate. Suspected pulmonary hypoplasia | Mild oligohydramnios sequence. Pulmonary aspiration of blood. Large retroplacental haemorrhage | Yes | Perinatal asphyxia |
| 24 | 402 | <1 | Reverse Doppler flow. Cleft soft palate. Lung disease | Ventricular septal defect. Bilateral pleural effusions | No | Severe fetal growth restriction |
| 27 | 810 | <1 | Clinical lung hypoplasia. Bilateral talipes. Oedema right leg | Hypoplastic R common iliac and R umbilical arteries | No | Pulmonary hypoplasia |
| 27 | 880 | 2 | Perinatal asphyxia. Right grade 4 IVH. Cerebellar haemorrhage | Right subdural haemorrhage. Global cerebral ischaemia. Ventricular septal defect | No | Perinatal asphyxia |
| 27 | 830 | 8 | Lung disease. Aortic thrombosis. Renal failure | Bilateral renal infarction. Bilateral adrenal necrosis. Pulmonary haemorrhage | No | Iatrogenic: aortic thrombosis with renal failure |
| 23 | 420 | 2 | Twin-twin transfusion. Donor twin. Lung disease. Pulmonary haemorrhage | Bilateral IVH grade 3. Haemorrhage around the right umbilical artery | No | Pulmonary haemorrhage |
| 25 | 690 | <1 | Severe lung disease. Never stable after initial resuscitation | Aspiration of contaminated amniotic fluid. Severe placental disease | Yes | Severe respiratory disease due to antenatal aspiration of blood contaminated liquor |
| 25 | 1012 | 19 | Bilateral grade 3 IVH, PVL. Skin breakdown, right buttock. Pericardial & pleural effusions with TPN. Postnatal asphyxia | Fresh IVH and PVH haemorrhage. Focal adrenal necrosis. Pulmonary haemorrhage | No | Iatrogenic: long line perforation |
| 25 | 700 | 19 | Severe lung disease. S aureus septicaemia with shock and NEC | Pulmonary fibroplasia. Extensive myocardial necrosis. Oesophagus: multiple abrasions | No | Infection |
| 24 | 692 | 8 | Twin-twin transfusion. Recipient twin. Severe lung disease. Bilateral grade 4 IVH | Brain stem gliosis and PVL. Early NEC. Thrombus right umbilical artery | No | Severe HMD with PIE |
| 25 | 994 | 13 | Mild RDS. Haemorrhage ? pulmonary. S epidermidis cultured | Massive pulmonary haemorrhage | Yes | Pulmonary haemorrhage |
| 25 | 414 | 20 | Reversed Doppler flow. Severe lung disease. Small left kidney. Abdominal calcification | TPN hepatitis. Prenatal renal vascular thrombosis. Fresh cerebellar haemorrhage. Dystrophic calcification in bowel | No | Severe fetal growth restriction |
| 27 | 1236 | 9 | Abruption. Severe lung disease. Intestinal perforation. Bilateral IVH. Renal failure | Hypoxic-ischaemic injury in periventricular white matter. Gastric ulcerations. Oesophageal ulcerations. TPN effect with cholestasis | No | Perinatal asphyxia |
| 24 | 680 | <1 | Deep decelerations. ? Supraglottic mass. Pneumothorax. Failure to resuscitate | Plug of mucoid material was found to occlude the tracheal lumen and extended the whole length of the trachea | Yes | Amniotic fluid plug in trachea after PPROM 1 week before delivery |