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Research Article
Richard Sindelar
Uppsala University
Corresponding Author
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Reliable data on causes of death (COD) in preterm infants is needed to assess perinatal care and current clinical guidelines. In this retrospective observational analysis of all deceased preterm infants born <37 weeks’ gestational age (n=278; 2012-2018) at a Swedish tertiary neonatal intensive care unit, we compared preliminary COD from Medical Death Certificates with autopsy defined COD (2002-2018), and assessed changes in COD between two periods (Period 1: 2002-2009 vs Period 2: 2011-2018). Autopsy was performed in 73% of all cases and was more than twice as high compared to national rates of infant autopsies in Sweden (33%). Autopsy defined COD differed from preliminary COD in 34.9% of the cases. Necrotizing enterocolitis (NEC) as COD increased between Period 1 and 2 (5% vs 26%), while intraventricular hemorrhage decreased (13% vs 6%). The autopsy rate did not change between the two study periods (75% vs 71%). We conclude that autopsy changed the preliminary COD in a third of cases, while the incidence of NEC as COD increased markedly during the study period. Since there is a high risk to determine COD incorrectly based solely on clinical findings in preterm infants, autopsy remains a valuable method to obtain reliable COD.
Keywords
Preterm Infants, Cause of Death, Autopsy, Necrotizing Enterocolitis, Infant Mortality
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This preprint is under consideration at Scientific Reports. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Richard Sindelar
Uppsala University
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 05 Mar, 2021
No community comments so far
Reviewer #7 agreed
On 28 Mar, 2021
Reviewer #6 agreed
On 28 Mar, 2021
Review #8 received
Received 28 Mar, 2021
Review #1 received
Received 28 Mar, 2021
Review #7 received
Received 28 Mar, 2021
Review #2 received
Received 28 Mar, 2021
Review #3 received
Received 28 Mar, 2021
Review #6 received
Received 28 Mar, 2021
Reviewer #10 agreed
On 25 Mar, 2021
Reviewer #3 agreed
On 25 Mar, 2021
Reviewer #9 agreed
On 25 Mar, 2021
Reviewer #4 agreed
On 25 Mar, 2021
Reviewer #5 agreed
On 25 Mar, 2021
Reviewer #8 agreed
On 25 Mar, 2021
Reviewer #1 agreed
On 25 Mar, 2021
Reviewer #2 agreed
On 25 Mar, 2021
Reviewers invited
Invitations sent on 25 Mar, 2021
Editor assigned
On 25 Mar, 2021
Editor invited
On 26 Feb, 2021
Submission checks complete
On 26 Feb, 2021
First submitted
On 25 Feb, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Reliable data on causes of death (COD) in preterm infants is needed to assess perinatal care and current clinical guidelines. In this retrospective observational analysis of all deceased preterm infants born <37 weeks’ gestational age (n=278; 2012-2018) at a Swedish tertiary neonatal intensive care unit, we compared preliminary COD from Medical Death Certificates with autopsy defined COD (2002-2018), and assessed changes in COD between two periods (Period 1: 2002-2009 vs Period 2: 2011-2018). Autopsy was performed in 73% of all cases and was more than twice as high compared to national rates of infant autopsies in Sweden (33%). Autopsy defined COD differed from preliminary COD in 34.9% of the cases. Necrotizing enterocolitis (NEC) as COD increased between Period 1 and 2 (5% vs 26%), while intraventricular hemorrhage decreased (13% vs 6%). The autopsy rate did not change between the two study periods (75% vs 71%). We conclude that autopsy changed the preliminary COD in a third of cases, while the incidence of NEC as COD increased markedly during the study period. Since there is a high risk to determine COD incorrectly based solely on clinical findings in preterm infants, autopsy remains a valuable method to obtain reliable COD.
Figure 1
Figure 2
Figure 3
This preprint is available for download as a PDF.
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