This week in my Intermediate Diagnostic Imaging studies we looked at neonatal imaging, a lot of neonatal imaging is sadly carried out after death – post mortem, I have decided that for this week’s blog this is a topic that I would like to do a bit of research on and discuss to further my interest in forensic radiography. Neonatal defines newborn infants being born prematurely or at full term and the care that they receive in the first few weeks of their life (OUP Press, 2011). It has been discovered that sadly 41% of child deaths under the age of five are among new born infants within the first 28 days of their life (World Health Organisation, 2011), with three quarters of neonatal deaths occurring within the first week of their life (World Health Organisation, 2011). Neonatal death is defined as a death of a child within the first 28 days of life (Patient.co.uk, 2014) and a stillbirth is defined as the death of a baby before or during birth after 24 weeks of pregnancy (SANDS, 2014).
Unfortunately with cases of stillborn or neonatal death the actual cause of death is in a large amount of cases unknown, in cases such as this the foetus or body may be subjected to post mortem imaging to find cause of death, whether it be plain film radiographs, Computed Tomography (CT) scans or Magnetic Resonance Imaging (MRI) or a medical autopsy. The death of a child is devastating to a parent, in a lot of cases in the death of a child the parent wants to know why that child has died. In previous years the child would undergo a post mortem autopsy to discover cause of death, but nowadays with the ever evolving imaging and diagnostic modalities medical autopsies are now being moved away from towards post mortem imaging techniques which are being found to achieve the same results with the correct accuracy and the positive fact that they are non invasive (Bakri & Jaudin, 2006). Usually a post-mortem plain radiograph skeletal survey is carried out with all prenatal and neonatal deaths (Thayyil, et al., 2011), then a conventional autopsy – only with parental consent. A lot of research has been carried out regarding the use of imaging modalities in replacement or adjacent to medical autopsies, although this has mostly been within cases of adult death (Bakri & Jaudin, 2006) the results of imaging modalities used in autopsies were found to be correct and accurate (Aghayev, 2004). Recently, Great Ormond Street Children’s hospital in London have been carrying out research titled ‘Post mortem Magnetic Resonance Imaging in fetuses, newborn and Children: A comparative study with conventional autopsy’ this research was approved by the Great Ormond Street Children’s Hospital research ethics committee (Thayyil, et al., 2011) within this study parents could consent to their child undergoing a MRI and occasionally a CT scan before a medical autopsy would be carried out, the results would be compared to derive the most accurate type of post mortem examination. When considering imaging modalities used within post mortem imaging CT is most commonly used with adults (Department of Health Post Mortem, Forensic and Disaster Imaging Group (PMFDI)., 2012), with prenatal and neonatal imaging MRI is considered the best imaging modality, when carried out alongside plain film radiographs (Department of Health Post Mortem, Forensic and Disaster Imaging Group (PMFDI)., 2012), although if this less invasive post mortem is non conclusive it is advised that the remains be submitted to undergo a medical autopsy alongside it. It is discussed that MRI foetal post-mortem imaging could overcome some weaknesses associated with medical autopsy and furthermore provide a multisystem analysis that is non invasive (Department of Health Post Mortem, Forensic and Disaster Imaging Group (PMFDI)., 2012).
Currently the number of autopsies undertaken within this age group is decreasing rapidly – as parents are not willing to consent to having their child undergo an autopsy as their wish is for their child’s remains to remain intact, this along with refusal of medical autopsy due to religion has lead to this decrease in the number of prenatal and neonatal autopsies being performed. It is discussed that the use of modern imaging modalities in post-mortem ‘virtual’ autopsies could lead to an increase in prenatal and neonatal virtual autopsy numbers (Thayyil, et al., 2011). It is also discussed that autopsies within this age range are essential in the evolution of paediatric medicine and also maternal medicine – to see if there is something that can be done within another pregnancy that could stop the same outcome – the death of a child. (World Health Organisation, 2011).
In conclusion it can be seen that the topic around neonatal are prenatal death is a very delicate one. The ever evolving and progressing field of diagnostic imaging could in the future become a major part of post mortem examinations for this age range, although currently there is still a lot of research that is being carried out around this subject, and its reliability when compared to conventional medical autopsies.
Aghayev, E., 2004. Virtopsy post-mortem multi-slice computed tomography (MSCT) and magnetic resonance imaging (MRI) demonstrating descending tonsillar herniation: comparison to clinical studies. Neuroradiology, 46(7), pp. 559-564.
Bakri, D. & Jaudin, R., 2006. Virtual Autopsy, London: Health Technology Assesment Unit Medical Development Division Department of Health.
Department of Health Post Mortem, Forensic and Disaster Imaging Group (PMFDI)., 2012. Can Cross-Sectional Imaging as an Adjunct and/or Alternative to the Invasive Autopsy be Implemented within the NHS?, London: Nataional Health Service (NHS).
OUP Press, 2011. Oxford English Dictionary. 12th ed. Oxford: OUP Oxford.
Patient.co.uk, 2014. Stillbirth and Neonatal Death. [Online] Available at: http://www.patient.co.uk/doctor/stillbirth-and-neonatal-death [Accessed 15 November 2014].
SANDS, 2014. Stillbirth and Neonatal Death. [Online] Available at: https://www.uk-sands.org/why-babies-die/stillbirth [Accessed 15 November 2014].
Thayyil, S. et al., 2011. Post mortem magnetic resonance imaging in the fetus, infant and child: A comparative study with conventional autopsy (MaRIAS Protocol). BMC Pediatrics, 11(120), pp. 2-11.
World Health Organisation, 2011. Newborn Death and Illness. [Online] Available at: http://www.who.int/pmnch/media/press_materials/fs/fs_newborndealth_illness/en/ [Accessed 15 November 2014].