IMPROVING THE QUALITY OF PERINATAL AND INFANT NECROPSY EXAMINATIONS -A FOLLOW-UP-STUDY

Aim-To compare the quality of perinatal and infant necropsy examinatio ns in 1996 with those performed in 1993. Methods-Cohort analysis, with data from the All Wales Perinatal Survey, of 1027 deaths (540 in 1993 ; 487 in 1996) of babies between 20 weeks' gestation and one year of a ge. The quality of the necropsy was assessed by scoring aspects identi fied as being part of the investigation. Results-Necropsy was performe d in 335 cases (62%) in 1993 and in 320 cases (66%) in 1996. The propo rtion done in a regional centre increased significantly hom 39% (131/3 35) in 1993 to 76% (243/320) in 1996 (p < 0.0001). The quality of necr opsy was above the minimum standard in 54% of cases in 1993 (171/314) compared with 93% in 1996 (289/312) (p < 0.0001). Improvement occurred in all categories. For stillbirths, 35% (46/133) were above the minim um standard in 1993 compared with 90% (104/116) in 1996 (p < 0.0001); for cases not classified as sudden unexpected death in infancy (SUDI), the improvement was from 62% in 1993 (40/65) to 97% in 1996 (73/75) ( p < 0.0001); and for SUDI cases, the improvement was from 32% in 1993 (10/31) to 91% in 1996 (21/23) (p < 0.0001). The quality of both nonre gional and regional necropsies improved. For non-regional cases, the s core was above the minimum standard in 28% (51/183) in 1993 compared w ith 69% (52/75) in 1996 (p < 0.0001); for regional cases it improved f rom 92% (120/131) in 1993 to 100% (237/237) in 1996 (p < 0.0001). Conc lusions-The quality of perinatal and infant necropsies improved consid erably between 1993 and 1996, reflecting better awareness of the impor tance of good quality examination and an increase in referrals to paed iatric centres.