Novel Applications and Refinements of Current Imaging Techniques in Perinatal and Childhood Death Investigation

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Background:It is estimated that 1 in 80 pregnancies in the UK will result in a termination or stillbirth due to an abnormality of the baby. An autopsy can provide information on the cause of death and help change management in future pregnancies (1), however many parents refuse this examination as they feel their child has suffered through enough. This means they miss out on valuable information about why their child died and whether future children will suffer a similar fate.'Less invasive' ways for investigating the cause of death using imaging have been pioneered at our institution and shown that by using magnetic resonance imaging (MRI) together with 'key-hole' surgery methods to obtain tissue samples, we get the same answer as autopsy in >90% (2) cases. This method is however expensive and unfortunately not widely available. We believe we can improve on this technique by using ultrasound imaging with needle biopsies which makes fewer and smaller marks to the skin and would be easier to roll-out nationally if it can achieve a similar level of accuracy as a full autopsy.Aims:This study will test how good ultrasound guided needle tissue biopsies are compared to autopsy. We will also investigate how good different imaging tests are when used alone and in combination with tissue samplingMethods:Parents who consent for childhood autopsy will be offered a series of imaging tests and less invasive needle biopsies. We will then compare these results with our current autopsy results and test for any differences in findings. Applications and benefits:Parents tell us that they want the 'minimum necessary' approach to autopsy during this very difficult and emotional time for them. By showing that a less invasive, imaging-led technique is achievable and can give accurate results, we intend to offer parents an alternative method for discovering the cause for their child's death. This means not only offering needle biopsies, but also understanding when imaging alone would be sufficient in coming to a diagnosis.The information gathered by using an alternative, more acceptable method of investigation may help parents in their grieving process by providing closure and understanding for reasons behind their child's death, and help to understand whether future children are at increased risk of similar diseases.Increasing the rate of uptake of this investigation may also mean we can better understand and explore reasons behind why children die. This can help inform public health policies and initiatives in improving maternal and child health. At present not all centres in the UK can offer a less invasive method of investigation. If this research can provide evidence for better practice, we hope this will set the foundations of a new NHS autopsy service. (1) Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths: When? Where? Why? Lancet 2005; 365:891-900(2) Thayyil S, Sebire NJ, Chitty LS et al Post-mortem MRI versus conventional autopsy in fetuses and children: a prospective validation study. Lancet 2013; 382: 223-233