Infections in a Children's Hospital Autopsy Population

Abstract

We reviewed our Children's Hospital autopsies (1986–2009, 3–8 year groups) to determine the contribution of infections/inflammation to death and trends over time. Infections were categorized as (1) underlying cause of death, (2) mechanism of death complicating another underlying cause of death, (3) contributing (4) agonal or (5) incidental. Of 608 autopsies (44% of deaths), 401 had 691 infections (66%, 1.72 infections/infected child). In categories 1–5, there were 85 (12.3%), 237(34.3%), 231 (33.4%), 82 (11.9%) and 56(8.1%) infections. Leading infections include bronchopneumonia (188), sepsis (144- Enterococcus most common with 22), meningitis (35- Streptococcus pneumoniae most common with 10), pneumonitis (33), peritonitis (29). Sepsis declined in 2002–2009, attributed to fluid resuscitation standardization. Meningitis declined after 1993, and may be partially attributed to vaccines (Hemophilus influenza, Streptococcus pneumoniae). Despite advances in anti-microbial therapy, 66% of pediatric autopsies had inflammatory lesions, predominately as the mechanism or contributing factor rather than the underlying cause of death.

Keywords: :

• autopsy
• pediatric
• infection

ACKNOWLEDGMENTS

Many thanks to Monica Flint for her clerical support.