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Human Development 2 > Pathology of Death in Childhood > Flashcards

Pathology of Death in Childhood Flashcards

1
Q

How many live births are there in children

A

Live births: > 600, 000 per annum

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2
Q

what are the total deaths in the country

A

Total deaths: 541, 589

- 3390 are children aged 0-16

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3
Q

What is neonatal death

A

this is death before the age of 1 year old

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4
Q

what makes up a large portion of childhood deaths

A

neonatal death

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5
Q

name the 3 ways that neonates tend to die

A
  • baby dies before leaving hospital
  • baby die after admission to hospital for recognised illness
  • baby may die outside of hospital = sudden unexpected death
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6
Q

what is it called when a baby dies outside of hospital

A
  • sudden unexpected death
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7
Q

what are the causes of neonatal and infant death

A
  • Complications of prematurity
  • Complications of delivery – e.g. birth asphyxia
  • Congenital malformations, chromosomal abnormalities – known (antenatal diagnosis), unknown
  • Infection
  • Accidents – e.g. drowning, suffocation, foreign body aspiration
  • Trauma – RTA
  • Non-accidental injury (NAI) – inflicted injury
  • Unexplained deaths - SIDS
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8
Q

what is the definition of childhood death

A
  • childhood death is death greater than 1 year of age
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9
Q

what can cause childhood deaths

A
  • malignancy, neurological disease, complications of prematurity
  • congenial malformation, chromosomal abnormality
  • admission to hospital with recognised illness
  • accidents, trauma, sucidie
  • non accidental injury
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10
Q

what is the leading cause of death in 1-4 years

A

Congenital malformations, deformations, chromosomal abnormalities

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11
Q

what are the leading cause of death in 5-19 year olds

A

Suicide, injury/poisoning – leading CoD in 5-19 years

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12
Q

what is the difference between sudden unexpected death in infancy (SUDI) and sudden unexpected death in childhood (SUDC)

A

Sudden unexpected death in infancy (SUDI) < 1-year-old

Sudden unexpected death in childhood (SUDC) >1-year-old

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13
Q

What is a sudden unexpected death

A

Death not anticipated as a significant possibility 24 hours earlier

- Any cause – natural or unnatural
- no symptoms
- ‘minor’ illness
- death within 24 hours of acute symptoms
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14
Q

what is the circumstance of death in sudden unexpected death

A

Baby or child is found dead in cot/bed

Sudden collapse during normal daily activityschool, sport

Baby dies in parents/carers arms (instantaneous death)

During a recognised illnesshospital, GP surgery, home

Accidents and trauma

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15
Q

how do you investigate sudden unexpected death

A

designated paediatrician co-ordinates response

  • police informed
  • coroner informed
  • social services
  • preliminary examination of the body - any evidence of inflicted injury
  • detailed history from family/carers and witnesses
  • death scene investigation
  • Coroner - all deaths where medical practitioner is unable to issue MCCD plus other circumstances
  • post mortem examination - paediatric pathologist
  • inquest - who died, how and where
  • if NAI is suspected then the death becomes responsibility of the police
  • forensic autopsy = home office pathologist and paediatric pathologist
  • child death overview
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16
Q

why do we do a post mortem examination

A

To elucidate the cause of deathprovides basis for counsellingidentify other family members at riskprevention of future deaths

Accurate certification of death for epidemiological and research purposes

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17
Q

what are the parts that make up the post mortem examination

A

CLINICAL HISTORY & CIRCUMSTANCES OF DEATH

RADIOLOGY

External examination

Microbiology

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18
Q

what makes up clinical history and circumstances of death in a post mortem examination

A 
birth 
development 
vaccinations 
previous illness
family history
19
Q

what makes up the radially section of the post mortem examination

A

Skeletal survey – exclude NAI, skeletal dysplasias reported by 2 paediatric radiologists before commencing autopsy

20
Q

what does the external examination of the post mortem examination effect

A
  • child identification
  • body weight and measurements

external signs of injury
- Skin - lacerations, bruises, petechiae, conjunctival petechiae(seen in asyphication), torn frenulum (if this is torn this suggests that a bottle has been forced in the babies mouth), perineum and anus
= stop post mortem examination and refer back to coroner

External signs of disease
- dysmorphism and deformities, rashes, oedema, jaundice

21
Q

what does the microbiology part of the post mortem examination include

A

Bacteriology – aseptic technique

  • Nasopharyngeal swabs
  • CSF- lumbar puncture or base of skull
  • Blood cultures (take from the heart)
  • Lung swab
  • Stool (parasites)

Virology

  • Swabs
  • Tissue: lung, liver, heart, spleenBlood, CSF
  • Stool

Toxicology

  • femoral blood
  • stomach content
  • urine

metabolic studies

  • vitreous
  • Guthrie card; blood and bile spots
  • skin for fibroblast culture
  • frozen tissue: muscle, heart, liver, kidney for oil-red-O, to assess for abnormal fat accumulation
22
Q

How do you do genetic testing

A

Requires consent
- Offence to analyse DNA without consent

Exceptions
- Coroner for identification of the deceased and determining the cause of death

PM practice:
- Store frozen tissue: muscle, heart, Kidney, liver, spleen, cartilage

If PM findings suggest a genetic disorder, recommendation in PM report that family are referred to Clinical geneticist

23
Q

what does the internal examination include

A

sampling

  • Blood - micro, toxicology, metabolic studies
  • fluids - pericardial, pleura
  • tissue samples/swabs - micro

organ examination

  • remove and weight and examination all organs
  • tissue samples from all organs

open the skull

  • remove and weigh the brain
  • fix in foramen for 1-2 week proper to dissection and sampling
24
Q

describe how tissue samples are made

A

Tissue blocks are chemically treated to remove water, embedded in paraffin and cut in 4 u.

Once placed on glass can be examined under the microscope

25
Q

how can the cause of death be identified by the post-mortem

A
  • macroscopically
  • on microscopic examination
  • from ancillary investigations
26
Q

What is Kawaski disease

A

Medium vessel vasculitis of childhood, <5 years, most reported cases East Asia (Japan).

27
Q

what are the symptoms of Kawasaki disease

A
  • fever for at least 5 days with 4 or the following
  1. bilateral conjunctival injection, non-exudative
    - cervical lymphadenopathy
    - polymorphous rash (not petechial bulls or vesicular)
    - oral inflammation and irritation (not discrete lesions or exuate)
    - ertherma and oedema of extermetieis progression to desquamination int he second week
28
Q

what type of inscision do you use

A

Y incision

29
Q

what happens if Kawaski disease is not treated

A

Coronary complications in 15-25% untreated patients: Giant coronary artery aneurysm

30
Q

what are the most common causes of SUDI

A

21% infection (pneumonia 22%)
16% non-infectious disease
63% unexplained SUDI

31
Q

What are the most common causes of SUDC

A

43% infection (RTI 51%)
28% non-infectious diseases
30% unexplained SUDC

32
Q

When is a unexplained SUDI diagnosed

A

Complete post mortem examination with all ancillary investigations, review of the circumstances of death and review of the clinical history

No clear cause of death= ‘Negative autopsy’

No features to suggest unnatural death or inflicted injury

33
Q

what is sudden infant death syndrome (SIDS)

A

Sudden unexpected death of an infant under 12 months of age, onset of lethal episode occurring during normal sleep, death remains unexplained after a through investigation

34
Q

after what investigations is sudden infant death syndrome unexplained

A
  • Complete post mortem examination
  • Review of the circumstances of death
  • Review of the clinical history.
35
Q

What is SIDS common

A

Commonest between 2 and 4 months

Commoner in winter months

Baby found dead in cot or co-sleeping

Death occurs silently during sleep

36
Q

What are the risk factors

A 
Social class IV or V
Unmarried mother
Young mother
High parity
High birth order
Short inter pregnancy interval
City dweller
Co-sleeping
Prone sleeping
Male baby
Maternal smoking
Maternal opiate addiction
Maternal infection in pregnancy
Low birth weight (<2.5 kg)
Preterm 
IUGR
Twins
Minor malformations
37
Q

What are the triple risk for SIDS

A
  • vulnerable ifnant
  • cortical developmental period
  • external stressor (environment)
38
Q

what factors make up a vulnerable infant

A

Prematurity
Male sex
Low birth weight

39
Q

what can cause SIDS

A

Developmental immaturity First 6 months, specifically between 2 and 4 monthsRapid neurodevelopmental changes in the brain
- suggest delayed development of arousal, cardio-respiratory control or cardiovascular control and thermal regulation

  • Laryngeal spasm with GOR
40
Q

what are external stressors in the triple risk theory

A 
Prone position
Bed-sharing (co-sleeping)
Minor illness e.g. URTI
Overheating
Parental smoking
41
Q

what are non specific post mortem findings in SIDS

A

Thymus with petechiae

Petechiae in pleura

Epicardial petechiae

Full expansion of lungs

Liquid heart blood

Empty bladder

Prominent LN & Peyer’s patches

Pulmonary congestion and oedema

Mild inflammation of upper respiratory tract

Persistent haemopoiesis in the liver

42
Q

what are mimics of abuse that you have have which are not abuse

A

Fractures

  • Sometimes seen in vaginal delivery
  • Osteopenia of prematurity
  • Vitamin D deficiency especially in breast fed babies
  • Osteogenesis imperfecta
  • Resuscitation

Shaken baby syndrome

    • Triad of encephalopathy, subdural haemorrhage (SDH), retinal haemorrhages
  • SDH - 25-46% of asymptomatic newborn babies;
  • retinal haemorrhages 34% of newborn babies (clear up to 2 months?)
43
Q

What is the human tissue act

A

Coroners post mortem does not require consent
Once investigation is complete consent is required to keep and use tissue for ‘scheduled purposes’:

  • keep as part of medical record- education and training
  • research
  • quality assurance and audit

Human Development 2 (34 decks)

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