Death

Published on 03/06/2015 by admin

Filed under Neonatal - Perinatal Medicine

Last modified 22/04/2025

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CHAPTER 31 Death

Mark Davies, David Cartwright

Actions at death of a baby

When a baby dies:

• Ensure that a formal note is inserted in the chart indicating death and the assessment made to ascertain this.

• Collect blood on a neonatal screening card (if baby has not had one collected already); label as post-mortem.

• Ensure that the events leading up to the death are adequately and clearly described in the chart notes.

• Discuss post-mortem examination (PM) with the parents before they leave the hospital — make a note in the chart as to whether the parents agree to a PM or do not want a PM.

• Written consent from a parent is now standard procedure (and a legal requirement in many places, e.g. Queensland) before proceeding with any PM.

• The death certificate should be completed by, at the latest, the next working day.

• Nursing staff should make arrangements for appropriate material to be given to the parents, and for social work follow-up. The parents should be offered an appointment with the consultant neonatologist who cared for the baby.

Unexplained neonatal death

In the event of an unexplained neonatal death, the results of investigations done on the following specimens may help with determining a possible cause of death and aid in counselling parents about future pregnancies.

Take the specimens as soon after death as possible (with parental consent) and discuss with pathology/metabolic medicine and genetics later.

Specimens to collect

1. Blood on a neonatal screening card (label card as postmortem specimen).

2. Urine (freeze).

3. Chromosomes, DNA (2 mL of blood in an EDTA tube).

4. A whole baby X-ray (babygram).

All of these are achievable without the need for autopsy — and the first three are not likely to be successfully collected if the baby goes to autopsy.

The coroner

Whilst the provisions of Coroners’ Acts will vary from state to state and across countries, the following circumstances will usually require a death to be reported to the coroner:

• the identity of the baby is unknown

• the baby is in care

• the death was violent, unnatural or occurred under suspicious circumstances

• a death certificate cannot be written

• the death was not reasonably expected to be the outcome of a health-related procedure.

If in doubt, talk to the coroner.

Related

Pocket Notes on Neonatology 2e