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Postmortem research: innovations and future directions for the perinatal and paediatric autopsy
  1. J C Hutchinson1,2,
  2. O J Arthurs2,3,
  3. N J Sebire1,2
  1. 1Department of Histopathology, Level 3 Camelia Botnar Laboratories, Great Ormond Street Hospital, London, UK
  2. 2University College London, Institute of Child Health, London, UK
  3. 3Department of Radiology, Great Ormond Street Hospital, London, UK
  1. Correspondence to Professor N Sebire, Department of Histopathology, Level 3 Camelia Botnar, Laboratories, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK; Neil.sebire{at}gosh.nhs.uk

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Introduction

Postmortem examination remains an important investigation in perinatal, infant and child deaths, with additional findings provided in 30–40%.1 Though additional investigations, including genetic testing, are now available, until recently the autopsy procedure had evolved little over centuries. However, the combination of advances in imaging technology, development of less-invasive sampling techniques and expansion of ‘omic’ approaches for fluid and tissue samples, together with reduction in parental acceptance of traditional autopsy are likely to change the way paediatric deaths are investigated.2 It is important that clinicians are aware of changes to postmortem practice, since requests for minimally invasive approaches from bereaved parents and religious communities are likely to become increasingly common. The aim is to appropriately consent for the investigation after death that will best answer the clinical question while being acceptable to parents. This article summarises current and future areas of paediatric autopsy research, including postmortem imaging, molecular biology and discovery-based laboratory approaches such as proteomics and transcriptomics.

Current challenges: evolution of the postmortem examination

Current trends in autopsy research focus on improving acceptability of the postmortem examination, empowering parents who do not accept traditional autopsy for various reasons. Postmortem MRI (PMMRI) shows the greatest promise, as part of a minimally invasive approach; PMMRI with placental examination and other adjunctive investigations (without incisions) …

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