Postmortem examinations on very premature infants are valuable to help doctors to understand and accept the certainty of death in certain circumstances and to help them advise parents, according to a small study. They may also help in future prognoses, and their findings may lead changes in intensive care policies and protocols.

Postmortem examinations on 29 infants of < 28 weeks’ gestation who died in intensive care within 28 days after their birth resulted in new diagnoses in no less than 79% and significant change in diagnosis in 28%, when compared with the clinical diagnosis. Injuries caused by treatment were evident in 41% of the group and were considered to be the main cause of death in 4% (four infants). Elsewhere published rates are 4–15%. Some deaths were due to complications of extreme prematurity such as lung disease, but complications of pregnancy or labour also featured.

The examinations were performed by an experienced perinatal pathologist at a major paediatric centre in New Zealand on 29 of 54 infants meeting the criteria who died during January 1995–December 2003.

Extreme prematurity can be given as the cause of death on the death certificate when extremely preterm infants die, but this tells us little and does not advance our knowledge, especially as infants this young are less likely to have postmortem examinations anyway.