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Chapter 25 ■ Perimortem Sampling 135

c. Further resources to guide physical exam are available online from the Wisconsin Stillbirth Service at

http://www2.marshfieldclinic.org/wissp/ and from the

Perinatal Society of Australia and New Zealand at

www.psanz.com.au/special-interest-groups/pnm.aspx.

E. Photographs

1. Digital photographs are the best, but any image is better than none.

2. Use of a blue background allows better definition of findings. Sterile towels or drapes can be used for this purpose.

3. Separate or duplicate copies of photographs should be

obtained for diagnostic and bereavement purposes.

Full face, body, and profile pictures should be taken

(Table 25.2) (12).

4. Every effort should be made to photograph any abnormalities seen on physical examination.

F. Examination of the Placenta

1. Ensure that the placenta is sent for pathology examination for all infants admitted to the neonatal intensive

care unit (13).

2. Placental findings are positive in 30% to 60% of neonatal autopsies (14).

3. Evaluation of the placenta may reveal maternal or

fetal vascular problems, in utero infections, inflammatory conditions and some inborn errors of metabolism. Cultures for bacteria and fungus as well as

viral polymerase chain reactions may be sent as

applicable. A discussion with pathology can guide

the evaluation (13).

G. Perimortem Sampling

1. General guidelines

a. Sterile technique should be used for all procedures,

even if they are performed postmortem.

b. Contact the laboratory to save any unused blood,

fluid or tissue samples. (Table 25.3 summarizes sample handling) (1,3,8,11).

c. If a metabolic disorder is a possibility, tissue samples

should be taken within 4 to 6 hours of death.

d. Resources to guide molecular testing as indicated

can be found at http://www.ncbi.nlm.nih.gov/sites/

GeneTests/clinic, a voluntary listing of US and

international genetics clinics providing genetic evaluation and genetic counseling.

2. Blood

a. Draw percutaneously or directly from heart (after

parental consent) if infant has expired. See Table

25.3 for samples required (1,6).

b. Be sure newborn screen sample has been sent

(15).

c. Obtain additional dried blood spots on filter

paper.

3. Urine

 5 to 10 mL by catheterization or suprapubic tap (8).

4. Cerebrospinal fluid

 Obtain at least 1 mL of cerebrospinal fluid; may be

obtained after death by needle insertion through anterior fontanelle (16).

5. Skin sample

a. Normal skin samples may be sent for fibroblast

culture (17).