Post-mortem computed tomography is a useful tool for determining the pulmonary ventilation status in newborns

• Florian T. Fischer

Abstract

Lung ventilation is a standard sign of life in newborns. Post-mortem computed tomography (PMCT) is highly sensitive to the presence of gas in the body including the lungs. Current standard examinations to determine the pulmonary ventilation status in newborns are the flotation test and histology. The purpose of this study was to compare the accuracy of PMCT with the flotation test for determining the lung ventilation status with histological control as reference standard. A cut-off value as CT number in Hounsfield Units (HU) determining lung ventilation of newborns in PMCT should be established.

Methods. A total of 38 infant lungs were examined of which 21 lungs were frominfants deceased shortly after live birth (control group) and 17 lungs belonged to infants where live birth was in question (study group). All lungs were examined using PMCT, flotation test, and histological examination.

Results. The control group showed an overall mean attenuation± standard deviation of –219±135 HU; the study group of 45±15HU in histologically nonventilated lungs versus –192±207 HU (p<0.001) in ventilated lungs. The best cut-off value for optimal discrimination of ventilated and nonventilated lungs in newborns was –35 mean HU.

Conclusion. PMCT is equally well suited to determine lung ventilation as the flotation test. It provides additional information regarding pulmonary infiltration, degree of putrefaction, or signs of trauma (fractures, pneumothorax). Histology remains mandatory in ambiguous cases.

Keywords:ventilation; forensic radiology; live birth; still birth; flotation test

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