P0567 - Two Case Reports: Utilizing Autopsy Review in Bereavement to Clarify Misconceptions and Help Families Find Meaning

Abstract:
After a child dies, the palliation of families often continues via bereavement programming offered by hospitals. However, few offer families the opportunity to posthumously review medical information including autopsy results.
Consistent themes emerge during family-centered autopsy reviews including the clarification of medical misconceptions, easing of guilt carried by decision-makers, and the desire to share knowledge. Those who have participated in autopsy review as a part of structured bereavement programming report that discussing exam findings helps them maintain bonds with their child’s caregivers, aids in coping, and promotes the child’s legacy. The value of autopsy review in bereavement warrants further exploration.
We will present two cases, each with unique psychosocial context and clinical findings. These examples demonstrate how autopsy review can mitigate complicated grief and promote legacy building. Both cases reveal unmet informational and emotional needs of the family as they grieved the loss of their child.
Case Description 1:
K.R. was a 7 week old who presented with cough, congestion and increased WOB. He was diagnosed with RSV, intubated and admitted to the PICU.
His bronchiolitis was followed by septic shock secondary to a MRSA infection. K.R. was placed on VA ECMO and CRRT. He then developed multi-organ failure, multifocal infarcts in the brain, decreased cardiac function, pericardial effusion, acute respiratory failure, acute renal failure, DIC, hemolysis, liver dysfunction and gangrene. His family opted to cease life-prolonging support.

K.R.’s mother stated “things were happening so fast” that she could not ask the questions that she had. Autopsy review revealed a singular, pertinent misconception that resulted in significant decisional regret for his mother. Her regret was relieved via this intervention.
Case 2:
G.L. was a full-term baby who was intubated in the delivery room and then transferred for hypoxic respiratory failure, and hepatic hemangioma. An echocardiogram revealed significant pulmonary hypertension. She developed near systemic pulmonary pressures and required escalation of her mechanical ventilation, ECMO and CRRT. G.L. then developed multi-organ failure and intractable seizures. Her parents opted to withdraw her life-prolonging support.
It was not clear to the team why G.L.’s lungs did not improve despite aggressive intervention. This uncertainty affected her mother’s coping. She frequently stated that she wanted her daughter’s life “to mean something”. Her mother’s search for meaning was directly addressed via this intervention.

Conclusion:
Autopsy review is an overlooked yet vital piece of bereavement programming that has the potential to positively impact long-term psychosocial outcomes for families that lose a child. Real world barriers to family centered autopsy review such as staff availability, limited time, and inadequate reimbursement can be addressed with programmatic infrastructure.