Neuropathologic findings and age‐related differences in Finnish pediatric medico‐legal autopsies

Abstract Neuropathological examination plays a critical role in medico‐legal cause‐of‐death investigation, especially in determining the cause and manner of death in pediatric autopsies. Although a comprehensive neuropathological examination is recommended, limited data exists of the diagnostic yield of neuropathology consultations in such cases. This retrospective register‐based study reviewed Finnish pediatric medico‐legal autopsies from 2016 to 2022 involving full neuropathological examination performed by a neuropathologist, with a focus on age‐related differences in consultation rates, themes, and diagnostic findings. Data were retrieved from the medico‐legal cause‐of‐death investigation documents, and included background characteristics, neuropathologic diagnoses, and causes and manners of death. A total of 118 pediatric medico‐legal autopsies with a neuropathology consultation were performed during the study period. The consultation rate was highest among infants (aged <1 year; 45.6%), compared to early childhood (aged 1–10 years; 23.0%) and late childhood (aged 11–18 years; 6.2%). Traumatic brain injury was the most frequent consultation theme overall (33.9%), while the frequency of epilepsy‐related consultations increased with age. Hypoxic‐ischaemic neuronal injury constituted the commonest finding, with an overall prevalence of 43.2%. Findings associated with childhood epilepsy were more prevalent in early and late childhood, with epilepsy accounting for 15.2% of deaths in the latter group. Positive diagnostic findings were uncommon among infants, consistent with a high proportion of cases (42.1%) classified as sudden infant death syndrome. These findings provide forensic pathologists with age‐specific diagnostic insights, supporting more targeted resource use and neuropathology consultation practices.