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Title: Section 69-9.3 - New York State Infant Autopsy Protocol

Effective Date

02/16/2005

Section 69-9.3 New York State Infant Autopsy Protocol.

NEW YORK STATE DEPARTMENT OF HEALTH

INFANT AUTOPSY PROTOCOL

DOH-4278 (9/03) p1

Maternal Age: ________

Birth Weight (in grams): ________

Gestational Age: ________

Pregnancy Complications: __________________________________________________________________________

PATHOLOGIST

______________________________________Date Form Completed_________________________________

DOH-4278 (9/03) p2

Page 2

Autopsy Format

§

Final Diagnoses

§

Final Cause and Manner of Death

§

External Examination

§

Postmortem Changes

§

Scars / Other Distinguishing Characteristics

§

Clothing

§

Weights and Measures

§

General Appearance / Development

§

Injuries (External and Internal)

§

Therapeutic Procedures

§

Resuscitation Evidence

§

External Integument

§

Internal Examination

Head

Neck

Body Cavities

Cardiovascular System

Respiratory System

Liver, Gallbladder and Pancreas

Hemolymphatic System

Genitourinary System

Endocrine System

Digestive System

Musculoskeletal System

§

Post-Mortem Studies

Full body X-rays

Histopathology

Toxicology

Metabolic Screen

Neuropathology

Cultures

Blood/Tissue retained for future studies

Other

DOH-4278 (9/03) p3

Page 3

Volume

VOLUME A-1a (Title 10)

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