Preparation of an autopsied infant should be practiced in the same manner as an adult or child where applicable. Arterial injection is the preferred method of distribution. Hypodermic and surface embalming are suggested if an arterial injection cannot be completed or as a secondary method. Identifying the Four Types of Autopsies Performed on Infants Organ Donor Autopsy – Organs and, or tissues are removed like a partial autopsy. Corneas, heart, lungs, liver, and skin are removed just as they are in an adult. Special or Localized Autopsy – A specific organ is removed for further testing and, or examination. Partial Autopsy – Only one cavity is opened in a partial autopsy. These include cranial, thoracic, abdominal, or spinal. Complete or Full Autopsy – The cranial and full trunk (including thoracic and abdominal) are opened and viscera removed. Vessel Selection: Autopsied Infants The preparation and vessel selection of an infant post embalming is similar to that of the adult, less the size of the arteries. If able, the common carotid, subclavian, common or external iliac should remain the primary arteries for injection. In cases where the pathologist has not left the vessels at a reasonable length for ligation, further dissection will have to be completed. The vessel size of an infant may not allow the use of string for ligation, and so the use of hemostats will be needed to hold the artery into position for injection. There is no need to locate the veins for drainage as these are not only difficult to identify, but also extremely small and unable to fit a canule. Drainage can be taken without instruments by draining into, the cavity and then being removed by an aspiration hose. When the subclavian artery cannot be located the axillary artery at its broadest point may be used. To access the axillary artery dissection of the pectoralis major and minors will allow easier access to the underlying artery. If the iliac vessels are difficult to locate or are too small for injection tubes, hypodermic treatment can occur.
A second U shaped incision can be made from the mid clavicle to the posterior portion of the rib cage where it turns to a right angle across the inferior margin of the sternum to a point, identical to the original mid clavicle incision. The skin can be separated and raised to expose the sternum at its junction with the rib cage where it can then be opened by severing the cartilage. The sternum can be lifted in a posterior direction toward the head to give space to locate the pericardium. At this point, the pericardium can be dissected to expose the heart and vessels. Please note that the internal thoracic arteries may need to be clamped before incision to avoid spillage of arterial fluid into the cavity. An opening can now be made into the ascending aorta at the left ventricle and injection tube placed. The entire body can be embalmed from this point of injection. Drainage can be completed by placing an incision in the right auricle of the heart. Cavity Treatment The treatment of the cavity of an infant is similar to the treatment of an adult or child. Cavity treatment is performed following the completion of arterial injection either immediately or several hours later. It will be at the embalming practitioner’s discretion as to when treatment will be performed. Re-aspiration of the cavity several hours later or even the next day is common and is often recommended. An infant trocar measuring approximately 12 inches in length and a ¼ inch in diameter will be used for aspiration and injection of this area. The standard point of entry is the left or right inguinal area of the abdomen. The amount of cavity fluid used will be based on the size of the infant. A trocar button or suture may be used to close the incision after treatment. **Note: Use of the axillary vessels is not advised due to the small and delicate arterial and venous walls. Also, the vessels may be too small to insert the arterial and drainage tubes. Preparation of Autopsied Infant Cases
PREPARATION OF A PRE-TERM INFANT
Preservative compounds and gels are strongly urged in infant autopsy cases to treat the trunk of the infant and treat the outer walls. Careful attention is shown to the back, shoulders, and buttocks. Compresses Compresses can be used both internally and externally by using cotton sheeting dampened with cavity or other specialty fluid to preserve areas of the body that may otherwise be treated through arterial embalming. Compresses should be left in place internally and for an extended period externally to allow the chemicals time to work to their full capacity and complete preservation. Hypodermic Injections When areas of the body cannot be reached, by means of arterial injection, a second method of injection may be used. Hypodermic fluids can be injected by using a hypodermic needle through the trunk into the extremities of the body while the cavity is still open. A hypodermic needle can also be used by going through the incised neck into the head or by use of any natural openings i.e., the mouth and nose. Viscera Treatment Treatment of the viscera will be performed the same way as an adult or a child. Some embalmers opt to place the bag and the viscera into the cavity prior to adding cavity fluid while others treat the viscera in the bag first and then place it into the cavity. Either way is correct. Viscera should be “clipped” before treatment to allow the escape of gasses built up within the organs.
Let’s take a moment to discuss the preparation of a pre-term infant. Because infants that are prematurely born present even further difficulties based on their tiny frame, it can be an almost impossible task to do a full arterial embalming or possibly even partial arterial embalming. The utilization of external compresses and topical agents constitute the best practice in the treatment of these cases. While the head, cavity or trunk of the body, and limbs can be treated hypodermically using a strong concentration of fluids and distributed with the hypodermic needle or infant trocar, the external surface layer of the skin can be placed, in cotton sheets that have been treated with surface gels or cavity fluids. Please do not use arterial fluids on the external surface layer of skin as this can do significant damage and may inhibit viewing. The use of these methods can be used on both autopsied and non-autopsied infant cases. If preparing an autopsied infant, internal compresses and external compresses are encouraged as this will preserve the inner cavity walls. Surface and Hypodermic Treatment - Preservative Compounds and Gels Preservative compounds are hardening and preserving formulated powders with active ingredients that have drying qualities. These are used for both internal and external surface preservation. Water-soluble formaldehyde-based gels are used as an external pack for post-embalming preparation where secondary treatment is required. Autopsy gel may be used in place of cavity fluid for infant embalming by lining the inside of the cavity before suture.
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