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  • Journal article
    Thayyil S, Sebire NJ, Chitty LS, Wade A, Olsen O, Gunny RS, Offiah A, Saunders DE, Owens CM, Chong WKK, Robertson NJ, Taylor AMet al., 2011,

    Post mortem magnetic resonance imaging in the fetus, infant and child: a comparative study with conventional autopsy (MaRIAS Protocol)

    , BMC Pediatrics, Vol: 11, ISSN: 1471-2431

    Background:Minimally invasive autopsy by post mortem magnetic resonance (MR) imaging has been suggested as an alternative for conventional autopsy in view of the declining consented autopsy rates. However, large prospective studies rigorously evaluating the accuracy of such an approach are lacking. We intend to compare the accuracy of a minimally invasive autopsy approach using post mortem MR imaging with that of conventional autopsy in fetuses, newborns and children for detection of the major pathological abnormalities and/or determination of the cause of death.Methods/Design:We recruited 400 consecutive fetuses, newborns and children referred for conventional autopsy to one of the two participating hospitals over a three-year period. We acquired whole body post mortem MR imaging using a 1.5 T MR scanner (Avanto, Siemens Medical Solutions, Enlargen, Germany) prior to autopsy. The total scan time varied between 90 to 120 minutes. Each MR image was reported by a team of four specialist radiologists (paediatric neuroradiology, paediatric cardiology, paediatric chest & abdominal imaging and musculoskeletal imaging), blinded to the autopsy data. Conventional autopsy was performed according to the guidelines set down by the Royal College of Pathologists (UK) by experienced paediatric or perinatal pathologists, blinded to the MR data. The MR and autopsy data were recorded using predefined categorical variables by an independent person.Discussion:Using conventional post mortem as the gold standard comparator, the MR images will be assessed for accuracy of the anatomical morphology, associated lesions, clinical usefulness of information and determination of the cause of death. The sensitivities, specificities and predictive values of post mortem MR alone and MR imaging along with other minimally invasive post mortem investigations will be presented for the final diagnosis, broad diagnostic categories and for specific diagnosis of each system.Clinical Trial Registration:

  • Conference paper
    Addison S, Sebire NJ, Judge-Kronis L, Taylor AM, Abrams D, Scott R, Robertson NJ, Peebles D, Mein C, Munroe PB, Thayyil Set al., 2011,


    , Publisher: NATURE PUBLISHING GROUP, Pages: 406-406, ISSN: 0031-3998
  • Conference paper
    Chandrasekaran M, Thayyil S, Bainbridge A, Kendall G, Gunny R, Cady E, Marlow N, Robertson NJet al., 2011,


    , Publisher: NATURE PUBLISHING GROUP, Pages: 161-161, ISSN: 0031-3998
  • Journal article
    Thayyil S, Shankaran S, Cowan F, Ayer M, Price D, Bainbridge A, Cady E, Marlow N, Costello A, Robertson N, Guhan Bet al., 2011,


    , PEDIATRIC RESEARCH, Vol: 70, Pages: 33-33, ISSN: 0031-3998
  • Journal article
    Thayyil S, 2011,

    Less invasive autopsy: an evidenced based approach

    , ARCHIVES OF DISEASE IN CHILDHOOD, Vol: 96, Pages: 681-687, ISSN: 0003-9888
  • Journal article
    Thayyil S, 2011,

    Brain cooling in babies: Are we ready for clinical trials in developing countries?

    , INDIAN PEDIATRICS, Vol: 48, Pages: 441-442, ISSN: 0019-6061
  • Book chapter
    Robertson NJ, Thayyil S, 2011,

    Hypothermic neural rescue for neonatal encephalopathy in mid- and low-resource settings

    , Neonatal Neural Rescue: A Clinical Guide, Pages: 128-141, ISBN: 9781107681606

    © Cambridge University Press 2013. The most significant burden of neonatal encephalopathy (NE) occurs in low- and mid-resource settings [1]. The WHO World Health Report 2005 estimated that an annual 1 million survivors of “birth asphyxia” may develop cerebral palsy, learning difficulties or other disabilities [2]. Globally, perinatal asphyxia is responsible for 42 million disability life adjusted years – this is double that due to diabetes and three quarters of that due to HIV/AIDS [1]. Almost one quarter of the world’s 4 million annual neonatal deaths are caused by perinatal asphyxia (Figures 12.1, 12.2) [3]: 99% of these deaths occur in low- and mid-resource settings especially those countries with higher neonatal mortality rates (Figures 12.1, 12.2). The potential benefits of therapeutic hypothermia (were it to be safe and effective in every setting) are potentially greater in low- and mid-resource settings where birth asphyxia is at least 10-fold higher than in the developed world. However, all the positive evidence about the safety and efficacy of cooling relates to high-income countries. Furthermore, there is a theoretical risk that problems such as immune suppression by hypothermia may be deleterious in a different setting; one pilot study in a low-resource setting [4] reported more deaths in the cooled group and the expensive high tech cooling devices used in the developed world are not appropriate for global use in low- and mid-resource settings.

  • Journal article
    Wilkinson DJ, Thayyil S, Robertson NJ, 2011,

    Ethical and practical issues relating to the global use of therapeutic hypothermia for perinatal asphyxial encephalopathy

  • Journal article
    Thayyil S, Robertson NJ, Sebire NJ, Taylor AMet al., 2010,

    Post-mortem MR and CT imaging in fetuses, newborns and children: an evidenced based approach

    , Diagnostic Histopathology, Vol: 16, Pages: 565-572, ISSN: 1756-2317

    There is insufficient evidence in the published literature to support the use of post-mortem MR imaging (MRI) as an alternative for conventional non-forensic autopsy in fetuses, newborns and children. Large prospective studies evaluating the accuracy of post-mortem MR imaging in a rigorous and blinded way are now nearing completion and the results are expected in 2011. Less-invasive autopsies by post-mortem MR imaging may have major effect in resurrecting consented autopsy rates; however an evidenced based and systematic approach towards less-invasive autopsy process is mandatory to ensure that the post-mortem data remains accurate and credible. Here we summarize the current evidence, ongoing research and future directions for less-invasive autopsy process in the United Kingdom. A joint effort between clinicians, radiologists, pathologists, parent groups and funding bodies is essential for successful implementation of less-invasive autopsy, in the UK. © 2010 Elsevier Ltd.

  • Journal article
    Robertson NJ, Kendall GS, Thayyil S, 2010,

    Techniques for therapeutic hypothermia during transport and in hospital for perinatal asphyxial encephalopathy

    , SEMINARS IN FETAL & NEONATAL MEDICINE, Vol: 15, Pages: 276-286, ISSN: 1744-165X

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