G127 VARIATIONS IN PRACTICE AMONG PAEDIATRIC CONSULTANTS WHEN REPORTING NEONATAL DEATHS TO THE CORONER

S. Chonat¹, M. Clements¹, R. Lakshman¹, R. Iles².¹West Suffolk Hospital, Bury St Edmunds, UK; ²Addenbrooke’s Hospital, Cambridge, UK

Aims: We wished to explore the opinion of paediatric consultants regarding their personal practice when referring cases of unexpected neonatal death to the coroner.

Method: An email questionnaire was sent to the lead consultants of 221 neonatal units in the UK. The questionnaire described two clinical scenarios of unexpected neonatal death associated with birth asphyxia. Consultants were asked to indicate if they would cite a cause of death, or refer the case to the coroner. They were also invited to add personal comments.

Results: Replies were obtained from 62 consultants, (28%). Sixty six per cent of respondents indicated that they would refer an unexplained neonatal death to the coroner. Twenty one per cent were unsure. Seven per cent would definitely not refer. A potential regional variation was identified. Personal comments included indications of directives from the local coroner’s office, the desire to avoid blame or litigation, and the wish to avoid parental distress. Some expressed an opinion that there was no role for the coroner in these cases.

Conclusion: This questionnaire received replies from only 28% of its target population; however it is clear that there is a lack of consensus regarding the referral of cases of unexplained neonatal death to the coroner. Potential regional variations in practice were identified. Local guidance may originate from …