Organ Weight Measured at Autopsy in Critically Ill Children

We determined whether organ weights at autopsy are correlated with disease acuity leading to pediatric intensive care unit (ICU) admission and death. The weights of heart, lungs, kidneys, liver, spleen, and brain were recorded in 68 pediatric ICU cases. For each organ, weight Z scores were calculated based on reference values previously established in large cohorts of deceased children by Kayser (any organ), or Dekaban and Sadowsky (brain only). Organ weight Z scores in pediatric ICU patients were severely increased (median [range] for heart, +3.2 [-6.3 to +37.7]; lungs, +3.0 [-8.6 to +38.1]; kidneys, +3.6 [-10.0 to +56.3]; liver, +4.2 [-14.9 to +70.5]; and spleen, +1.3 [-11.5 to +155.8]). Conversely, the brain weight Z score was lower compared to any other organ using either set of reference values: Kayser, 21.1 (-10.5 to +10.6; P < 0.0001); Dekaban and Sadowsky, 20.2 (-7.4 to +7.7; P < 0.0001). Pediatric ICU cases were subdivided based on disease acuity: (1) previously healthy with an acute illness (n = 11), (2) chronic disease due to congenital malformations (n 5 29), and (3) chronic disease without any detectable malformation (n = 28). Organ weight Z scores were similar among subgroups with the exception of the brain, which was statistically decreased in chronic disease pathologies (groups 2 and 3). Overall, this study demonstrates the heterogenous distribution of organ weights at autopsy in critically ill children; the weight of heart, lungs, kidneys, and liver, being most frequently increased. The brain is relatively smaller in chronic disease pathologies of pediatric ICU patients.