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Title: Unraveling Specific Causes of Neonatal Mortality Using Minimally Invasive Tissue Sampling: An Observational Study
Author: Madhi, Shabir A.
Pathirana, Jayani
Baillie, Vicky
Izu, Alane
Bassat Orellana, Quique
Blau, Dianna M.
Breiman, Robert F.
Hale, Martin
Mathunjwa, Azwifarwi
Martines, Roosecelis B.
Nakwa, Firdose L.
Nzenze, Susan
Ordi i Majà, Jaume
Raghunathan, Pratima L.
Ritter, Jana M.
Solomon, Fatima
Velaphi, Sithembiso
Wadula, Jeannette
Zaki, Sherif R.
Chawana, Richard
Keywords: Neonatologia
Mortalitat infantil
Infant mortality
Issue Date: 9-Oct-2019
Publisher: Oxford University Press
Abstract: Background. Postmortem minimally invasive tissue sampling (MITS) is a potential alternative to the gold standard complete diagnostic autopsy for identifying specific causes of childhood deaths. We investigated the utility of MITS, interpreted with available clinical data, for attributing underlying and immediate causes of neonatal deaths. Methods. This prospective, observational pilot study enrolled neonatal deaths at Chris Hani Baragwanath Academic Hospital in Soweto, South Africa. The MITS included needle core-biopsy sampling for histopathology of brain, lung, and liver tissue. Microbiological culture and/or molecular tests were performed on lung, liver, blood, cerebrospinal fluid, and stool samples. The “underlying” and “immediate” causes of death (CoD) were determined for each case by an international panel of 12–15 medical specialists. Results. We enrolled 153 neonatal deaths, 106 aged 3–28 days. Leading underlying CoD included “complications of prematurity” (52.9%), “complications of intrapartum events” (15.0%), “congenital malformations” (13.1%), and “infection related” (9.8%). Overall, infections were the immediate or underlying CoD in 57.5% (n = 88) of all neonatal deaths, including the immediate CoD in 70.4% (58/81) of neonates with “complications of prematurity” as the underlying cause. Overall, 74.4% of 90 infection-related deaths were hospital acquired, mainly due to multidrug-resistant Acinetobacter baumannii (52.2%), Klebsiella pneumoniae (22.4%), and Staphylococcus aureus (20.9%). Streptococcus agalactiae was the most common pathogen (5/15 [33.3%]) among deaths with “infections” as the underlying cause. Conclusions. MITS has potential to address the knowledge gap on specific causes of neonatal mortality. In our setting, this included the hitherto underrecognized dominant role of hospital-acquired multidrug-resistant bacterial infections as the leading immediate cause of neonatal deaths.
Note: Reproducció del document publicat a:
It is part of: Clinical Infectious Diseases, 2019, vol. 69, supl. 4, p. S351–S360
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ISSN: 1058-4838
Appears in Collections:Articles publicats en revistes (ISGlobal)

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