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Unraveling Specific Causes of Neonatal Mortality Using Minimally Invasive Tissue Sampling: An Observational Study

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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.

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Clinical Infectious Diseases, 2019, vol. 69, supl. 4, p. S351–S360

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Articles publicats en revistes (ISGlobal)

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Unraveling Specific Causes of Neonatal Mortality Using Minimally Invasive Tissue Sampling: An Observational Study