Validating a Minimally Invasive Tissue Sampling (MITS) Method in Determining Cause of Death in Stillbirths and Neonates.

Naanlep Matthew Tanko,Milan Terzic,Alpamys Issanov,Dimitri Poddighe,Ibrayimov Bakytkaly

doi:10.3390/children8121095

Abstract

Complete diagnostic autopsy (CDA) remains the gold standard and a valuable technique for determining cause of death. It is a source of health statistics that can be used to measure health care services’ quality, unraveling important information on disease processes, particularly in emerging and unknown diseases. It can also be a vital tool for medical education and biomedical research. However, autopsy rates have been declining globally. There is an urgent need to develop and validate alternative methods in different settings to provide reliable information on cause of death. In this study, we aimed to determine cause of death (KazCoDe) in neonates and infants using minimally invasive tissue sampling (MITS), and to compare these results with those of CDA. We conducted MITS and CDA sequentially on 24 deceased children at the Pathological Bureau of the Akimat of the city of Nur-Sultan. Clinical data of the study subjects were extracted from their clinical records. During both procedures, brain, liver and lung tissues were collected for pathological diagnosis. Fifteen (62.5%) and nine (37.5%) were stillbirths and neonates, respectively. Eight (33.3%) were females and 16 (66.7%) were males. MITS diagnosis of cause of death was concordant with CDA diagnosis in 83.3% out of the 24 cases when considering the immediate and underlying causes of death and reviewing all the clinical and laboratory test results as part of the diagnostic evaluation to arrive at a cause of death (ICD-PM). We concluded that MITS is a valuable and reliable method for cause of death diagnosis in stillbirths and neonates, which can contribute vital mortality statistics in children in the absence of CDA.

Highlights

Postmortem examination remains a valuable technique in providing mortality statistics that can be used to design and implement health care programs and for monitoring their effectiveness
The University Medical Center (UMC) Expert Commission on Bioethics granted a waiver of documentation of informed consent for both Complete diagnostic autopsy (CDA) and minimally invasive tissue sampling (MITS), and ethical approval was obtained before study subjects were enrolled (Certificate/Decision; No 6 of the Ethical Commission of the UMC of 20 September 2019)
We performed coupled MITS and CDA approaches on 24 stillbirths and neonates (15 stillbirths and 9 neonates)

Summary

Introduction

Postmortem examination remains a valuable technique in providing mortality statistics that can be used to design and implement health care programs and for monitoring their effectiveness. Sessa et al and Salerno et al [2,3] recently conducted two detailed reviews They included all case reports, case series, retrospective and prospective studies, letters to the editors, and reviews that focused on MERS-CoV, SARS-CoV, SARS-CoV-2, and autopsy; CDA provided a substantial amount of information on the pathology of these pathogens that could have been missed without autopsy. In their conclusion, they recommended that we still need autopsies in the 21st century and the dictum “to learn from the dead” should not be an exception but the rule, regarding unknown and emerging diseases. Worst still is the fact that low- and middle-income countries (LMIC), which bear most of the global burden of disease, suffer more from the lack of these vital statistics [4,5,6]

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