Unraveling Specific Causes of Neonatal Mortality Using Minimally Invasive Tissue Sampling: An Observational Study
Unraveling Specific Causes of Neonatal Mortality Using Minimally Invasive Tissue Sampling: An Observational Study
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DOI：
10.1093/cid/ciz574
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发表时间：
2019-10-15
影响因子：
11.8
通讯作者：
Chawana, Richard
中科院分区：
文献类型：
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作者：
Madhi, Shabir A.;Pathirana, Jayani;Chawana, Richard
背景。死后微创组织取样（MITS）是确定儿童死亡具体原因的金标准完全诊断尸检的潜在替代方法。我们调查了MITS的效用，并用现有的临床数据进行解释，以确定新生儿死亡的潜在和直接原因。这项前瞻性的、观察性的试点研究纳入了南非索韦托的Chris Hani Baragwanath学术医院的新生儿死亡病例。MITS包括对脑、肺和肝组织进行针芯活检。对肺、肝、血、脑脊液和粪便样本进行微生物培养和/或分子检测。每个病例的“潜在”和“直接”死因（CoD）由一个由12-15名医学专家组成的国际小组确定。我们登记了153例新生儿死亡，其中106例年龄在3-28天。主要的潜在死因包括“早产并发症”（52.9%）、“产时并发症”（15.0%）、“先天性畸形”（13.1%）和“感染相关”（9.8%）。总体而言，感染是所有新生儿死亡中57.5% （n = 88）的直接或潜在死亡原因，包括以“早产并发症”为潜在原因的新生儿中70.4%（58/81）的直接死亡原因。总体而言，90例感染相关死亡中，74.4%是医院获得性死亡，主要原因是耐多药鲍曼不动杆菌（52.2%）、肺炎克雷伯菌（22.4%）和金黄色葡萄球菌（20.9%）。在以“感染”为根本原因的死亡中，无乳链球菌是最常见的病原体（5/15[33.3%]）。MITS有潜力解决关于新生儿死亡具体原因的知识差距问题。在我们的研究中，这包括迄今未被充分认识到的医院获得性耐多药细菌感染作为新生儿死亡的主要直接原因的主导作用。
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.