Background Review of data from multiple sources is often necessary to determine cause of death for stillbirths and neonatal deaths, especially in low- to middle-income countries (LMICs) where available data may vary. The minimally invasive tissue sampling (MITS) procedure provides granular histologic and microbiologic data that clinical reports and verbal autopsies cannot provide. Expert panel evaluation of data from individual deaths can be resource-intensive but remains essential to accurately infer causes of death. Methods The Project to Understand and Research Preterms and Stillbirths in South Asia (PURPOSe) study uses review panels to evaluate causes of death in 2 LMICs. To make the process manageable, a subset of the study variables was selected with professional input and organized into case reports. Case reports include clinical information, laboratory results, fetal or neonatal organ histology and polymerase chain reaction results from tissue obtained by MITS. Panelists evaluated the complete case report forms and then determined the cause of death based on available data. Results Computerized case reports averaged 2 to 3 pages. Approximately 6 to 8 cases were reviewed and discussed per 1-hour panel meeting. All panelists were provided the same information; missing data were noted. This limited bias between panelists and across meetings. Study teams notably took ownership of data quality. Conclusions Standardized case reports for cause-of-death determination panel evaluation improve the efficiency of the review process, clarify available information, and limit bias across panelists, time, and location.

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Objective: To examine internal organ tissues and placentas of stillbirths for various pathogens. Design: Prospective, observational study. Settings: Three study hospitals in India and a large maternity hospital in Pakistan. Population: Stillborn infants delivered in a study hospital. Methods: A prospective observational study. Main outcome measures: Organisms identified by pathogen polymerase chain reaction (PCR) in internal organs and placental tissues of stillbirths.Results: Of 2437 stillbirth internal tissues, 8.3% (95% CI 7.2-9.4) were positive. Organisms were most commonly detected in brain (12.3%), cerebrospinal fluid (CSF) (9.5%) and whole blood (8.4%). Ureaplasma urealyticum/parvum was the organism most frequently detected in at least one internal organ (6.4% of stillbirths and 2% of all tissues). Escherichia coli/Shigella was the next most common (4.1% one or more internal organ tissue sample and 1.3% of tissue samples), followed by Staphylococcus aureus in at least one internal organ tissue (1.9% and 0.9% of all tissues). None of the other organisms was found in more than 1.4% of the tissue samples in stillbirths or more than 0.6% of the internal tissues examined. In the placenta tissue, membrane or cord blood combined, 42.8% (95% CI 40.2-45.3) had at least one organism identified, with U. urealyticum/parvum representing the most commonly identified (27.8%). Conclusions: In about 8% of stillbirths, there was evidence of a pathogen in an internal organ. Ureaplasma urealyticum/parvum was the most common organism found in the placenta and in the internal tissues, especially in the fetal brain.

Background: Despite significant advancement in neonatal intensive care, the incidence of late-onset neonatal sepsis (LONS) remains a major cause of neonatal morbidity and mortality. The causative organisms and their susceptibility to antibiotics vary in different regions; which forms a basis in the selection of empiric antibiotic in suspected cases of sepsis. Aims and Objectives: To determine the drug sensitivity pattern of the commonly isolated pathogens in LONS. Materials and Methods:This study was done after obtaining approval from the Institutional Human Ethical Committee of JJM Medical College Davangere. The blood culture sensitivity data of all neonates admitted and treated as cases of LONS over a period of 2 years (December 2013 to December 2015) at the neonatal intensive care unit of Bapuji Hospital were studied retrospectively. Results: A total of 212 neonates admitted were suspected cases of LONS. 51.88% of them were blood culture positive, with 78.18% of the isolated organisms being Gram-positive and 24 (21.81%) Gram-negative. The most frequently isolated organism was coagulase-negative Staphylococcus aureus (78.18%) followed by Klebsiella pneumoniae (10.9%). 71.25% of these organisms showed resistance to ampicillin, and 56.25% showed resistance to gentamicin which is the World Health Organization recommended an empirical choice of antibiotics. Conclusion: Our study has shown an increasing trend of resistance to the commonly prescribed first-line empiric antibiotics such as ampicillin and gentamicin. Hence, periodic surveillance of antibiotic susceptibility is of prime importance to choose the right empiric antibiotic.