Minimally Invasive Tissue Sampling in Preterm Deaths: A Validation Study

Abstract

Uncertainty about the causes of neonatal deaths impedes achieving global health targets to reduce mortality. Complete diagnostic autopsy (CDA) is the gold standard to determine cause of death. However, it is often difficult to perform in high-burden, low-income settings. Validations of more feasible methods to determine cause of death are needed. This prospective, multi-center study in Ethiopia assessed the validity of the minimally invasive tissue sampling (MITS) approach to contribute to causes of death in preterm neonates compared to CDA. The MITS and CDA of 105 cases were reviewed. The MITS sampling success for lungs and liver was 100% and 84%, respectively. The kidney and brain had sampling successes of 58% each. MITS showed good agreement with CDA for the diagnosis of hyaline membrane disease (kappa = 0.78), and moderate to substantial agreement for pneumonia and pulmonary hemorrhage (kappa = 0.59 and 0.68, respectively). Even though CDA is the gold standard in identifying the cause of death, we believe that the MITS method can be a useful alternative method in supporting determination of cause of death in low-resource settings.

Why parents agree or disagree for minimally invasive tissue sampling (MITS) to identify causes of death in under-five children and stillbirth in North India: a qualitative study

“…The proportion (44.4%) of parents/family consented for MITS in this study was similar to the observations from Ethiopia (39.8%), but lesser than South Africa (65.7% for neonatal deaths and 65.5% for post-neonatal deaths) [ 23 , 40 , 41 ]. The lower proportion of consent among the post-neonatal deaths was a challenge.…”

“…The post-mortem minimally invasive autopsy (MIA) and minimally invasive tissue sampling (MITS) have emerged as a suitable alternative, which include post-mortem examination, imaging (variably) and needle-based tissue sampling from different organs (variably) for histopathologic, microbiological and other desired investigations [ 16 – 19 ]. The MIA and MITS have potential to support establishing accurate cause of death and stillbirth, but are less invasive, non-disfiguring, quicker and cheaper compared to the standard autopsy and feasible in resource limited settings [ 20 – 23 ]. The acceptability for MITS in hypothetical setting has been explored in different socio-cultural, religious and geographic contexts; Asia (India, Pakistan, and Bangladesh), Africa (Ethiopia, Gabon, Kenya, Mali, Mozambique, and South Africa) and Europe (United Kingdom and Belgium) from both parents/families, community and healthcare providers perspectives [ 24 – 31 ].…”

Short Term Outcome and Predictors of Mortality Among Very Low Birth Weight Infants—A Descriptive Study: Authors' Reply

“…Minimally invasive tissue sampling (MITS) is a possible alternative to complete diagnostic autopsy (CDA) for cause of death determination. MITS showed good agreement with CDA for the diagnosis of hyaline membrane disease and moderate to substantial agreement for pneumonia and pulmonary hemorrhage [3].…”

Prematurity: An Overview and Public Health Impacts of Being Born Too Early

“…We showed that the minimally invasive tissue sampling (MITS) method can sample adequate core tissue for histopathological studies equivalent to the standard autopsy for most newborn conditions in preterm infants including for lung pathologies (respiratory distress syndrome, pulmonary hemorrhage) and hepatic lesions. 9 The MITS method was deficient in obtaining sufficient core tissue of the intestine and brain. 9 Among the 441 autopsies of preterm neonatal deaths, Hyaline Membrane Disease (HMD) was recorded in 81.6%, Pneumonia in 44.7%, pulmonary haemorrhage or diffuse alveolar haemorrhage in 39%, and meconium aspiration in 5.9%.…”

“… 9 The MITS method was deficient in obtaining sufficient core tissue of the intestine and brain. 9 Among the 441 autopsies of preterm neonatal deaths, Hyaline Membrane Disease (HMD) was recorded in 81.6%, Pneumonia in 44.7%, pulmonary haemorrhage or diffuse alveolar haemorrhage in 39%, and meconium aspiration in 5.9%. 10 HMD was conspicuous in the extremely and moderately preterm infants and that might have contributed to a higher death rate in these groups of babies.…”