MINIMALLY INVASIVE TISSUE SAMPLING (MITS): AN ALTERNATIVE TO CONVENTIONAL AUTOPSY IN NEONATAL DEATHS Athira Sreenivas, PhD scholar, Department of Pathology, Kasturba Medical College, MAHE, Manipal, Karnataka Mary Matrhew, Professor, Department of Pahology, Kasturba Medical College, MAHE,Manipal,Karnataka
Abstract BACKGROUND: Minimally Invasive Tissue Sampling (MITS) is a feasible autopsy technique which establishes the cause of death in countries with low resources. RATIONALE: An autopsy is essential to confirm the cause of death. However, parents refuse to consent for autopsy due to disfigurement of the body, religious reasons and emotional attachment to the baby. MITS from important organs can circumvent the need for a complete autopsy. STRATEGY: A fine needle with 16G size is inserted through skin into the target organ and tissue obtained is processed to establish histopathological and molecular diagnosis. RESULTS: The concordance rates of MITS versus conventional autopsy in establishing cause of death is 100%. CONCLUSION: MITS is a feasible technique which can serve as an alternative to conventional autopsy in establishing cause of death. Accurate diagnosis of the cause of neonatal death is important for prevention and morbidity in subsequent pregnancies.
Introduction Conventional autopsy is the gold standard for confirming and establishing the cause of death in the neonatal period. The procedure includes dissection of organs and body cavities, followed by sectioning of relevant tissues to establish the diagnosis.
Need for the Technique • The Neonatal Mortality Rate in India is 22.7 per 1000 live births 3 (2018). • India being a conservative multicultural nation, many parents refuse to consent for autopsy in neonates due to religious, emotional attachment and cultural reasons.4
MITS
• Public reluctance for autopsy has increased over time more so due to adverse media attention, delay in last rites, and spiritual or • MITS is an autopsy technique which collects the tissue samples from ethnic views. Fear of disfigurement of the deceased’s body, has led relevant organs and body fluids using fine needles immediately after to refusal for conventional autopsy.4 death.1 • In many cases the certified cause of death can be discordant from • Feasible, less traumatic, less invasive and time consuming the actual cause of death and hence the need for a post-mortem 5 technique which would circumvent the need for a complete autopsy examination. in determining the cause of death.2 • Accurate diagnosis of the cause of neonatal death is important for prevention and morbidity in subsequent pregnancies. • Tissues obtained by MITS technique are processed for histological • MITS can be advised as an alternative when parents refuse for a 2 and microbiological examination to establish the cause of the death. conventional autopsy. • MITS technique is a convenient replacement for conventional autopsy especially in conservative societies.
Method • Instrument: BARD MONOPTY needle with 16G, 160mm for brain and 16G, 100mm for lungs, liver and kidney. • Needle is be pierced through the skin into the target area and cores of tissue is collected. • Tissue sample is taken for histopathological and molecular testing.
Benefits for the Community • Helps in establishing the cause of death, concordance rates of MITS versus conventional autopsy in establishing cause of death 6 in neonates is 100%. • Convenient and feasible replacement to conventional autopsy technique and prevention of deaths and morbidity in subsequent pregnancies. • Alleviates parental fear of similar episodes occurring in subsequent pregnancies and prevent poor perinatal outcomes. • No delay in last rites of the deceased and no cultural and religious beliefs are affected. • Helps in changing the perceptions of the community towards autopsy practice, improves neonatal mortality and aids in recommending changes in health policies.
References
Bard Monopty Needle
1. Health Europa. Minimally Invaisve Tissue Sampling Part of new surveillance alliance. Availablefromhttps://www.healtheuropa.eu/minimally-invasive-tissue-sampling-new-global-surveillancealliance/86402/ Accessed on 19 th March 2020. 2. Costache M, Lazaroiu AM, Contolenco A, Costache D, George S, Sajin M, Patrascu OM. Clinical or postmortem? the importance of the autopsy; a retrospective study. Maedica. 2014 Sep;9(3):261. 3. UNICEF for every child. Neonatal Mortality. Available on UNICEF Data: Monitoring the situation of children and women, neonatal mortality, September 2019. Accessed on 19th March 2020. 4. Gurley ES, Parveen S, Islam MS, Hossain MJ, Nahar N, Homaira N, Sultana R, Sejvar JJ, Rahman M, Luby SP. Family and community concerns about post-mortem needle biopsies in a Muslim society. BMC medical ethics. 2011 Dec;12(1):10. 5. Hunt R, Barr P. Errors in the certification of neonatal death. Journal of paediatrics and child health. 2000 Oct;36(5):498-501. 6. Menendez C, Castillo P, Martínez MJ, Jordao D, Lovane L, Ismail MR, Carrilho C, Lorenzoni C, Fernandes F, Nhampossa T, Hurta%do JC. Validity of a minimally invasive autopsy for cause of death determination in stillborn babies and neonates in Mozambique: an observational study. PLoS medicine. 2017 Jun;14(6).