Exploring minimally invasive tissue sampling as an alternative to conventional autopsy in neonatal deaths

Purpose: Neonatal mortality is a significant public health concern which requires accurate identification of the cause of death (CoD). There has been a decline in conventional diagnostic autopsy (CDA) globally due to ethical and cultural barriers, resulting in lack of comprehensive data on neonatal deaths. Minimally invasive tissue sampling (MITS) of organs has emerged as an innovative alternative to CDA as it is less invasive and feasible. This study evaluates the effectiveness of MITS versus CDA in determining the cause of death in neonates. Methods: This was a single-center observational study conducted on 100 neonatal autopsies. The demographic, clinical, imaging data and ancillary tests were analyzed prior to performing both the techniques. Sensitivity, specificity, positive predictive value, negative predictive value, and interrater reliability were assessed. Results: The concordance rate for lesions in the brain, lung, and liver in MITS versus CDA was 79%, 84%, and 94% respectively. There was high sensitivity and specificity for intraventricular hemorrhage (IVH) and hyaline membrane disease (HMD) by the MITS technique, however it was not useful in detecting focal and peripheral lesions in organs. Conclusions: MITS is a promising alternative to CDA with comparable diagnostic accuracy in determining causes of death in neonates.