İstanbul’da otopsisi yapılmış travmatik olmayan bebek ölümlerinin değerlendirilmesi

Abstract

Amaç: Bu çalışmada, travmatik olmayan bebek ölüm vakalarının demografik özellikleri, mevsimsel dağılımları ile adli tıp uygulamaları sonucu elde edilen, histopatolojik ve mikrobiyolojik bulguların belirlenen ölüm sebeplerine katkısının saptanması amaçlandı. Yöntem: Adli Tıp Kurumu Başkanlığı İstanbul Morg İhtisas Dairesince Ocak 2017-Aralık 2019 tarihleri arasında otopsisi yapılan travmatik olmayan 299 bebek ölüm vakası retrospektif olarak incelendi. Kan, beyin omurilik sıvısı (BOS), akciğer ve dalak dokusu kültürlerinden (4 steril ortam) en az 3’ünde ya da trakeal sürüntü, akciğer dokusu ve kan kültürlerinin tamamında aynı mikrobiyolojik ajan tek başına üremişse kültür üremeleri o etken patojen için anlamlı kabul edildi. Bulgular: Vakaların %53,2’sinin erkek cinsiyette olduğu, ölümlerin %79,3’ünün postneonatal dönemde ve en sık kış mevsiminde gerçekleştiği tespit edildi. Ölüm sebebi bildirilen 274 vaka içinde en sık ölüm sebebi pnömoni olup, %59,1 oranında gerçekleşti. Etken patojen olarak, %19,3 vakadan alınan kültürlerde anlamlı üremeler saptandı. Sadece kan kültürü incelenen 290 vakanın %6,2’sinde, BOS kültürü incelenen 279 vakanın %11,1’inde kültürün steril olduğu tespit edildi. Akciğer dokuları postmortem histopatolojik değerlendirilmesinde %31,8 vakada enfeksiyon bulgusu saptanmazken, en sık bulgu %28,4 vaka ile interstisyel pnömoni olarak belirlendi. Sonuç: Bebek ölüm vakalarına tıbbi öykü ile birlikte otopside, postmortem histopatolojik ve mikrobiyolojik incelemelerin yapılması, multidisipliner bir yaklaşımla tüm bulguların değerlendirilmesi, negatif otopsi oranlarını düşürmeye ve bebek ölümlerinin önlenmesine yönelik yapılacak ileri çalışmalara katkı sağlayacaktır.

Keywords

• Bebek ölümleri
• otopsi
• ölüm sebebi
• postmortem histopatoloji
• postmortem mikrobiyoloji.
• Bebek ölümleri, otopsi, ölüm sebebi, postmortem histopatoloji, postmortem mikrobiyoloji.

Evaluation of non-traumatic infant autopsies in Istanbul

Abstract

Introduction: Aim of this study is to determine the demographic characteristics, seasonal distribution of non-traumatic infant death cases and the contribution of histopathological examination and postmortem microbiological analyses on determining the causes of deaths of autopsied cases in a forensic manner. Methods: This study was carried out retrospectively on non-traumatic infant deaths autopsies between January 2017 and December 2019 in the Istanbul Morgue Department of Council of the Forensic Medicine. If the same microbiological agent was grown alone at least three of the blood, cerebrospinal fluid (CSF), lung and spleen tissue cultures (4 sterile sites) or in all of the tracheal swabs, lung tissue and blood cultures, the culture growth was accepted significant for that causative pathogen. Results: It was found that 53.2% of the 299 cases were male and 79.3% of the deaths occurred in postneonatal period and most frequently in the winter season (33.8%). The cause of death was determined in 274 cases, and the most common cause of death was pneumonia with a rate of 59.1% (n: 162). According to the criteria determined above for the causative pathogen; the significant growth was detected in cultures in 54 (19.7%) cases. It was found that 6.2% of 290 cases which blood culture was examined were sterile, and 11.1% of 279 cases whose CSF culture was examined were found to be sterile. Postmortem histopathological evaluation of lung tissues revealed no signs of infection in 95 (31.8%) cases, while the most common finding was interstitial pneumonia with 85 (28.4%) cases. Conclusion: The performing postmortem histopathological and microbiological examinations at autopsy with medical history in infant mortality cases, evaluation of all findings with a multidisciplinary approach will contribute to further studies to reduce negative autopsy rates and prevent infant deaths.

Keywords

• Infant deaths
• autopsy
• cause of death
• post-mortem histopathology
• post-mortem microbiology.

References

1. Available at: https://www.who.int/data/gho/data/themes/topics/indicator-groups/indicator-group-details/GHO/infant-mortality#:~:text (cited: 04 April 2022).
2. Available at: UNICEF-2020-Child-Mortality-Report.pdf (childmortality.org) http://childmortality.org/wp-content/uploads/2020/09/UNICEF-2020-Child-Mortality-Report.pdf (cited: 04 April 2022).
3. Available at: GHO | By category | Child mortality (who.int) http://apps.who.int/gho/data/node.main.ChildMort?lang=en (cited: 04 April 2022).
4. Available at: Child mortality and causes of death (who.int) http://www.who.int/data/gho/data/themes/topics/topic-details/GHO/child-mortality-and-causes-of-death (cited: 04 April 2022).
5. Yılmaz R, Pakiş I, Turan N, Can M, Kabakuş Y, Gürpınar SS. Evaluation of the causes of death in the 0-1 age group determined by the Council of Forensic Medicine. Turkish Arch Pediatr 2010;45(1):31–6.
6. Kaya A, Bilgin UE, Şenol E, Koçak A, Aktaş EÖ, Şen F. İzmir’de yapılan bebeklik dönemi adli otopsiler: 1999-2007.Ege Tıp Dergisi / Ege Journal of Medicine 49(3): 177-184,2010
7. Dogan E. Evaluation of 0-1 Years Old Non-traumatic Infant Deaths Reported by the Council of Forensic Medicine [in Turkish]. Master thesis. Council of Forensic Medicine, Istanbul; 2017.
8. Çapkur M. A multi-perspective review of the autopsies carried out on the children by the department of forensic medicine within the five-year period between 2006 and 2010 in and around Deni̇zli̇. Master thesis. Akdeniz Unıversity; 2014.

9. Naeye RL, Burt LS, Wright DL, Blanc WA, Tatter D. Neonatal mortality, the male disadvantage. Pediatrics 1971;48(6):902–6.
10. Brothwood M, Wolke D, Gamsu H, Benson J, Cooper D. Prognosis of the very low birthweight baby in relation to gender. Arch Dis Child 1986;61(6):559–64
11. Drevenstedt GL, Crimmins ME, Vasunilashorn S, Finch CE. The rise and fall of excess male infant mortality. PNAS 2008;105(13):5016-21
12. Available at: https://data.tuik.gov.tr/Bulten/Index?p=Olum-ve-Olum-Nedeni-Istatistikleri-2019-33710 (cited: 21 Jan 2021)
13. Korkmaz A, Aydın Ş, Çamurdan AD, Okumuş N, Onat FN, Özbaş S. Analysis of infant mortality causes and a new national mortality registration system in Turkey. Journal of Child Health and Diseases 2013;56(3):105–21.
14. Çatak B, Öner C. Do infant death causes change? A database originated cross-sectional study. Turkish J Fam Med Prim Care 2019;13(3):311–7.
15. Tümer AR, Tümer L, Bilge Y. Sudden unexpected child deaths: forensic autopsy results in cases of sudden deaths during a 5-year period. J Trop Pediatr 2005;51(3):131–5.
16. Kurdoğlu M, Kurdoğlu Z, Küçükaydın Z, Kolusarı A, Adalı E, Yıldızhan R, vd. Distribution and Incidence of Congenital Malformations at Van Region. Van Medical Journal 2009;16(3):95–8.
17. Çakmak B, Hısım Y, Aysal T, Özsoy Z, Demi̇rtürk F. Major Congenital Anomalies: Gaziosmanpasa University Three Years Experience. Medical Journal of Tokat Gaziosmanpasa University 2012;4:24–8.
18. Yılmaz M, Bayraktar F. Evaluation of Perinatal and Infant Mortality Data in Düzce Between 2014-2017. Estudam Public Health Journal 2020;5(1):35–42.
19. Ely, D. M. & Driscoll, A. K. Infant mortality in the United States, 2017: Data from the period linked birth/infant death file. National Vital Statistics Reports 68, 1–19 (2019).
20. du Toit-Prinsloo L, Dempers J, Verster J, Hattingh C, Nel H, Brandt VD, Jordaan J, Saayman G. Toward a standardized investigation protocol in sudden unexpected deaths in infancy in South Africa: a multicenter study of medico-legal investigation procedures and outcomes. Forensic Sci Med Pathol 2013 Sep;9(3):344-50.
21. Lawoyin TO. Risk factors for infant mortality in a rural community in Nigeria. J R Soc Health 2001;121(2):114-8.
22. Weinbaum FI, Lavie S, Danek M, Sixsmith D, Heinrich GF, Mills SS. Doing it right the first time: quality improvement and the contaminant blood culture. J Clin Microbiol 1997;35(3):563–5.
23. Morris JA, Harrison LM, Partridge SM. Postmortem bacteriology: A re-evaluation. J Clin Pathol 2006;59(1):1–9.
24. Paudel R, Dogra P, Montgomery-Yates AA, Coz Yataco A. Procalcitonin: A promising tool or just another overhyped test?. Int J Med Sci 2020; 17(3):332-337. doi:10.7150/ijms.39367.
25. Ramsthaler F, Kettner M, Mall G, Bratzke H. The use of rapid diagnostic test of Procalcitonin serum levels for the postmortem diagnosis of sepsis. Forensic Sci Int 2008;178(2–3):139–45.
26. Bode-Jänisch S, Schütz S, Schmidt A, Tschernig T, Debertin AS, Fieguth A, Hagemeier L, Teske J, Suerbaum S, Klintschar M, Bange FC. Serum procalcitonin levels in the postmortem diagnosis of sepsis. Forensic Sci Int 2013 Mar 10;226(1-3):266-72.
27. Simoes EAF, Cherian T, Chow J, Shahid-Salles SA, Laxminarayan R, John TJ. Acute Respiratory Infections in Children. In: Jamison DT, Breman JG, Measham AR, Alleyne G, Claeson M, Evans DB, et al., editors. Disease Control Priorities in Developing Countries. 2nd ed. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2006: p.483-9.