İstanbul’da otopsisi yapılmış travmatik olmayan bebek ölümlerinin değerlendirilmesi

Öz

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.

Anahtar Kelimeler

• 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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

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