Pathology
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Atlas of Neonatal Pathology
Marta Ježová, Josef Feit
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+ Introduction
+ Using this atlas
+ Conditions of using this atlas
+ Technical notes
+ Hardware
+ Software
+ How to use the atlas
+ Navigating through the text pages
+ Controlling the pictures
+ Logos and labels
+ What will you need to use the atlas
+ Bugs, problems
+ Netscape
+ Microsoft Internet Explorer
+ Some other Internet resources concerning dermatopathology and pathology
+ Support
+ Support
+ Neonatal pathology
+ Basic terms and classification of newborn infants
+ The Apgar score
+ Classification of newborn infants by weight and gestation
+ Pathology of gestation length
+ Prematurity
+ Postmaturity (Clifford syndrome)
+ Growth and developement
+ Intrauterine growth retardation (IUGR), small for gestational age infant (SGA)
+ Large for gestational age infant (LGA)
+ Physical maturity
+ Pathology of prematurity
+ Gross appearance of premature infant
+ Difficulties in maintaining homeostasis
+ Thermoregulation
+ Hypoglycemia
+ Hyperbilirubinemia
+ Fluids and electrolytes
+ Apnea of prematurity
+ Anemia of prematurity
+ Hyaline membrane disease (HMD)
+ Necrotizing enterocolitis (NEC)
+ Intraventricular hemorrhage (IVH)
+ Periventricular leukomalacia (PVL)
+ Patent ductus arteriosus (PDA)
+ Iatrogenic diseases and damage
+ Respiratory system
+ Injuries caused by endotracheal intubation
+ Pulmonary air leak
+ Bronchopulmonary dysplasia (BPD)
+ Retinopathy of prematurity (ROP)
+ Cardiovascular system
+ Total parenteral nutrition associated hepatic damage
+ Infections
+ Viability, survivability and long term sequelae of prematurity
+ Viability
+ Survivability in prematurity
+ Severe long term sequelae in babies born prematurely
+ Birth asphyxia
+ Hypoxic-ischemic encephalopathy (HIE)
+ Meconium aspiration syndrome (MAS)
+ Persistent pulmonary hypertension of the newborn (persistent fetal circulation)
+ Birth trauma
+ Extracranial lesions
+ Soft tissus injuries
+ Intraabdominal injuries
+ Peripheral and cranial nerve injuries
+ Bone injuries
+ Cranial trauma
+ Perinatal infection
+ Intrauterine infections (TORCH group)
+ Sepsis neonatorum
+ Blenorrhea neonatorum
+ HIV infection
+ Stillbirth and perinatal mortality
+ Stillbirth
+ Perinatal mortality
+ Neonatal pathology nonrelated to prematurity, birth asphyxia or infection
+ Congenital anomalies in liveborn infants
+ Kernicterus
+ Hemorrhagic disease of the newborn
+ Spontenous gastric perforation in a neonate
Periventricular leukomalacia (PVL)
Introduction

Periventricular leukomalacia means infarction of the periventricular white matter.

The periventricular area is particularly vulnerable to hypoxic-ischemic injury because of high metabolic rate and watershed blood supply (boundary between the ventriculopetal and ventriculofugal arteries within the brain, the latter are poorly developed in premature infants) The lesion is common in preterm infants, 28 – 32 weeks is the highest incidence.

Etiology
  • ischemic injury following birth asphyxia, prolonged apnea
  • additional risk factors include chorioamnionitis, sepsis, meningitis
  • PVL can develop several weeks after birth
Clinical signs
Nonlethal but most frequent cause of cerebral palsy in survivors. Spastic diplegia is the most common clinical presentation. Diagnosed using cranial ultrasound.
Macroscopic appearance
  • white spots of coagulation necrosis located in the periventricular white matter of the centrum semiovale
  • bilateral symmetric distribution is common
  • breaking into pseudocysts (cystic PVL) or healing with gliotic scar
Pictures

Cystic periventricular leucomalacia in 6-weeks old infant. Elective premature delivery at 32 weeks because of severe hydrops universalis. The cause of hydrops was not found. Sepsis occured during the stay in the neonatal intesive care unit and the baby died of protracted septic shock. Periventricular leucomalatia, Macro, autopsy (73866) Periventricular leucomalatia, Macro, autopsy (73867) Periventricular leucomalatia, Macro, autopsy (73868) Periventricular leucomalatia, Macro, autopsy (73869) Periventricular leucomalatia, Macro, autopsy (73870)