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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
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+ 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
Bronchopulmonary dysplasia (BPD)
Introduction

BPD is a chronic lung disease that occurs in infants who received respiratory support with mechanical ventilation and prolonged oxygenation. It is seen in babies recovering form respiratory distress syndrome, sepsis or prolonged apnea and most babies who develop BPD nowadays have birthweights below 1000 g. BPD is defined as receiving supplemental oxygen or ventilatory support at 36 weeks of postmenstrual age.

Clinical signs
  • there is delayed resolution of RDS
  • classified as mild, moderate or severe depending on the need for supplemental oxygen and positive pressure ventilation
  • most patients with BPD survive
  • increased risk for repated and serious pulmonary infections and asthma during childhood
  • poor growth and psychomotoric delay is a frequent problem
  • severe BPD is complicated by cor pulmonale and secondary pulmonary hypertension
Etiology
  • extreme lung immaturity
  • hyperoxia injury
  • barotrauma
  • patent ductus arteriosus
  • fluid overload
  • fetal inflammatory response  —  antenatal exposure to proinflammatory cytokines as found in choriamnionitis or funisitis effects pulmonary developement and contributes to the developement of BPD. There is also strong association of BPD and postnatal sepsis.
Macroscopic appearance

Classic BPD

Originally described in 1967 as severe lung injury caused by oxygen toxicity and barotrauma with prolonged aggresive ventilation in the treatment of RDS. Its etiopathogenesis was abnormal reparative process in response to injury and inflammation. There was a progress from an acute exsudative phase of acinar injury to reparative and chronic fibroproliferative phase. The histopathologic findings originally reported were airway epithelial lesions, smooth muscular hyperplasia, extensive peribronchiolar and instersticial fibrosis, focal hemorrhage, areas of overdistension and atelectasis and hypertensive vascular disease.

New BPD

In recent years with gentler ventilation techniques, antental glucocoricoid therapy and surfactant therapy the histologic changes seen in infants differ.New BPD is characterised by decrease in alveolar number (enlarged simplified alveoli), abnormal microvasculature and intersticium with less prominent celularity and fibroproliferation. The current view is that new BPD is caused by interruption of normal developemental pathways for terminal maturation and alveolarization of lungs of very preterm infants. The maximum rate of accretion of alveoli is seen in a period from 25 weeks to 4 months after birth.

Pictures

Classic bronchopulmonary dysplasia in infant aged 3 months. Premature birth at 29 weeks with birth weight 970 g. The baby was dependent on ventilatory support from birth. Premature rupture of membranes which occured at 23 week's gestation was a significant risk factor as well as several episodes of sepsis. Death from pneumonia. Bronchopulmonary dysplasia, Macro, autopsy (73786)

Bronchopulmonary dysplasia in 11-week old infant. Premature birth at 26 weeks with birth weight 1100 g. The baby suffered from early onset neonatal sepsis, (Streptococcus agalactiae), RDS, repeated episodes of late sepsis and was operated on necrotizing enterocolitis. Death due to massive intracranial hemorrhage. Bronchopulmonary dysplasia, Macro, autopsy (73785)

Bronchopulmonary dysplasia: Bronchopulmonary dysplasia, Macro, autopsy (74363)