Pathology
Images
Atlas of Neonatal Pathology
Marta Ježová, Josef Feit
×
+ 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
Hypoxic-ischemic encephalopathy (HIE)
Introduction

Acute and subacute brain injury due to perinatal asphyxia.

Etiology

The fundamental abnormality in HIE is a deficit of oxygen supply. This is due to hypoxemia (diminished amount of oxygen in th blood supply) and ischemia (a diminished amount of blood perfusing the brain). Loss of cerebrovascular autoregulation (the ability of brain vessels to maintain a constant cerebral blood flow in spite of fluctuations in the cerebral perfusion pressure) which occurs in asphyxiated newborns also contributes to the injury.

During the perinatal period hypoxemia and/or ischemia result most commonly from asphyxia. Various causes are listed above. Only 10% of cases occur in the early postnatal period with diseases in organs responsible for oxygen delivery. These are pulmonary system diseases (airway obstruction, tracheoesophageal fistula, pneumothorax, pneumonia, hypoplastic lungs, diaphragmatic hernia etc.) and nonpulmonary causes (heart defects, heart failure etc.).

There is no single presentation of this disease. Extension and distribution of brain lesions depend upon the maturational stage of the brain and the severity and duration of asphyxial injury. In premature infant the target region for pathologic damage is the periventricular white matter. Anoxic and ischemic damage to the cerebral cortex is characteristic to the term infant. Ischemic damage to the basal ganglia, thalamus and nuclei od midbrain and brain stem may be seen in infants of any gestational age.

Clinical signs

Mild HIE

  • irritability, poor feeding, excessive crying or sleepiness
  • muscle tone is normal to slightly increased
  • full recovery within few days

Moderate and severe HIE

  • lethargy, stupor or coma
  • irregular heart rate, episodes of apnea
  • poor or absent neonatal reflexes (sucking, swallowing, grasping, Moro)
  • seizures in the first days of life
  • persistent hypotonia

Prognosis

Mortality rate is 50 – 75% in severe HIE. Most deaths occur in the first weeks of life due to multiorgan failure, cardiorespiratory arrest or pneumonia. 80% of infants who survive develop serious complications  —  mental retardation, epilepsy, cerebral palsy or combination of these. Some infants with history of mild to moderate HIE have significant learning disabilities and ADHD in spite of absence of obvious signs of brain injury

Cerebral palsy is non-progressive motor deficit sustained in the perinatal period. The neuropathology of cerebral palsy is complex including not only hypoxic-ischemic encephalopathy itn the perinatal period but also malformations, traumatic lesions, infections and inborn metabolic disordes. The exact time of injury often remains uncertain, probably only 10  —  25% cases are related to intrapartum asphyxia.

Major neuropathological patterns of injury in HIE

Selective neuronal necrosis

White matter lesions

Combined grey and white matter lesions

Late stages of HIE in survivors

Unifocal pseudocyst

Pictures

Normal brain, term infant: Normal brain, newborn, Macro, autopsy (73839) Normal brain, newborn, Macro, autopsy (73840) Normal brain, newborn, Macro, autopsy (73838)

Cut slides of normal brain, term neonate: Normal brain, newborn, Macro, autopsy (73841)

Term infant with severe birth asphyxia due to amniotic fluid embolism in the mother which suddenly developed during the delivery. Apgar score 0-3-3-4. Early onset of seizures after birth, coma, multiorgan failure. Severe hypoxic-ischemic encephalopathy and death at 1 month of age. Hypoxic encephalopathy, Macro, autopsy (73808) Hypoxic encephalopathy, Macro, autopsy (73812) Hypoxic encephalopathy, Macro, autopsy (73811) Hypoxic encephalopathy, Macro, autopsy (73815) Hypoxic encephalopathy, Macro, autopsy (73810) Hypoxic encephalopathy, Macro, autopsy (73813) Hypoxic encephalopathy, Macro, autopsy (73814) Hypoxic encephalopathy, Macro, autopsy (73809)

Severe hypoxic-ischemic encephalopathy in term neonate: Hypoxic encephalopathy, Macro, autopsy (73804) Hypoxic encephalopathy, Macro, autopsy (73802) Hypoxic encephalopathy, Macro, autopsy (73807) Hypoxic encephalopathy, Macro, autopsy (73805) Hypoxic encephalopathy, Macro, autopsy (73803) Hypoxic encephalopathy, Macro, autopsy (73806)

Hypoxic-ischemic encephalopathy in a child surving for 1 year: Hypoxic encephalopathy, Macro, autopsy (73798) Hypoxic encephalopathy, Macro, autopsy (73799) Hypoxic encephalopathy, Macro, autopsy (73800) Hypoxic encephalopathy, Macro, autopsy (73801)

Porencephaly in 7-week old infant who died of protracted septic shock: Porencephaly, Macro, autopsy (73875) Porencephaly, Macro, autopsy (73874)

Hypoxic-ischemic encephalopathy: Hypoxic encephalopathy, Macro, autopsy (74392) Hypoxic encephalopathy, Macro, autopsy (74393)

Hypoxic-ischemic encephalopathy, multicystic: Hypoxic encephalopathy, multicystic, Macro, autopsy (74385) Hypoxic encephalopathy, multicystic, Macro, autopsy (74386) Hypoxic encephalopathy, multicystic, Macro, autopsy (74387) Hypoxic encephalopathy, multicystic, Macro, autopsy (74388) Hypoxic encephalopathy, multicystic, Macro, autopsy (74389) Hypoxic encephalopathy, multicystic, Macro, autopsy (74390) Hypoxic encephalopathy, multicystic, Macro, autopsy (74391)