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
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+ 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
Total parenteral nutrition associated hepatic damage
Introduction

Disturbance of liver function and cholestatic jaundice are well recognized complications of prolonged paranteral nutrition. The TPN-associated cholestasis is related to the duration of treatment and correlated inversely with the gestational age and birth weight.

Etiology
  • hepatic damage due to amino acid component of intravenous nutrition (hepatotoxic damage)
  • lack of oral feeding
Macroscopic appearance

Dark green liver.

Pictures

Hepatic damage with prolonged total parenteral nutrition in premature infant born at 25 week's gestation with birth weight 800g. The baby underwent an operation for necrotizing enterocolitis for the first time at the age of 10 days. The baby died from complications of NEC at 33 days of age. Note the icteric skin and dark green liver. Intrahepatic cholestasis, Macro, autopsy (73831) Intrahepatic cholestasis, Macro, autopsy (73832)

Histology
  • cholestasis (bile within hepatocytes and canaliculi) is the earliest morphologic alteration
  • prolonged therapy is associated with portal fibrosis, bile ducts proliferation and mild portal inflammatory reaction
  • progression to hepatic fibrosis is possible