Atlas of Neonatal Pathology
Marta Ježová, Josef Feit
+ Introduction
+ Using this atlas
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+ 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
Perinatal infection

Infections make a major contriution to perinatal mortality and morbidity. The fetus and neonate are particulary vulnerable to infection because of humotal and cellular defence mechanisms are inadequately developed. The situations resembles taht of the immunosupressed adult. The signs of infectin may be diffucult to distinguish from those of birth asphyxia or respiratory distress syndrom. Infections and sepsis as a major problem in preterm infants.


General routes of infection

  • Transplacental (hematologic)
    • used by most viruses and parasites (TORCH infections):
      • toxoplasmosis
      • rubella
      • cytomegalovirus
      • herpes simplex (TORCH infections)
      • parvovirus B19
      • Treponema pallidum
      • Listeria monocytogenes etc.
  • Ascending (transcervical) infection
    • organisms ascend from maternal genital tract
    • the neonate acquires the infection by swallowing and aspiration of infected amniotic fluid or during the passage through the birth canal
    • frequently used by
      • bacteria (β-Streptococci of group B)
      • Escherichia coli and other bowel bacteria)
      • Candida sp.
      • herpesvirus may be acquired from focal herpetic lesions in the birth canal
  • Iatrogenic
    • Amniocentesis, cordocentesis, exchange transfusion, cerclage
  • Postpartum
    • Organisms spread from maternal or enviromental sources (sick persons, asymptomatic carrers with bacterial colonization). The infection is usually transmitted by hands of caregivers. Bacteria in particular, less viruses and fungi are implicated. Cytomegalovirus and HIV virus may be transmitted via brest feeding. The umbilicus provides a potential site of entry of microorganism, but umbilical sepsis is quite a rare occurence nowadays. Hospital-acquired infections (nosocomial) are the constant hazard for newborns hospitalized in intensive care units.