Pathology
Images
Atlas of Neonatal Pathology
Marta Ježová, Josef Feit
Index
Contents
Authors
Up
Next
Back
×
+ 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
Retinopathy of prematurity (ROP)
Introduction

First described in 1940 and termed retrolental fibroplasia. The incidence of ROP is inversely proportional to gestational age. ROP probably develops in genetically susceptible infants.

Etiology
  • Immature retina without full vascularization
  • Hyperoxia and changes in oxygen exposure disrupt the natural course of vascularization
  • Changes in expression of VEGF (vascular endothelial growth factor) which is strongly induced by hypoxia
  • First phase (hyperoxic)  —  VEGF is markedly decreased, there is retinal vasoconstriction and endothelial cells undergo apoptosis
  • Second phase (relative hypoxic)  —  VEGF increases and induces abnormal growth of retinal vessels (neovascularization) Those new vessels are fragile and can bleed. With healing fibrous scars develop. Severe involvement is characterized by extraretinal fibrovascular proliferation that means spread of the abnormal vessels into the vitreous. The retina is pulled anteriorly and may detach. Total retinal detachement and full blindness is the worst complication
Classification

Staging of ROP

  • 1  —  demarcation line lying in plane of retina, at junction of vascularized and avascular retina
  • 2  —  ridge, the demarcation line extends out of the plane of the retina
  • 3  —  ridge with extraretinal fibrovascular proliferation, neovascularization may extend into vitreous
  • 4  —  subtotal retinal detachment
  • 5  —  total retinal detachment
Clinical signs
  • Complications: myopia, visual impairment, blindness, strabism and glaucoma
  • Therapy: repeated examinations for ROP in threatened infants until the retina is fully vascularized, cryotherapy or vitrectomy in advanced ROP