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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
Sepsis neonatorum
Introduction

Bacterial sepsis occurring in the first 28 days of life characterized clinically by abrupt onset, rapid progression, often without demostrable anatomic localization and high mortality rate even with appropriate antibiotic treatment.

Clinical signs
  • inderteminate signs
  • lethargy, irratability
  • hypothermia or hyperthermia
  • respiratory distress
  • feeding disturbances
  • mild jaundice
  • seizures
  • apnea
Etiology
  • Gram-positive
    • group βhemolytic Streptococcus group B  —  asymptomatic vaginal colonization is found in 15 – 25 % of pregnant women. Vertical transmission is up to 60%, but only 1% of these colonized infants develop neonatal disease. IGBS is associated with both early and late onset sepsis and the most common etiologic agent of neonatal meningitis. The presentation depends on the GBS serotype Listeria monocytogenes  —  early and late onset sepsis
    • Staphylococcus aureus  —  septicemia, abscesses in the lungs, supurative skin infections, osteomyelitis
    • Staphylococcus epidermidis  —  late onset sepsis, nosocomial infections associated with intravenous catheters or invasive procedures
  • Gram-negative
    • E. coli  —  commonly encountered in sepsis, neonatal meningitis, nosocomial infections by strains with increased antibiotic resistance
    • Klebsiella, Enterobacter
    • Haemophilus influenzae
Classification
  • Early onset sepsis
  • Late onset sepsis
Clinical signs
  • Early onset sepsis
    • manifests in the first 7 days of life, commonly in the first hours after birth
    • associated with obstetric complications: premature delivery, chorioamnionitis, prolonged membrane rupture, prolonged labor, maternal fever
    • the organism is acquired directly from the mothers genital tract or by swallowing or aspiration of infected amniotic fluid
    • often due to group B βhemolytic Streptococcus
    • fulminant clinical course, respiratory symptoms predominate
    • mortality rate is very high
    • the main pathological finding is widespread pneumonia, hyaline membranes may be superimposed
    • lungs appear congested and airless
  • Late onset sepsis (7 – 28 days)
    • present after 7th day of life, commonly during the second to fourth week after birth
    • spread of microorganisms is either vertical (intrapartum contact with foci of maternal genital infection in most GBS sepsis) or from postnatal spread from the caregiving enviroment
    • no associaton with obstetric complications
    • mortality rate is lower than in early onset form
    • Bacteriaemia results in meningeal seeding, neonatal menignitis and ventriculitis are typical. Clinical presention of meningitis is subtle and may be dominated by nonneural signs. Nuchal rigidity and bulging anterior fontanella are late. There is high incidence of hydrocephalus in survivors.
Pictures

Immaturity, pneumonia: Immaturity, pneumonia, Macro, autopsy (74412) Immaturity, pneumonia, Macro, autopsy (74413)