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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
+ 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
Prematurity
Introduction

A premature birth is one that occurs before 37 weeks of gestation.

The incidence of premature labor in the Czech republic is almost 8% and the number is continously increasing.

Etiology
  • chorioamnionitis  —  the major cause of premature labor
  • multiple gestation pregnancy  —  often due to assisted reproductive technology, 40% are delivered prematurely
  • maternal age: adolescents or mother older than 40 years
  • diabetes mellitus
  • polyhydramnios
  • abruptio placentae
  • low socioeconomic status
  • tobacco abuse
Clinical signs

Spontaneous preterm birth

Partus prematurus in cursu with uterine contractions

Preterm premature rupture of membranes (PPROM)  —  spontaneous rupture of membranes before the onset of labor prior to 37 weeks. PPROM is most likely due to chorioamnionitis.

Elective preterm delivery because of problems with the pregnancy.

The most common reason is preeclampsia, eclamptic convulsions or HELLP syndrome, placental abruption, intrauterine growth retardation or certain fetal anomalies (hydrops).

Clinical management of PPROM

Immediate labor: in case of chorioamnionitis, advanced labor, fetal distress, placental abruption and fetal lung maturity

Conservative management: on the condition that there is no intra-amniotic infection. The vast majority of women otherwise preceed to active labor and delivery soon. With therapy (tocolytics, antibiotics) and conservative management approximately 50% of remaining pregnancies deliver during the subsequent week after PPROM. Steroids given to a mother in preterm labor improve pulmonary function in the infant with increased surfactant synthesis and secretion and significantly reduce mortality and morbidity of preterm delivery. Optimal benefit starts 24 hours after the onset of treatment and lasts 7 days.

The main risk of premature rupture of membranes is ascending infection. The risk increases with duration of PPROM.

Prognosis is extremely poor if PPROM occurs before fetal viability and especially before 20 weeks of gestation. Lethal pulmonary hypoplasia is the result of early severe oligohydramnios (Potter's sequence).

Pictures

Potter's sequence in 28-week gestation neonate. Elective preterm delivery because of prolonged rupture of membranes and anhydramnios from 19 weeks's gestation. Early neonatal death from lung hypoplasia. Potter's sequence, Macro, autopsy (73878) Potter's sequence, Macro, autopsy (73879) Potter's sequence, Macro, autopsy (73876) Potter's sequence, Macro, autopsy (73877)

Potter's sequence, twin A. Preterm delivery at 29 week's gestation with prolonged rupture of membranes 6 weeks before delivery (dichorionic diamniotic twins). The baby was dependent on ventilatory support untill death at 3 months of age. The baby died of respiratory failure due to bronchopulmonary dysplasia complicated by pneumonia. Note lower extremity deformities. Potter's sequence, Macro, autopsy (73880)

Immaturity (24-week), hypoplastic lungs, apoplexia: Immaturity, lung hypoplasia, apoplexia, Macro, autopsy (74408) Immaturity, lung hypoplasia, apoplexia, Macro, autopsy (74409) Immaturity, lung hypoplasia, apoplexia, Macro, autopsy (74410)