Pathology of the newborn - Masarykova univerzita · PDF fileI Sepsis neonatorum I Congenital malformations, genetic diseases I Congenital tumors I early newborns: up to 7th day. Pathology

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

Pathology of the newborn


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis


Basic definitionsI AbortionI DeliveryI Fetus immaturus non vitalisI Fetus immaturus vitalisI Fetus maturusI Fetus permaturus

I dead born fetus < 1000 gI alive born fetus < 500 g, if survives no longer than

24 hours


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis



I alive born fetus over 500 gI alive born fetus under 500 g, surviving more than 24

hours


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Apgar score

Mors praenatalis

Mors neonatalis



I weight less than 1000 gI usual length under 38 cmI born before 28 week of gestation


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis



I weight 1000 – 2500I 29 – 38 week


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis




Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis



I weight over 4000 gI length over 52 cmI born after 41 week of gestation


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis


Hypotrophy of the fetusI Small for dateI Multiple pregnancy

I placental insufficiencyI metabolic diseasesI alcoholI . . .


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis


Hypotrophy of the fetusI Small for dateI Multiple pregnancy

I physiologicalI child is small, but usually quickly catches up


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis


Apgar scoreI Heart rateI RespirationI Muscular toneI Reaction to nasal catetherI Color

I not present (0 points)I under 100 (1 point)I over 100 (2 points)


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis



I not present (0 points)I slow, irregular (1 point)I good, cry (2 points)


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis



I week (0 points)I extremities flexed (1 point)I active movements (2 points)


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Apgar score

Mors praenatalis

Mors neonatalis



I no response (0 points)I grimase (1 point)I cry (2 points)


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis



I general cyanosis (0 points)I body pink, extremities cyanotic (1 point)I whole newborn is pink (2 points)


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis


Results of Apgar scoreI AS < 2I AS 4 – 6I AS > 7

I mortality 50 %


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Apgar score

Mors praenatalis

Mors neonatalis



I mortality 20 %


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I almost all newborns survive


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis


Mors praenatalisI No signs of lifeI Maceration (I. – III. grade)I Intrauterine asphyxia

I no respiration, heart action, movement


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis



I I.: skinI II.: organs, brainI III.: softening of ligaments and joints


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis



I alteration of the heart rateI petechiae, ecchymosesI release of meconium into the amnial fluidI premature activation of respirationI aspiration of amniotic fluid (lanugo, meconium

bodies)


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis


Macerace, gr. III.


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis


Macerace, gr. III.


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis


Mors neonatalisI Before the 28th dayI Mechanical trauma during the deliveryI Ischemia during the deliveryI Morbus haemorrhagicus neonatorumI Sepsis neonatorumI Congenital malformations, genetic diseasesI Congenital tumors

I early newborns: up to 7th day


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis



I CNS hemorrhageI rupture of the tentoriumI spinal column traumaI bone fracturesI hematomas


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis



I damage and bleeding into the CNS (especially inimmature newborns)


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis



I heemorhagic diathesis (lack of vitamin K)I multiple organ bleedings


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis



I abruption of the placentaI chorioamnionitisI generalized infection of the motherI respirators, catethers (umbilical catethers)


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis



I organ malformations (CNS, the heard and bloodvesels, urogenital tract)


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis



I teratomasI Willms tumorI nephroblastomaI retinoblastomaI hepatoblastoma


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Apgar score

Mors praenatalis

Mors neonatalis


ImmaturityI LungsI CNSI KidneyI Intestine

I to 24. week: tubuloalveolarI to 28. week: transformation to alveolar lungI to 29. week: the lungs are fully alveolarI further development, pneumocytes of the 1st and

2nd type, surfactant production


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis



I gyrification of the brain: after 6th monthI persistency of the germinative periventricular layer


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Apgar score

Mors praenatalis

Mors neonatalis



I immature glomeruli


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis




Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis


Pneumopatology of the newbornI Hyaline membranesI Bronchopulmonary dysplasiaI Interstitial emphysemaI Aspiration of amniotic fluidI Adnate bronchopneumoniaI Atelectasis

I immaturity of pulmonary parenchymaI affects immature newborns


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis



I affects newborns, who survived the RDS with hyalinemembranes

I corresponds to reparation of pulmonary tissue


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis



I caused by arteficial ventilation of the newborns withatelectasis

I gas bubbles enter the the interstitiumI may get as far as soft tissues of the mediastinum


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis



I fetal asphyxiaI premature activation of the respiratory reflex


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis



I infection of the motherI amniotic fluid infection


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis



I not enough air within the lungs


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis


Hyaline membrane syndromeI Affects immature newbornsI RDS, immature lungI Oxygen administration is necessaryI Toxic oxygen damages alveolar lining

I under 2000 g


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis



I no surfactant (pneumocytes of the 2nd type)I the lung collapses during the expiriumI inspiration requires increased effort


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis



I increased concetration of oxygen is inevitable(incubator)

I it is necessary to keep oxygen levels as low aspossible

I lung damageI retinal damage (retrolental fibroplasia)


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis



I necrotic alveolar lining and exsudate forms hyalinemembranes

I especially ventilated alveoli are damagedI the condition improves in surviving patients


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis


Hyaline membranes


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis


Bronchopulmonary dysplasiaI Clinical signsI PathogenesisI Histology

I immature newbornsI survived RDS, who were treated with oxygen therapy

and artifitial ventilationI changes develop gradually during monthsI death often within 6 months, surviving have

pulmonary disease


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis



I ventilated alveoli damaged by oxygen disappear(fibrosis)

I perialveolar fibrosis develops in partially damagedalveoli

I previously unventilated (atelectatic) alveoli developnormally (or get hyperexpanded)


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis



I the surface of the lungs is unevenI fibrosis, irregular dilatation of alveoli (compensatory

emphysema)


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis


Bronchopulmonary dysplasia


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis


Aspiration of the amniotic fluidI Problem with blood supply of the fetusI Clinical pictureI HistologyI Prognosis

I insufficiency of the placentaI strangulation of the umbilical cordI large infarcions of the placenta and other placental

pathology


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis



I alteration of fetal soundsI stress of the fetus leads to meconium releaseI activation of the respiratory reflex


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis



I tiny keratotic squames, lanugo, meconium bodies,amnial cells are aspired to bronchi and alveoli

I variable extent


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Apgar score

Mors praenatalis

Mors neonatalis



I massive aspiration is lethalI condition may be complicated by bronchopneumonia,

especially in infected amnial fluid


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis


Aspiration of the amniotic fluid


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis


Aspiration of the amniotic fluid


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis


Adnate pneumoniaI Inflammation of the lung before, during and short

after the deliveryI EtiologyI Prognosis


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis




I disease of mother (virosis. . . )I aspiration of infected amniotic fluidI incubator


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis




I serious complication of overall condition of the child


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis


Adnate pneumonia


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis


Adnate pneumonia


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis


AtelectasisI Areas of unventilated lung in a newbornI Usually alteration with areas ventilad normallyI EtiologyI Prognosis

I firm, dark areas of consolidated tissueI alveoli contain no air (therefore protected against

toxic oxygen)I (collapse: not ventilated pulmonary tissue, which

was ventilated previously)


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis



I surrounding tissue is hyperventilatedI prominent especially in artificially ventilated babies

(emphysema)


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Apgar score

Mors praenatalis

Mors neonatalis



I immaturity of pulmonary tissueI aspiration


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis



I tendency to spontaneous healing


Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis


Atelectases, tetralogy of Fallot

Documents

Pathology of the newborn - Masarykova univerzita · PDF fileI Sepsis neonatorum I Congenital malformations, genetic diseases I Congenital tumors I early newborns: up to 7th day. Pathology