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

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

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

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

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

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

hours

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

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

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

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

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

I weight 1000 – 2500I 29 – 38 week

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

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

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

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

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

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

Hypotrophy of the fetusI Small for dateI Multiple pregnancy

I placental insufficiencyI metabolic diseasesI alcoholI . . .

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

Hypotrophy of the fetusI Small for dateI Multiple pregnancy

I physiologicalI child is small, but usually quickly catches up

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

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)

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

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

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

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

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

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

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

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

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

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

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

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

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

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

I mortality 50 %

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

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

I mortality 20 %

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

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

I almost all newborns survive

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

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

I no respiration, heart action, movement

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

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

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

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

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

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)

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

Macerace, gr. III.

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

Macerace, gr. III.

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

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

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

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

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

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 damage and bleeding into the CNS (especially inimmature newborns)

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

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

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

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

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

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

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

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 teratomasI Willms tumorI nephroblastomaI retinoblastomaI hepatoblastoma

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

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

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

ImmaturityI LungsI CNSI KidneyI Intestine

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

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

ImmaturityI LungsI CNSI KidneyI Intestine

I immature glomeruli

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

ImmaturityI LungsI CNSI KidneyI Intestine

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

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

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

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

I affects newborns, who survived the RDS with hyalinemembranes

I corresponds to reparation of pulmonary tissue

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

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

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

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

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

I fetal asphyxiaI premature activation of the respiratory reflex

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

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

I infection of the motherI amniotic fluid infection

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

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

I not enough air within the lungs

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

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

I under 2000 g

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

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

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

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

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

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)

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

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

I necrotic alveolar lining and exsudate forms hyalinemembranes

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

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

Hyaline membranes

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

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

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

Bronchopulmonary dysplasiaI Clinical signsI PathogenesisI Histology

I ventilated alveoli damaged by oxygen disappear(fibrosis)

I perialveolar fibrosis develops in partially damagedalveoli

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

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

Bronchopulmonary dysplasiaI Clinical signsI PathogenesisI Histology

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

emphysema)

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

Bronchopulmonary dysplasia

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

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

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

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

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

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

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

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

I variable extent

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

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

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

especially in infected amnial fluid

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

Aspiration of the amniotic fluid

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

Aspiration of the amniotic fluid

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

Adnate pneumoniaI Inflammation of the lung before, during and short

after the deliveryI EtiologyI Prognosis

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

Adnate pneumoniaI Inflammation of the lung before, during and short

after the deliveryI EtiologyI Prognosis

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

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

Adnate pneumoniaI Inflammation of the lung before, during and short

after the deliveryI EtiologyI Prognosis

I serious complication of overall condition of the child

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

Adnate pneumonia

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

Adnate pneumonia

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

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)

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

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

I surrounding tissue is hyperventilatedI prominent especially in artificially ventilated babies

(emphysema)

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

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

I immaturity of pulmonary tissueI aspiration

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

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

I tendency to spontaneous healing

Pathology of thenewborn

Basic definitions

Apgar score

Mors praenatalis

Mors neonatalis

Pneumopatologyof the newborn

Atelectases, tetralogy of Fallot