Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Pathology of the newborn Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Basic definitions Abortion Delivery Fetus immaturus non vitalis Fetus immaturus vitalis Fetus maturus Fetus permaturus dead born fetus < 1000 g alive born fetus < 500 g, if survives no longer than 24 hours Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Basic definitions Abortion Delivery Fetus immaturus non vitalis Fetus immaturus vitalis Fetus maturus Fetus permaturus alive born fetus over 500 g alive born fetus under 500 g, surviving more than 24 hours Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Basic definitions Abortion Delivery Fetus immaturus non vitalis Fetus immaturus vitalis Fetus maturus Fetus permaturus weight less than 1000 g usual length under 38 cm born before 28 week of gestation Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Basic definitions Abortion Delivery Fetus immaturus non vitalis Fetus immaturus vitalis Fetus maturus Fetus permaturus weight 1000 – 2500 29 – 38 week Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Basic definitions Abortion Delivery Fetus immaturus non vitalis Fetus immaturus vitalis Fetus maturus Fetus permaturus Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Basic definitions Abortion Delivery Fetus immaturus non vitalis Fetus immaturus vitalis Fetus maturus Fetus permaturus weight over 4000 g length over 52 cm born after 41 week of gestation Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Hypotrophy of the fetus Small for date Multiple pregnancy placental insufficiency metabolic diseases alcohol . . . Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Hypotrophy of the fetus Small for date Multiple pregnancy physiological child is small, but usually quickly catches up Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Apgar score Heart rate Respiration Muscular tone Reaction to nasal catether Color not present (0 points) under 100 (1 point) over 100 (2 points) Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Apgar score Heart rate Respiration Muscular tone Reaction to nasal catether Color not present (0 points) slow, irregular (1 point) good, cry (2 points) Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Apgar score Heart rate Respiration Muscular tone Reaction to nasal catether Color week (0 points) extremities flexed (1 point) active movements (2 points) Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Apgar score Heart rate Respiration Muscular tone Reaction to nasal catether Color no response (0 points) grimase (1 point) cry (2 points) Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Apgar score Heart rate Respiration Muscular tone Reaction to nasal catether Color general cyanosis (0 points) body pink, extremities cyanotic (1 point) whole newborn is pink (2 points) Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Results of Apgar score AS < 2 AS 4 – 6 AS > 7 mortality 50 % Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Results of Apgar score AS < 2 AS 4 – 6 AS > 7 mortality 20 % Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Results of Apgar score AS < 2 AS 4 – 6 AS > 7 almost all newborns survive Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Mors praenatalis No signs of life Maceration (I. – III. grade) Intrauterine asphyxia no respiration, heart action, movement Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Mors praenatalis No signs of life Maceration (I. – III. grade) Intrauterine asphyxia I.: skin II.: organs, brain III.: softening of ligaments and joints Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Mors praenatalis No signs of life Maceration (I. – III. grade) Intrauterine asphyxia alteration of the heart rate petechiae, ecchymoses release of meconium into the amnial fluid premature activation of respiration aspiration of amniotic fluid (lanugo, meconium bodies) Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Macerace, gr. III. Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Macerace, gr. III. Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Mors neonatalis Before the 28th day Mechanical trauma during the delivery Ischemia during the delivery Morbus haemorrhagicus neonatorum Sepsis neonatorum Congenital malformations, genetic diseases Congenital tumors early newborns: up to 7th day Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Mors neonatalis Before the 28th day Mechanical trauma during the delivery Ischemia during the delivery Morbus haemorrhagicus neonatorum Sepsis neonatorum Congenital malformations, genetic diseases Congenital tumors CNS hemorrhage rupture of the tentorium spinal column trauma bone fractures hematomas Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Mors neonatalis Before the 28th day Mechanical trauma during the delivery Ischemia during the delivery Morbus haemorrhagicus neonatorum Sepsis neonatorum Congenital malformations, genetic diseases Congenital tumors damage and bleeding into the CNS (especially in immature newborns) Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Mors neonatalis Before the 28th day Mechanical trauma during the delivery Ischemia during the delivery Morbus haemorrhagicus neonatorum Sepsis neonatorum Congenital malformations, genetic diseases Congenital tumors heemorhagic diathesis (lack of vitamin K) multiple organ bleedings Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Mors neonatalis Before the 28th day Mechanical trauma during the delivery Ischemia during the delivery Morbus haemorrhagicus neonatorum Sepsis neonatorum Congenital malformations, genetic diseases Congenital tumors abruption of the placenta chorioamnionitis generalized infection of the mother respirators, catethers (umbilical catethers) Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Mors neonatalis Before the 28th day Mechanical trauma during the delivery Ischemia during the delivery Morbus haemorrhagicus neonatorum Sepsis neonatorum Congenital malformations, genetic diseases Congenital tumors organ malformations (CNS, the heard and blood vesels, urogenital tract) Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Mors neonatalis Before the 28th day Mechanical trauma during the delivery Ischemia during the delivery Morbus haemorrhagicus neonatorum Sepsis neonatorum Congenital malformations, genetic diseases Congenital tumors teratomas Willms tumor nephroblastoma retinoblastoma hepatoblastoma Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Immaturity Lungs CNS Kidney Intestine to 24. week: tubuloalveolar to 28. week: transformation to alveolar lung to 29. week: the lungs are fully alveolar further development, pneumocytes of the 1st and 2nd type, surfactant production Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Immaturity Lungs CNS Kidney Intestine gyrification of the brain: after 6th month persistency of the germinative periventricular layer Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Immaturity Lungs CNS Kidney Intestine immature glomeruli Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Immaturity Lungs CNS Kidney Intestine Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Pneumopatology of the newborn Hyaline membranes Bronchopulmonary dysplasia Interstitial emphysema Aspiration of amniotic fluid Adnate bronchopneumonia Atelectasis immaturity of pulmonary parenchyma affects immature newborns Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Pneumopatology of the newborn Hyaline membranes Bronchopulmonary dysplasia Interstitial emphysema Aspiration of amniotic fluid Adnate bronchopneumonia Atelectasis affects newborns, who survived the RDS with hyaline membranes corresponds to reparation of pulmonary tissue Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Pneumopatology of the newborn Hyaline membranes Bronchopulmonary dysplasia Interstitial emphysema Aspiration of amniotic fluid Adnate bronchopneumonia Atelectasis caused by arteficial ventilation of the newborns with atelectasis gas bubbles enter the the interstitium may get as far as soft tissues of the mediastinum Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Pneumopatology of the newborn Hyaline membranes Bronchopulmonary dysplasia Interstitial emphysema Aspiration of amniotic fluid Adnate bronchopneumonia Atelectasis fetal asphyxia premature activation of the respiratory reflex Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Pneumopatology of the newborn Hyaline membranes Bronchopulmonary dysplasia Interstitial emphysema Aspiration of amniotic fluid Adnate bronchopneumonia Atelectasis infection of the mother amniotic fluid infection Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Pneumopatology of the newborn Hyaline membranes Bronchopulmonary dysplasia Interstitial emphysema Aspiration of amniotic fluid Adnate bronchopneumonia Atelectasis not enough air within the lungs Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Hyaline membrane syndrome Affects immature newborns RDS, immature lung Oxygen administration is necessary Toxic oxygen damages alveolar lining under 2000 g Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Hyaline membrane syndrome Affects immature newborns RDS, immature lung Oxygen administration is necessary Toxic oxygen damages alveolar lining no surfactant (pneumocytes of the 2nd type) the lung collapses during the expirium inspiration requires increased effort Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Hyaline membrane syndrome Affects immature newborns RDS, immature lung Oxygen administration is necessary Toxic oxygen damages alveolar lining increased concetration of oxygen is inevitable (incubator) it is necessary to keep oxygen levels as low as possible lung damage retinal damage (retrolental fibroplasia) Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Hyaline membrane syndrome Affects immature newborns RDS, immature lung Oxygen administration is necessary Toxic oxygen damages alveolar lining necrotic alveolar lining and exsudate forms hyaline membranes especially ventilated alveoli are damaged the condition improves in surviving patients Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Hyaline membranes Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Bronchopulmonary dysplasia Clinical signs Pathogenesis Histology immature newborns survived RDS, who were treated with oxygen therapy and artifitial ventilation changes develop gradually during months death often within 6 months, surviving have pulmonary disease Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Bronchopulmonary dysplasia Clinical signs Pathogenesis Histology ventilated alveoli damaged by oxygen disappear (fibrosis) perialveolar fibrosis develops in partially damaged alveoli previously unventilated (atelectatic) alveoli develop normally (or get hyperexpanded) Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Bronchopulmonary dysplasia Clinical signs Pathogenesis Histology the surface of the lungs is uneven fibrosis, irregular dilatation of alveoli (compensatory emphysema) Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Bronchopulmonary dysplasia Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Aspiration of the amniotic fluid Problem with blood supply of the fetus Clinical picture Histology Prognosis insufficiency of the placenta strangulation of the umbilical cord large infarcions of the placenta and other placental pathology Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Aspiration of the amniotic fluid Problem with blood supply of the fetus Clinical picture Histology Prognosis alteration of fetal sounds stress of the fetus leads to meconium release activation of the respiratory reflex Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Aspiration of the amniotic fluid Problem with blood supply of the fetus Clinical picture Histology Prognosis tiny keratotic squames, lanugo, meconium bodies, amnial cells are aspired to bronchi and alveoli variable extent Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Aspiration of the amniotic fluid Problem with blood supply of the fetus Clinical picture Histology Prognosis massive aspiration is lethal condition may be complicated by bronchopneumonia, especially in infected amnial fluid Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Aspiration of the amniotic fluid Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Aspiration of the amniotic fluid Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Adnate pneumonia Inflammation of the lung before, during and short after the delivery Etiology Prognosis Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Adnate pneumonia Inflammation of the lung before, during and short after the delivery Etiology Prognosis disease of mother (virosis. . . ) aspiration of infected amniotic fluid incubator Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Adnate pneumonia Inflammation of the lung before, during and short after the delivery Etiology Prognosis serious complication of overall condition of the child Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Adnate pneumonia Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Adnate pneumonia Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Atelectasis Areas of unventilated lung in a newborn Usually alteration with areas ventilad normally Etiology Prognosis firm, dark areas of consolidated tissue alveoli contain no air (therefore protected against toxic oxygen) (collapse: not ventilated pulmonary tissue, which was ventilated previously) Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Atelectasis Areas of unventilated lung in a newborn Usually alteration with areas ventilad normally Etiology Prognosis surrounding tissue is hyperventilated prominent especially in artificially ventilated babies (emphysema) Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Atelectasis Areas of unventilated lung in a newborn Usually alteration with areas ventilad normally Etiology Prognosis immaturity of pulmonary tissue aspiration Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Atelectasis Areas of unventilated lung in a newborn Usually alteration with areas ventilad normally Etiology Prognosis tendency to spontaneous healing Pathology of the newborn Basic definitions Apgar score Mors praenatalis Mors neonatalis Pneumopatology of the newborn Atelectases, tetralogy of Fallot