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Pediatric Pathology
Pediatric Pathology

Dr. Krishna Tadepalli, MD, www.mletips.com
2. Disorders of Prematurity
2. Disorders of Prematurity

Dr. Krishna Tadepalli, MD, www.mletips.com
Disorders of Prematurity
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Depends on birth weight( 2,300gm) and gestational age (34weeks), infants are
classified i...
Disorders of Prematurity
1. Fetal Growth Restriction (FGR) = low birth weight (<2500 gm); same as SGA;
also called intra u...
RDS Pathogenesis
RDS -- Pathogenesis

Dr. Krishna Tadepalli, MD, www.mletips.com
Dr. Krishna Tadepalli, MD, www.mletips.com
Patchy Atelectasis – Neonatal Lungs
Patchy Atelectasis – Neonatal Lungs

Anderson

Dr. Krishna Tadepalli, MD, www.mletips....
Dr. Krishna Tadepalli, MD, www.mletips.com
Hyaline Membrane
Hyaline Membrane

Dr. Krishna Tadepalli, MD, www.mletips.com
Hyaline Membrane
Hyaline Membrane

Dr. Krishna Tadepalli, MD, www.mletips.com
Dr. Krishna Tadepalli, MD, www.mletips.com
Anderson

Dr. Krishna Tadepalli, MD, www.mletips.com
Disorders of Prematurity
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Necrotizing Enterocolitis (NEC)
MC in Premature babies
Pathogenesis – unknown...
NEC
NEC

Dr. Krishna Tadepalli, MD, www.mletips.com
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2.disorders of prematurity; pediatric pathology

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2.disorders of prematurity; pediatric pathology

  1. 1. Pediatric Pathology Pediatric Pathology Dr. Krishna Tadepalli, MD, www.mletips.com
  2. 2. 2. Disorders of Prematurity 2. Disorders of Prematurity Dr. Krishna Tadepalli, MD, www.mletips.com
  3. 3. Disorders of Prematurity • • • Depends on birth weight( 2,300gm) and gestational age (34weeks), infants are classified into 1. Appropriate for gestational age ( AGA) = between 10th to 90th percentile 2. Small for gestational age (SGA) below 10th percentile 3. Large for gestational age (LGA) = above 90th percentile Pre- term = born before 37 weeks Post – term = after 40 (?)weeks • Causes of Prematurity = 2nd MCC of neonatal mortality, • • • • Preterm premature rupture of membranes (PPROM) ;- 1/3rd of preterm deliveries, risk factors are many ( previous episode, vaginal bleeding, smoking, poor nutrition etc.,) Intrauterine infection ;- 25% of all preterm labors, mainly due to placental infection, MC organisms  Ureaplasma, Mycoplasma, Gardnerella, Trichomonas, Gonorrhea, Chlamydia; TLRs (TLR4) are key factors; Uterine, cervical & placental abnormalities ;Multiple gestations ( twin pregnancy) Dr. Krishna Tadepalli, MD, www.mletips.com
  4. 4. Disorders of Prematurity 1. Fetal Growth Restriction (FGR) = low birth weight (<2500 gm); same as SGA; also called intra uterine growth retardation (IUGR); – Risk factors (Fetal  chromosomal, congenital anomalies or infections; Placental  Uteroplacental insufficiency, genetic mosaicism of placenta (Trisomy 7); Maternal  toxemia of pregnancy, chronic HTN, malnutrition and Drugs & chemicals ( smoking and alcohol) 1. Neonatal RDS = DAD or Hyaline Membrane Disease; MCC of RDS Hyaline Membrane Disease (others – maternal sedation, fetal head injury etc.,); almost always preterm and AGA babies; other associations – male baby, Maternal Diabetes, C-section; X-ray of lungs  ground glass like; the most important underlying factor = immaturity of lungs (lack of surfactant); – surfactant is important for innate immunity and decrease surface tension; hyaline membrane = protein and fibrin rich exudate with necrotic type II pneumocytes, never seen in still born; hormones increase (Glucocorticoids) or decrease (insulin) surfactant synthesis; – Grossly = solid (atlectatic) lungs, liver like, sink in water – Rx = exogenous surfactant + Oxygen; antenatal Glucocorticoids to mother; delay labor; – Complications of Rx = Retinopathy of prematurity and Broncho-pulmonary dysplasia, PDA, Intraventricular H.age, Necrotizing Enterocolitis Dr. Krishna Tadepalli, MD, www.mletips.com
  5. 5. RDS Pathogenesis RDS -- Pathogenesis Dr. Krishna Tadepalli, MD, www.mletips.com
  6. 6. Dr. Krishna Tadepalli, MD, www.mletips.com
  7. 7. Patchy Atelectasis – Neonatal Lungs Patchy Atelectasis – Neonatal Lungs Anderson Dr. Krishna Tadepalli, MD, www.mletips.com
  8. 8. Dr. Krishna Tadepalli, MD, www.mletips.com
  9. 9. Hyaline Membrane Hyaline Membrane Dr. Krishna Tadepalli, MD, www.mletips.com
  10. 10. Hyaline Membrane Hyaline Membrane Dr. Krishna Tadepalli, MD, www.mletips.com
  11. 11. Dr. Krishna Tadepalli, MD, www.mletips.com
  12. 12. Anderson Dr. Krishna Tadepalli, MD, www.mletips.com
  13. 13. Disorders of Prematurity 3. • • • • • • • • Necrotizing Enterocolitis (NEC) MC in Premature babies Pathogenesis – unknown (? Multifactorial) Associated with prematurity, enteral feeding or formula milk (bacterial introduction), inflammatory mediators (PAF) are important ( increased mucosal permeability); Clinically  bloody stools, abdominal distention, CVS collapse Diagnosis = air in the intestinal walls (Pneumatosis intestinalis) involves terminal ileum and large intestines; Microscopy  mucosal or mural necrosis, ulceration, bacterial colonization, gas in walls, Rx = needs bowl resection with high mortality, Complication post – NEC strictures ( due to healing by fibrosis) Dr. Krishna Tadepalli, MD, www.mletips.com
  14. 14. NEC NEC Dr. Krishna Tadepalli, MD, www.mletips.com

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