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The critical role of perinatal pathology
1St George's Hospital, Tooting, London, UK.
Insights
Histological examination of tissues is crucial for understanding preterm birth complications, including infection, brain injury, and sudden infant death. This approach aids in preventing preterm birth morbidity and mortality.
Area of Science:
- Pathology
- Neonatology
- Obstetrics
Background:
- Histological examination remains vital for diagnosing preterm birth complications despite advances in imaging and biochemistry.
- Infection and inflammatory cytokines are increasingly implicated in early labor and preterm infant brain damage.
- Distinguishing true infection from contamination in labor requires demonstrating a pathological inflammatory response in tissues.
Purpose of the Study:
- To highlight the essential role of histological examination in the multidisciplinary approach to preventing preterm birth complications.
- To emphasize the importance of placental histology (chorioamnionitis) for confirming infective etiology.
- To underscore the necessity of pediatric pathology in explaining adverse outcomes and sudden unexpected deaths in preterm infants.
Main Methods:
- Histological examination of placental tissues to identify chorioamnionitis.
- Post-mortem histological examination of lungs to understand poor response to neonatal intensive care.
- Systemic study of brain tissue using advanced histological techniques to investigate injury mechanisms.
- Paediatric pathology for investigating sudden unexpected deaths.
Main Results:
- Histology confirms chorioamnionitis as evidence of infection in preterm birth.
- Lung histology reveals unsuspected pneumonia, emphysema, or hypoplasia explaining adverse outcomes.
- Brain tissue analysis may elucidate the role of apoptosis in preterm infant brain injury.
- Paediatric pathology identified myocardial necrosis and cardiac tamponade as causes of sudden death.
Conclusions:
- Histological examination is indispensable for diagnosing the causes of preterm birth, associated morbidity, and mortality.
- Understanding inflammatory responses and tissue damage through histology is key to developing preventative strategies.
- Paediatric pathology plays a critical role in explaining unexpected deaths and guiding future clinical care for preterm infants.
Abstract:
In spite of great advances in imaging and biochemistry, histological examination of tissues remains a vital part of the multidisciplinary approach to the prevention of the onset, morbidity and mortality of preterm birth. There has been increasing interest in the role of infection and inflammatory cytokines in causation both of early labour and the white matter damage in the brain of preterm infants. However, labour itself is associated with the build up of increased numbers of inflammatory cells in the uterine cervix and increased concentrations of inflammatory cytokines and positive microbiological cultures may reflect carriage or contamination. Confirmation of an infective aetiology in an individual case is best achieved by demonstration of a pathological inflammatory response in tissues, for example, by showing the presence of chorioamnionitis in the placenta. A proper understanding of the poor response to neonatal intensive care of some preterm babies often requires histological examination of the lungs after death, where unsuspected pneumonia, interstitial emphysema and/or pulmonary hypoplasia may help provide an explanation for the adverse outcome in individual cases. The pathophysiological mechanism of brain injury in preterm infants is undergoing re-evaluation, and the systemic study of brain tissue using the latest histological techniques may elucidate the importance of apoptosis in this situation and could point the way towards an effective preventative strategy. Paediatric pathology is also essential to explain many cases of sudden unexpected death in preterm infants, as demonstrated by the recent realisation that death may be caused by total parenteral nutrition fluid-associated myocardial necrosis, and acute cardiac tamponade.