Immunohistochemical investigation of pulmonary surfactant in perinatal fatalities

In order to verify forensic pathological significance of immunohistochemical investigation of pulmonary surfactant, 11 forensic and 16 clinico-pathological cases of perinatal death were comparatively examined. Surfactant appeared in some infants of 31-32 weeks gestation and was usually positive thereafter, indicating maturity of fetal lungs, although it may not have fully developed until about the 36th week of gestation. It was negative in all cases of the hyaline membrane disease except for a full-term infant (secondary respiratory distress syndrome). In usual cases, surfactant coating the expanded alveolar epithelia with its diffuse deposit in the intra-alveolar spaces was considered to indicate duration of hypoxia under persistent respiration (agonal state). Such finding was most intensely observed in asphyxia and in severe respiratory failure from intrinsic causes in the infants over ca. 36 weeks of gestation. With reference to pulmonary micromorphology, the amount of intra-alveolar surfactant seemed to be most closely related to the alveolar septal (interstitial) edema.