Perinatal asphyxia is one of the leading causes of morbidity and mortality in the perinatal period, with 4 million neonates suffering annually from birth asphyxia. Tissue hypoxia can cause several pathological changes in multiple organs, hypoxic-ischemic encephalopathy (HIE) representing one of the most severe consequences in the newborn, occasionally leading to the insurgence of the multi-organ dysfunction syndrome. The pathological diagnosis of neonatal asphyxia is complex, histological markers of tissue hypoxia often overlapping with pathological changes due to other etiologies. This work is aimed at summarizing the most important pathological markers of asphyxia occurring in a newborn in the different organs. The endothelial lesions (swelling, apoptosis, detachment and loss of the endothelial barrier) in our experience, represent the most relevant pathological changes induced by hypoxia in all the organs. The finding of increased hepatic hemopoiesis represents one of the most important markers of chronic tissue hypoxia. In conclusion, the accurate histological study of all the organs in every case of perinatal asphyxia may allow, in expert hands, perinatal pathologists to give important data to neonatologists for reaching, together, a complex clinical/pathological diagnosis, able to explain the clinical course in the majority of asphyxiated newborns undergoing multiple organ dysfunction.
Proceedings of the International Course on Perinatal Pathology (part of the 10th International Workshop on Neonatology · October 22nd-25th, 2014) · Cagliari (Italy) · October 25th, 2014 · The role of the clinical pathological dialogue in problem solving
Guest Editors: Gavino Faa, Vassilios Fanos, Peter Van Eyken