| Object:To determine what portion of autopsies reveal clinically meaning unexpected finding in neonatal intensive care unit(NICU)and to explore the incidence of neonatal acute respiratory distress syndrome(nARDS)in dead newborns.Method:We collected the autopsy results and meaningful clinical information of all dead neonates in the NICU of Zhujiang Hospital affiliated to Southern Medical University from January 01,1993 to December 31,2007,including the gender,gestational age,day of birth of neonates,clinical injury factors,clinical diagnosis,and meaningful auxiliary examination.In order to study the difference of hyaline membrane disease(HMD)in different periods,we divided the period into two stages:January 01,1993 to December 31,2001 as the first stage,and January 01,2002 to December 31,2007 as the second stage.According to the gestational age,it was divided into two gestational age segments:preterm infants and term infants.According to the age of death,it was divided into three groups:<3 days,3 to 7 days,and>7 days.The Goldman classification system was used to classify the autopsy findings of each patient into major diagnostic differences(Class ? and class ?)and minor diagnostic differences(Class ? and Class?).Divided into two groups based on lung pathology,with and without transparent membrane formation group.nARDS was diagnosed based on pulmonary pathological of diffuse alveolar injury(DAD),clinical injury factors,gestational age,and age.Result:In the given time period,472 autopsies were performed.A total of 237 cases(50.2%)were subject to review after excluding stillbirths,abortions and incomplete information cases.There were 170 males and 67 females.Premature babies were the predominant deaths in the first stage(63.9%)and full-term babies in the second stage(58.5%),the difference was statistically significant(P=0.002).The age of death was concentrated in two age groups<3 days and?7 days.In the first stage,14 cases were identified as class ? discrepancy.Critical findings,such as neonatal hyaline membrane(HMD)(7 of 14 cases,50%),neonatal pulmonary hemorrhage(NPH)(5 of 14 cases,35.7%),heart failure(1 of 14 cases,7.1%)and neonatal pneumonia(1 of 14 cases,7.1%).In the second stage,major significant finding had not been clinical detected,whether clinical manageable or not(class ? and class ?),were found 23 of 63 cases(36.5%).A total of 20 of 63 cases(31.7%)were identified as class ?discrepancy,such as infections diseases(especially fungal infection,8 of 20 cases,40.0%),HMD(7 of 20 cases,35.0%),nervous system diseases(2 of 20 cases,10.0%),NPH(21 of 20 cases,5.0%)and congenital megacolon complicated with intestinal obstruction,necrotizing enterocolitis(NEC)(1 of 20 cases,5.0%).Among of class ? discrepancy,the missed diagnosis rate of NPH in the first stage was higher than that in the second stage(35.7%VS5.0%,P=0.021),but infection diseases in the first stage was lower(7.1%VS40.0%,P=0.033).The total incidence of nARDS in the second stage was significantly higher than that in the first stage(70.8%VS45.7%,P=0.001),but the incidence of mixed RDS and simple ARDS were not statistically significant(P=0.807).The common clinical injury factors of nARDS are hypoxic factors,such as asphyxia,intrauterine distress,inhalation of amniotic fluid,and infection diseases.The incidence of infection diseases in the second stage was greater than that in the first stage,and the difference was statistically significant(P=0.000).The incidence of second-stage sepsis was higher in the group with transparent membrane formation,and the difference was statistically significant(P=0.032).The incidence of neonatal pneumonia in the second stage of the non-transparent membrane formation group was higher than that in the first stage(P=0.001).Conclusion:1.Neonatal autopsy can find major diagnostic errors,which is critical to understand the characteristics of the disease at each stage.Autopsy finding can help clinicians to verify clinical diagnosis,which is critical to reducing neonatal mortality.2.Neonatal acute respiratory distress syndrome(nARDS)was widespread in critically ill newborns.The total incidence rates of the two-stage ARDS were 45.7%and 70.8%,respectively,and the mixed RDS were 54.4%and 52.2%respectively.Hypoxia and infectious diseases were the main clinical injury factors. |
PDF Full Text Request