Contribution to the study of pulmonary pediatric pathology in autopsies

Abstract

Study model: retrospective study. Objectives: The aim of the present study was to determine the frequency of some of the main pediatric pulmonary diseases among the autopsies
performed at the Serviço de Patologia do HCFMRP-USP, compared to the pertinent literature in order to compose an updated text which could help mainly undergraduate students in understanding such problems. Methodology: The following data retrieved from the files of 505 pediatric autopsies performed between June 1993 and June 1996 were analyzed: sex, gestational age, age at death, body weight, cause of death, weight and pulmonary problems (petechiae, hemorrhage, lobation defects, hypoplasia, pneumonia, pneumothorax, hemothorax, pleural effusion, interstitial emphysema, hyaline membrane disease, bronchopulmonary dysplasia and atelectasia). The Epi-Info-6 program was used to tabulate and analyze the data. Results: Males predominated over female and indeterminate sex (53.7%; 45.9% and 0.4%, respectively). Most of the deaths were observed in the early neonatal (47%), intra-uterine (19%) and late neonatal (7%), periods, performing 73% of all cases and gestational age ranged from 16 to 43 weeks. Prematurity was the most frequent cause of death (29.7%), followed by congenital anomalies (10.9%), intrauterine anoxia (8.3%), infections (8.1%), perinatal causes (2.4%), isoimmunization (1.8%), neoplasia (0.4%) and other causes (38.4%). The pulmonary problems found were petechiae (49.1%), massive hemorrhage (34.5%), pleural effusion (29.5%), hyaline membrane disease (25.6%), atelectasia (24.6%), pneumonia (16.8%), pneumothorax (10.8%), lobation defects (8.6%), interstitial emphysema (5%), hypoplasia (4.4%) and bronchopulmonary dysplasia (2.4%). Conclusions: Pulmonary problems are very common in pediatric autopsies and frequently represent the cause of death. Their frequency is similar to that reported in the pertinent literature and the variations possibly reflect the differences in pre and perinatal care in the different countries. Most of the pulmonary alterations found are linked to prematurity and congenital anomalies, corresponding to a third of the cases. Reduction of the frequency of these groups would have an important medical and socio-economic impact.