The Study On The Clinical Pathological And Medicolegal Characteristic Of The Neonatal Respiratory System Disease

Objective:This study is to analasyze the forensic pathological characteristics on the neonata respiratory system disease,including mother facters and the characteristics of neonate itself. And to summarize the pulmonary pathological changes characteristic and discuss the influence on the hydrostatic test of lung lead by the pulmonary pathological changes.To explore the value of pulmonary interstitial emphysema in identifying stillbirth and livebirth and the significance of surfactant pulmonary protein in diagnosing the neonatal pulmonary disease.Background:The pulmonary disease is one of the main cause on the neonate death.The lung pathological changes are the important part on neonatal forensic pathological examination. Hydrostatic test of lung is suspected as the acknowledged normal experiment on the identification of stillbirth and livebirth,it is thought that the lung pathological changes have distinguished effects on the result of the hydrostatic test of lung.Pulmonary interstitial emphysema is put forward and applied on identifying the stillbirth and livebirth abroad. The neonate death is published on individual case report ,and the systematic study on neonatal respiratory system disease is not covered.Method:We retrospectively analyze 70 cases including neonate death cases and the stillbirth at the School of Forensic Medicine from 1985 to the June of 2006. According to the neonate death cause,we devide two groups,one is the lung disease death cause group (34 cases) and the other is the other system disease death cause group (18 cases).The index discussed include mother's age,gestation time,the mode of delivery,the sex of the newborn,day age,the score of Apgar,the clinical manifestation and so on,then conclude the clinical feature of the neonatal respiratory disease. Explore the diagnosis significance in respiratory disease by surfactant pulmonary protein immunotisochemical staining.Meanwhile ,according to wehter the newborn has breathed when delivey we devide these cases into two groups,one is the stillbirth group(52 case) and the other is the livebirth( 18 case).Then we analyze the relation between the lung pathological and hydrostatic test of the lung and explore the pathological changes of pulmonary interstitial emphysema in stillbirth and livebirth.In our study,we use the image ananlysis instrument and SPSS11.5 statistics software as a ajunctive means.Result: In this study the case count present the increasing tendency from the year 1985 to 2006.The respiratory disease is 65.4% among the neonatal death cause,others is 34.6%. The mother's age is 82.4% in 21-30 years,the term delivery is 79.4%. In the delivery mode comparaion,the neonatal respiratory disease death rate in selective cesarean is significantly greater than the vaginal delivery and the acute cesarean P<0.05. The ratio of male to the femal in neonate is the 2.4:1. the death rate in the early neonate period is 86.5%. The Apgar score in one minute after be born is 58.8% over 8 ', the score in the respiratoy group is significantly greater than the other group P< 0.05.The clinical manifestation of the neonatal respiratory is not specific. The weight in our study is significantly lower than the normal referenced value, the ratio of lung weight to body weight in the two group is significantly higher than the normal referenced value P<0.05 .The ratio of normal weight neonate is 67.6%. The diffuse distribution is 40.4% in the lung pathological changes,23.1% in right lung and 19.2% in the lower lobe of the double lung.Outside pulmonary system the adrenal hemorrhage is 54.7% and is the most common complication.The time of the cuticular epithelium in alveoli is 1.91±1.39 day and the respiratoy system disease is 85%.The disease of the placenta and umbilical cord is 44.4% in the stillbirth death cause.But the carried placenta count is 22.9%. Of the stillbirth,the mother's age is all within 21-30 years,the term delivery is 58.8%.the ration of male to femal in the stillbirth is 1.25:1.The weight of the stillbirth is significantly lower than the normal reference value P<0.05.The ratio of normal weight is 72.2%. In the hydrostatic test of lung. the negative of this test in livebirth is 50%, the stillbirth is all negative. About pulmonary interstitial emphysema (PIE), 3 cases in the stillbirth are suspective PIE and 15 cases are not PIE;there are evident and suspective PIE in livebirth. The positive optical desity of the SP-B in the respiratory system group is significantly lower than the other group. The non-concordance rate of neonatal clinical diagnosis and pathological diagnosis is 44. 2% and among it the respiratory system disease misdiagnosed is 65.2%.Conclusion:①In mother factors,the normal productive age,the term delivery is the characteristic,the death rate in the selective cesarean is higher than it in the vaginal delivery and acute cesarean.②There is the characteristic of male newborn, the early neonate periond, higher Apgar score and the non-specific clinal feature, the concordance of the clinical and pathological diagnosis is lower.The body weight, lung weight and the ratio of the lung weight to body weight are more significant indexes.The distribution of the lung pathology is mainly diffusal, then the right lung and the lower lobe. the cuticular epithelium in lung alveoli is associated in the the neonatal death cuase. The adrenal hemorrhage is the most common complication.So the ratio of the lung weight to the body weight is used of the appreciation to the the development and the severity of the lung. And pay attention to examine the evrery lobe of the lung.③The disease of the placenta and the umbilical cord is the main death cause of the stillbirth, so the doctor should retain the placenta to be carried.④The result of the hydrostatic test of lung is directively associated with the pathological changes of the lung. The pulmonary interstitial emphysema is valuable in the identification of the stillbirth and livebirth.⑤The pulmonary surfactant is lower in the respiratory system disease, so it isexpected to be the adjunctive means.