Perinatal cardiac failure from the eyes of the pathologist

Abstract

Cardiac abnormalities in neonates are often underdiagnosed and require an high index of suspicion by the perinatal pathologist. Perinatal conditions, such as preterm birth, infection and asphyxia can affect newborn health and disease, and in particular may cause relevant pathological changes in the cardiovascular system. On the basis of our experience on the histological study of the neonatal heart, endothelial damage represents a diffuse pathological feature in the myocardial vessels of newborns subjected to perinatal hypoxia. Endothelial cell swelling, apoptosis, detachment and microthrombosis are the most frequent lesions observed in the neonatal heart. In cases of severe vascular changes associated with disseminated intravascular coagulation (DIC), cardiomyocyte apoptosis and coagulative necrosis represent the histological marker of cardiac pathology in the neonatal heart. A new and very sensitive early tool to identify cardiac changes in perinatal period is represented by immunoreactivity of cardiac cells for S100B protein. Immunostaining for S100B protein in the neonatal heart might indicate an early protective reaction of cardiomyocytes in newborns subjected to asphyxia, clearly indicating a chronic or sub-acute evolution of the clinical picture, and contrasting with the hypothesis of a sudden death. In conclusions, our data shows that the perinatal pathologist represents a pivotal figure in the early study and detection of cardiac changes in all neonates, particularly in newborns undergoing asphyxia in the perinatal period.   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 Eyke