Respiratory distress syndrome of the preterm neonate — placenta and necropsy as witnesses

AIM: To assess the agreement between clinical diagnosis of hyaline membrane disease (HMD) and lung necropsy pathological findings of deceased neonates. MATERIAL AND METHODS: Review of clinical files and necropsy studies of 40 newborn infants ≤ 37 weeks gestational age. RESULTS: The concordance between clinics and necropsy for the diagnosis of HMD was 43% (n = 17). At the necropsy study of the lungs, 11 cases (28%) of clinically diagnosed HMD were associated to meconium aspiration, pneumonia, or pulmonary hemorrhage; 12 (30%) cases were pneumonia and/or meconium aspiration and pulmonary hemorrhage without hyaline membranes. Of the 17 pneumonias, 15 (88%) were associated to histological chorioamnionitis, RR 3.76 (95%CI: 1.9-4.2) (p < 0.001). CONCLUSIONS: The clinical diagnosis of HMD needs a cautious interpretation, as it may be mistaken, or HMD may occur in association with other pathological situations enhancing a more ominous prognosis.