Pulmonary Pathology in Perinatal and Neonatal Autopsies

Authors

  • Mohasin Jakirhusain Halgale Department of Pathology, R.C.S.M. Government Medical College, Kolhapur, Maharashtra, India
  • Sapna Shreyas Deshpande Department of Pathology, D.Y. Patil Medical College, Kolhapur, Maharashtra, India
  • Varad Manoj Agarwal Department of Pathology, D.Y. Patil Medical College, Kolhapur, Maharashtra, India

DOI:

https://doi.org/10.21276/apalm.3912

Keywords:

infant, newborn, perinatal mortality, autopsy, lung diseases

Abstract

Background Neonatal mortality accounts for nearly half of under-five deaths globally, with pulmonary disorders being a leading cause. Clinical diagnoses are often limited, making autopsy essential for accurate cause-of-death determination and clinicopathological correlation.

Methods This retrospective and prospective observational study was conducted at a tertiary care center from January 2020 to June 2025. A total of 102 perinatal and neonatal autopsies were analyzed (43 retrospective, 59 prospective). Clinical, maternal, and obstetric data were reviewed. Detailed autopsies with emphasis on pulmonary pathology were performed. Lung tissues were processed and examined histologically using hematoxylin and eosin staining, with special stains where required.

Results Pulmonary pathology was the primary cause of death in 96.07% of cases and a contributing factor in 3.93%. Pneumonia was the most common lesion (56.87%), followed by respiratory distress syndrome (16.67%), meconium aspiration syndrome (13.72%), pulmonary hemorrhage (8.82%), pulmonary hypoplasia (1.96%), and congenital pulmonary airway malformation (1.96%). Pulmonary lesions accounted for 100% of deaths in full-term and post-term neonates and 88.89% in preterm neonates. Maternal complications were present in 36.27% of cases. Autopsy findings frequently revealed diagnoses not identified clinically.

Conclusion Pulmonary disorders are the leading cause of perinatal and neonatal deaths. Autopsy remains indispensable for accurate diagnosis, identifying unsuspected conditions, and improving clinical care and public health strategies, particularly in resource-limited settings.

References

1. UNICEF Data. Neonatal mortality. Updated March 2025. https://data.unicef.org

2. WHO GHO. Child mortality and causes of death. Geneva: World Health Organization; 2023.

3. Sweet DG, Carnielli VP, Greisen G, Hallman M, Klebermass-Schrehof K, Ozek E, Te Pas A, Plavka R, Roehr CC, Saugstad OD, Simeoni U. European consensus guidelines on the management of respiratory distress syndrome: 2022 update. Neonatology. 2023 Mar 7;120(1):3-23.

4. Bhandari V, Black R, Gandhi B, Hogue S, Kakkilaya V, Mikhael M, Moya F, Pezzano C, Read P, Roberts KD, Ryan RM. RDS-NExT workshop: consensus statements for the use of surfactant in preterm neonates with RDS. Journal of Perinatology. 2023 Aug;43(8):982-90.

5. Dini G, Ceccarelli S, Celi F, Semeraro CM, Gorello P, Verrotti A. Meconium aspiration syndrome: from pathophysiology to treatment. Ann Med Surg (Lond). 2024 Feb 15;86(4):2023-2031.

6. Suhren JT, Hussein K, Kreipe H, Schaumann N. Comparison of Clinical Diagnosis and Autopsy Findings of Early Neonatal Deaths: Diagnostic Challenges and the Value of Autopsy in Identifying Rare Pathologies. Pediatr Dev Pathol. 2025 Jan-Feb;28(1):38-45.

7. Leulseged H, A Rees C, Alemu A, A Tippett Barr B, Dheresa M, Madrid L, Scott A, Assefa N. The discrepancy of antemortem clinical diagnosis and postmortem autopsy diagnosis of lung pathologies in under-five deaths and the reasons for discrepancies: a case series analysis. BMC Pediatr. 2024 May 28;24(1):365.

8. Fan HC, Chen CM. Meconium aspiration syndrome: An overview of the literature. Tungs' Medical Journal. 2024 Jan 1;18(1):4-11.

9. Sreenivas A, Lewis L, Prakash PY, Purkayastha J, Vani Lakshmi R, Mathew M. Comparative agreement of clinical diagnoses and neonatal autopsy findings in a tertiary care center. J Matern Fetal Neonatal Med. 2025;38(1):2554711.

10. Ingale SR, Bhatia VO, Tatya HS, Kulkarni KK. Spectrum of pathology in neonatal deaths: an autopsy study. Indian J Forensic Med Pathol. 2024 June 24;17(2):125-128.

11. Kalra V, Singh M. A comparative analysis of 125 neonatal autopsies. The Indian Journal of Pediatrics. 1979 Jan;46(1):36-41.

12. Nakamura Y, Hosokawa Y, Yano H, Nakashima N, Nakashima T, Komatsu Y, Nakashima H, Fukuda S, Kuyama M, Hashimoto T, Nagasue N, Aiko Y, Kabashima S. Primary causes of perinatal death. An autopsy study of 1000 cases in Japanese infants. Hum Pathol. 1982 Jan;13(1):54-61.

13. Sarna MS, Saili A, Dutta AK, Kumari S. Neonatal mortality patterns in an urban hospital. Indian Pediatr. 1991 Jul;28(7):719-24.

14. Rajashekar S, Bhat BV, Veliath AJ, Ratnakar C. Perinatal autopsy—a seven-year study. The Indian Journal of Pediatrics. 1996 Jul;63(4):511-6.

15. Ravikumara M, Bhat BV. Early neonatal mortality in an intramural birth cohort at a tertiary care hospital. Indian J Pediatr. 1996 Nov-Dec;63(6):785-9.

16. Kamath BD, MacGuire ER, McClure EM, Goldenberg RL, Jobe AH. Neonatal mortality from respiratory distress syndrome: lessons for low-resource countries. Pediatrics. 2011 Jun 1;127(6):1139-46.

Downloads

Published

25-08-2026

Issue

Section

Original Article

How to Cite

1.
Pulmonary Pathology in Perinatal and Neonatal Autopsies. Ann of Pathol and Lab Med [Internet]. 2026 Aug. 25 [cited 2026 Aug. 26];13(8):A373-A378. Available from: https://pacificejournals.com/journal/index.php/apalm/article/view/3912