title: Postmortem CT investigation of air/gas distribution in the lungs and gastrointestinal tracts of newborn infants: a serial case study with regard to still- and live birth.
abstract: Flotation tests on the lungs and gastrointestinal tract to investigate aeration are classic procedures to examine the life of a newborn after birth; however, there are arguments about the reliability. The present study investigated serial forensic autopsy cases of newborn infants without marked decomposition (n=4) with regard to air/gas distribution in the lungs and gastrointestinal tracts by means of postmortem CT (PM-CT) as well as macromorphology and histology, compared with intrauterine and aborted fetuses (n=3). No gas was detected in the lungs or gastrointestinal tracts in all of three intrauterine fetal deaths. Gas was diffusely detected in the lungs of a newborn fatality attributed to smothering after birth; however, two neonatal fatalities had poor lung gas contents due to marked congestion with edema and diffuse atelectasis. In a case of unsuccessful cardiopulmonary resuscitation following possible birth asphyxia, pulmonary aeration was evidently localized on CT morphology, despite a larger amount of bowel gas, and was also uneven in histology, showing a membranous immunostaining pattern of pulmonary surfactant on the intra-alveolar surfaces of expanded alveoli. The combined use of PM-CT is useful to demonstrate air/gas distributions in the lungs and gastrointestinal tract for interpretation of spontaneous breathing after birth in newborn fatalities.
authors.affiliation: Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, 545-8585 Osaka, Japan. michi.leg@med.osaka-cu.ac.jp
authors.forename: Tomomi
authors.initials: T
authors.lastname: Michiue
authors.forename: Takaki
authors.initials: T
authors.lastname: Ishikawa
authors.forename: Osamu
authors.initials: O
authors.lastname: Kawamoto
authors.forename: Nozomi
authors.initials: N
authors.lastname: Sogawa
authors.forename: Shigeki
authors.initials: S
authors.lastname: Oritani
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Maeda
mesh_terms: D037881:Aborted Fetus / Q000473:pathology; D004646:Emphysema / Q000000981:diagnostic imaging*; D049429:Forensic Pathology; D005740:Gases / Q000032:analysis*; D041981:Gastrointestinal Tract / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D007150:Immunohistochemistry; D007231:Infant, Newborn; D050498:Live Birth; D008168:Lung / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology; D009929:Organ Size; D037662:Pulmonary Surfactant-Associated Protein A / Q000378:metabolism; D050497:Stillbirth; D014057:Tomography, X-Ray Computed
chemical_list: D005740:Gases; D037662:Pulmonary Surfactant-Associated Protein A