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.