Intraairway Feulgen-positive bodies in hyaline membrane disease of the newborn.

Abstract

In reviewing cases of hyaline membrane disease of the newborn (HMD) we have been struck by the occurrence of dense basophilic bodies within the airways. To further examine this phenomenon we reviewed lung histology from 246 consecutive stillborns and liveborns 24 hours or less of age autopsied at The Johns Hopkins Hospital. Cases with autolysis or major malformations were excluded. We found the basophilic bodies in 61 (71%) of 87 infants with HMD. The material forming the bodies was Feulgen-positive and derived from necrotic respiratory epithelial cells. Pyknotic nuclei were extruded from necrotic cells and fused to form the bodies some of which reached a size of over 50 microns in maximum dimension. Among the 159 cases without HMD, only 13, all of which were among 81 cases of fetal pneumonia, showed small, 2-5 microns in diameter, intraairway Feulgen-positive bodies. The bodies in these cases of fetal pneumonia were derived from disintegrating leukocytes. The study shows that the formation of intraairway Feulgen-positive bodies derived from necrotic epithelial cells is a common finding in infants dying with HMD during the first day of life. The early development and frequent occurrence of the bodies lends support to the idea that respiratory epithelial cell necrosis is the cause of HMD of the newborn.