Roentgenological and autopsy studies on the gas content of the lungs and gastro-intestinal tract in living and stillborn infants, and sources of error in resuscitation.

Abstract

The postnatal flow of the air column in the gastro-intestinal tract of full-term infants, prematures, and of infants born alive but dying subsequently, has been studied with special reference to the determination for forensic purposes of the lifetime. The propulsion of gas along the G-I-tract was found to proceed at the same speed in the full-terms and prematures, in the ventricle within 5–15 min, in the intestine within 1–2 hours, in the colon within 5–6 hours and in the rectum within 12 hours. The movement of the gas column was much slower in those infants, who died some hours after birth. Furthermore, the effect of artificial respiration with a mask on the gas content of the G-I-tract of stillborn infants was investigated both roentgenologically and in autopsies with floating tests and microscopy. It became evident that during the course of resuscitation, appreciable amounts of air can be introduced into the lungs, ventricle, and even into the intestine. The air was detectable in the X-ray photographs and in the autopsies with the floating tests. Consequently the blowing method of artificial respiration introduces an obvious source of error into the interpretation of macroscopic autopsy findings. The histological examination proved to be most reliable, since artificial respiration did not open the alveoles. It may have induced the development of large bullas, resembling distended putrefaction bullas. The foetal lungs, and foetal asphyctic lungs with bullas, could be differentiated from the aerated lungs of infants who had been alive for at least 17 min.