• Domenic R Cincotta, Neil J Sebire, Emma Lim, and Mark J Peters.
• Paediatric and Neonatal Intensive Care Unit, Great Ormond Street Hospital for Children, NHS Trust, London, UK.
• Pediatr Crit Care Me. 2007 Jul 1;8(4):378-82.

ObjectiveThe histopathologic pattern of acute fibrinous and organizing pneumonia (AFOP) has been described recently in cases of acute respiratory distress syndrome (ARDS) in adults and differs from the well-recognized pattern of classic diffuse alveolar damage (DAD). The objective of this study was to determine whether similar appearances can be seen in infant ARDS.DesignCase report and retrospective review of infant lung biopsies 1995-2005.SettingPaediatric and neonatal intensive care units in a tertiary referral center.PatientsNone.InterventionsNone.Measurements And Main ResultsA formerly premature infant with ARDS secondary to respiratory syncytial virus pneumonitis had histopathologic features of AFOP on open lung biopsy. Nine infants from 1995 to 2005 had definite histology of DAD or AFOP and fulfilled American-European Consensus Conference criteria for the diagnosis of ARDS. Of these, classic DAD findings were present in seven, whereas two had features of AFOP and DAD. Features suggesting viral infection were identified in five infants.ConclusionsThe histopathologic features of AFOP may be seen in some cases of infant ARDS. The variability in the histopathology of ARDS raises questions as to the pathogenesis and clinical correlates of these different patterns.

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