Modular tools for the analysis of pulmonary histological images: A pilot study on the differential thanatological diagnosis between born alive and stillbirth

The determination of autonomous life signs in neonatal bodies is crucial in forensic practice, given its numerous legal implications. Current techniques, not individually exhaustive, often focus on verifying the occurrence of autonomous respiration, despite potential artifacts from decomposition and/or resuscitation efforts. This preliminary study proposes a novel technique for more accurate differential diagnosis by using modular tools to histologically analyze neonatal lungs. Lung sections, obtained from one fetal intrauterine death, two postnatal deaths due to intrapartum asphyxia, and one neonatal death (control case), were processed using a high-resolution scanner, converting stained histological slides into digital optical microscopy images. Based on their expertise, two forensic pathologists conducted a double-blind image analysis using two different open-source software, thereby marking areas (called "grains") corresponding to the aerated alveoli, and obtaining consistent quantitative parameters. The results, showing significant differences between the cases according to the circumstances of death, aligned with available clinical and thanatological data, thus providing a proof-of-concept. Although based on the operator's expertise, the tested modular tool proved promising for future forensic applications in this specific field. However, it would be worthy of further research to make the results reproducible, of high predictive value in differential thanatodiagnosis, and usable in courtrooms. Moreover, a casuistry extension and an experimental estimation of all factors potentially affecting results are advisable for the full implementation of this novel method in forensic investigations.