Hyaline Membrane Disease - Respiratory Distress Syndrome

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Syndrome What is hyaline membrane disease? Hyaline membrane disease (HMD), also called respiratory distress

syndrome (RDS), is one of the most common problems of prematurebabies. It can cause babies to need extra oxygen and help breathing.

The course of illness with hyaline membrane disease depends on thesize and gestational age of the baby, the severity of the disease,the presence of infection, whether or not a baby has a patent ductus

arteriosus (a heart condition), and whether or not the baby needsmechanical help to breathe. HMD typically worsens over the first 48to 72 hours, then improves with treatment.

What causes HMD? HMD occurs when there is not enough of a substance in the lungscalled surfactant. Surfactant is made by the cells in the airwaysand consists of phospholipids and protein. It begins to be producedin the fetus at about 24 to 28 weeks of pregnancy. Surfactant isfound in amniotic fluid between 28 and 32 weeks. By about 35 weeksgestation, most babies have developed adequate amounts of

surfactant. Surfactant is normally released into the lung tissues where it helps


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lower surface tension in the airways. This helps keep the lungalveoli (air sacs) open. When there is not enough surfactant, thetiny alveoli collapse with each breath. As the alveoli collapse,damaged cells collect in the airways and further affect breathingability. These cells are called hyaline membranes. The baby worksharder and harder at breathing, trying to re-inflate the collapsedairways.

As the baby's lung function decreases, less oxygen is taken in andmore carbon dioxide builds up in the blood. This can lead toincreased acid in the blood called acidosis, a condition that canaffect other body organs. Without treatment, the baby becomesexhausted trying to breathe and eventually gives up. A mechanicalventilator (breathing machine) must do the work of breathing

instead. Who is affected by HMD? HMD occurs in over half of babies born before 28 weeks gestation,

but only in less than one-third of those born between 32 and 36weeks. Some premature babies develop HMD severe enough to need amechanical ventilator (breathing machine). The more premature thebaby, the higher the risk and the more severe the HMD.

Although most babies with HMD are premature, other factors caninfluence the chances of developing the disease. These include thefollowing:

Caucasian or male babies

previous birth of baby with HMD

cesarean delivery

perinatal asphyxia

cold stress (a condition that suppresses surfactant production)

perinatal infection

multiple births (multiple birth babies are often premature)

infants of diabetic mothers (too much insulin in a baby's systemdue to maternal diabetes can delay surfactant production)

babies with patent ductus arteriosus

What are the symptoms of HMD? The following are the most common symptoms of HMD. However, eachbaby may experience symptoms differently. Symptoms may include:

respiratory difficulty at birth that gets progressively worse

cyanosis (blue coloring)

flaring of the nostrils


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tachypnea (rapid breathing)

grunting sounds with breathing

chest retractions (pulling in at the ribs and sternum duringbreathing)

The symptoms of HMD usually peak by the third day, and may resolvequickly when the baby begins to diurese (excrete excess water inurine) and begins to need less oxygen and mechanical help to

breathe. The symptoms of HMD may resemble other conditions or medical

problems. Always consult your baby's physician for a diagnosis. How is HMD diagnosed? HMD is usually diagnosed by a combination of assessments, including

the following: appearance, color, and breathing efforts (indicate a baby's need

for oxygen).

chest x-rays of lungs - often show a unique "ground glass"appearance called a reticulogranular pattern. X-rays areelectromagnetic energy used to produce images of bones andinternal organs onto film.

blood gases (tests for oxygen, carbon dioxide and acid in arterial

blood) - often show lowered amounts of oxygen and increased carbon

dioxide.

echocardiography (EKG) - sometimes used to rule out heart problemsthat might cause symptoms similar to HMD. An electrocardiogram isa test that records the electrical activity of the heart, showsabnormal rhythms (arrhythmias or dysrhythmias), and detects heartmuscle damage.

Treatment for HMD: Specific treatment for HMD will be determined by your baby's

physician based on: your baby's gestational age, overall health, and medical history

extent of the conditionyour baby's tolerance for specific medications, procedures, ortherapies

expectations for the course of the conditionyour opinion or preferenceTreatment for HMD may include:

placing an endotracheal (ET) tube into the baby's windpipe

mechanical breathing machine (to do the work of breathing for thebaby)


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supplemental oxygen (extra amounts of oxygen)

continuous positive airway pressure (CPAP) - a mechanicalbreathing machine that pushes a continuous flow of air or oxygento the airways to help keep tiny air passages in the lungs open

surfactant replacement with artificial surfactant - most effective

if started in the first six hours of birth. Surfactant replacement

has been shown to reduce the severity of HMD. Surfactant is givenas prophylactic (preventive) treatment for some babies at veryhigh risk for HMD. For others it is used as a "rescue" method. The

drug comes as a powder to be mixed with sterile water and then isgiven through the ET tube (breathing tube). Surfactant is usuallygiven in several doses.

medications (to help sedate and ease pain in babies duringtreatment)

Complications of HMD:

Babies with HMD sometimes develop complications of the disease orproblems as side effects of treatment. As with any disease, moresevere cases often have greater risks for complications. Somecomplications associated with HMD include the following:

air leaks of the lung tissues such as:

pneumomediastinum - air leaks into the mediastinum (the space in

the thoracic cavity behind the sternum and between the twopleural sacs containing the lungs).

pneumothorax - air leaks into the space between the chest walland the outer tissues of the lungs.

pneumopericardium - air leaks into the sac surrounding theheart.

pulmonary interstitial emphysema (PIE) - air leaks and becomestrapped between the alveoli, the tiny air sacs of the lungs.

chronic lung disease, sometimes called bronchopulmonary dysplasia

Prevention of HMD: Preventing a preterm birth is the primary means of preventing HMD.When a preterm birth cannot be prevented, giving the mothermedications called corticosteroids before delivery has been shown to

dramatically lower the risk and severity of HMD in the baby. Thesesteroids are often given to women between 24 and 34 weeks gestationwho are at risk of early delivery.

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Hyaline Membrane Disease - Respiratory Distress Syndrome

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