Hyaline Membrane Disease

Respiratory Distress Syndrome (of the Newborn)
 

• Acute pulmonary disorder of the newborn characterized by

  • Generalized atelectasis

  • Intrapulmonary shunting

  • Ventilation-perfusion abnormalities

  • Reduced lung compliance

• M:F =1.8:1

• Cause

  • Immature surfactant production (usually begins at 18-20 weeks of gestational age)

    • Causes acinar atelectasis

• Predispositions

  • Premature infants

  • Cesarean section

  • Infants of diabetic mothers

  • Perinatal asphyxia

• Clinical findings

  • Onset

    • Usually less than 2-5 hours after birth

    • Increases in severity from 24 to 48 hours

    • Then, gradual improvement after 48-72 hours

  • Abnormal retraction of chest wall

  • Cyanosis

  • Expiratory grunting

  • Increased respiratory rate

• Imaging findings

  • Typically, diffuse “ground-glass” opacification of both lungs with air bronchograms and hypoaeration

  • Hypoaeration from loss of lung volume (may be counteracted by respiratory therapy)

  • Fine granular pattern

  • Prominent air bronchograms

  • Bilateral and symmetrical distribution

• Prognosis

  • Spontaneous clearing within 7-10 days (mild course in untreated survivors)

  • Death in 18%

• Acute complications

  • Barotrauma may produce

    • Parenchymal pseudocyst

    • Pulmonary interstitial emphysema

      • Pseudoclearing

        • Lungs appear less because of innumerable small pockets of air in the peribronchial interstitial spaces

    • Pneumomediastinum

    • Pneumothorax

Diffuse ground-glass appearance to both lungs with a left-sided
tension pneumothorax and pneumomediastinum
(orogastric tube is in distal esophagus)

• Pneumopericardium

• Pneumoperitoneum

• Air in the retroperitoneum

• Subcutaneous emphysema

• Diffuse opacity

  • Worsening RDS

  • Superimposed pneumonia

  • Massive aspiration

  • Pulmonary hemorrhage

  • Congestive heart failure (from PDA or fluid overload)

    • Persistent patency of ductus arteriosus

      • Oxygen stimulus is missing to close duct

• Hemorrhage

  • Pulmonary hemorrhage

  • Intracranial hemorrhage

• Necrotizing enterocolitis

• Acute renal failure

• Chronic complications

  • Lobar emphysema

  • Localized interstitial emphysema

  • Recurrent inspiratory tract infections

  • Retrolental fibroplasia

  • Subglottic stenosis from intubation

• Treatment

  • Supportive

  • Exogenous surfactant via trachea

  

Dahnert 4^th edition