HYALINE MEMBRANE DISEASE, RESPIRATORY DISTRESS, AND SURFACTANT DEFICIENCY

Clinical observations and measurements of arterial blood gas tensions and pH were made in 55 infants surviving for more than 4 hours but dying in the newborn period. After death the pressure-volume characteristics of the lung were investigated and correlated with the estimation of pulmonary surfactant and the histological appearance of the lung. Infants dying with deficiency of pulmonary surfactant always had clinical respiratory distress, unless they were unable to make spontaneous respiratory efforts on which an assessment could be based, and hyaline membranes, dilatation of alveolar ducts, and atelectasis were always present in the lungs. Calculated right-to-left shunts were no greater at 4 hours of age in infants dying from hyaline membrane disease than in infants who died from other causes. Clinical respiratory distress was associated with a variety of conditions, and terminology is discussed. Normal pulmonary surface activity was found in infants who had hyaline membrane formation due to massive pulmonary hemorrhage or hydrops fetalis. Pulmonary surfactant was present in functionally significant amounts by the twenty-fourth week of gestation in infants dying from illnesses other than hyaline membrane disease and increased in amount as term was approached. It is concluded that the state at birth of the mechanism responsible for the production of pulmonary surfactant is the crucial factor determining the development of hyaline membrane disease, and that this illness arises because the synthetic mechanism is so immature that it cannot supply the demand for surfactant or because it has been damaged by prenatal or intrapartum asphyxia, or because of the interaction of these two influences.

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Furosemide in Hyaline Membrane Disease

PEDIATRICS ◽

10.1542/peds.62.5.785 ◽

1978 ◽

Vol 62 (5) ◽

pp. 785-788

Author(s):

Keith H. Marks ◽

William Berman ◽

Zvi Friedman ◽

Victor Whitman ◽

Cheryl Lee ◽

...

Keyword(s):

Interstitial Fluid ◽

Hyaline Membrane Disease ◽

Skinfold Thickness ◽

Acute Stage ◽

Control Group ◽

Arterial Blood Gas ◽

Cardiorespiratory Function ◽

Arterial Blood ◽

Significant Difference ◽

Hyaline Membrane

In a randomized clinical trial designed to evaluate the effect of diuresis on infants with hyaline membrane disease, seven infants were treated with furosemide (2 mg/kg intravenously) and five received 5% dextrose water in 0.225% sodium chloride (control group). Arterial blood gas analyses performed before and during the six hours after treatment showed no significant difference between control and treated infants. Urine output and urine sodium and calcium loss were significantly increased (P < .05) in the infants receiving furosemide. The diuresis seemed to have no effect on left atrial size determined echocardiographically, whereas measurements of dynamic skinfold thickness suggested mobilization of subcutaneous water. One infant became seriously dehydrated and hypotensive secondary to a massive diuresis. We concluded that furosemide had a potent diuretic effect in infants with hyaline membrane disease but does not improve cardiorespiratory function acutely. This may be because of failure to mobilize pulmonary interstitial fluid in the time period tested. It may also be possible that the presence of pulmonary interstitial fluid does not play an important role in the impairment of gas exchange in the acute stage of hyaline membrane disease.

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EOSINOPHILS IN THE THYMUS IN HYALINE MEMBRANE DISEASE (RESPIRATORY DISTRESS SYNDROME)

PEDIATRICS ◽

10.1542/peds.24.2.205 ◽

1959 ◽

Vol 24 (2) ◽

pp. 205-214

Author(s):

Maurice M. Black ◽

Aldo G. Baldi

Keyword(s):

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Perinatal Death ◽

Hyaline Membrane Disease ◽

Axillary Lymph Nodes ◽

Control Group ◽

Axillary Lymph ◽

Hyaline Membrane ◽

Made In

An examination was made of the prominence of perivascular aggregates of eosinophilic leukocytes in thymic septa of cases of respiratory distress syndrome (hyaline membrane disease). Similar examinations were also made in cases of stillbirth and perinatal death unassociated with hyaline membrane disease. Moderate or marked thymic eosinophilia was found in more than 70% of 27 cases of hyaline membrane disease. This degree of eosinophilia was encountered in less than 10% of the control group. Numerous eosinophils were also found in the axillary lymph nodes of four of eight cases of hyaline membrane disease, but in only 2 of 20 control cases. The data are considered in terms of their relationship to adrenocorticoid levels in the fetus and the pathogenesis of hyaline membrane disease.

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Neonatal outcome in new-borns admitted in NICU of tertiary care hospital in central India: a 5-year study

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20182512 ◽

2018 ◽

Vol 5 (4) ◽

pp. 1364 ◽

Cited By ~ 3

Author(s):

Jyotsna Verma ◽

Shweta Anand ◽

Nawal Kapoor ◽

Sharad Gedam ◽

Umesh Patel

Keyword(s):

Intensive Care ◽

Birth Weight ◽

Low Birth Weight ◽

Respiratory Distress ◽

Neonatal Mortality ◽

Distress Syndrome ◽

Perinatal Asphyxia ◽

Hyaline Membrane Disease ◽

Low Birth Weight Babies ◽

Hyaline Membrane

Background: Neonatal mortality rate contributes significantly to under five mortality rates. Data obtained from pattern of admission and outcome may uncover various aspects and may contribute and help in managing resources, infrastructure, skilled hands for better outcome in future.Methods: This retrospective study was done on 1424 neonates who were admitted at LN Medical College and JK Hospital, Bhopal in neonatal intensive care unit (NICU) in the Department of Paediatrics from January 2013-December 2017.Results: 1424 newborns admitted within 24 hours of birth were included in the study. About 767 were male neonates, (Male: female1.16:1). The low birth weight babies were 54% in our study. Among the various causes of NICU admission, Respiratory distress was present in 555 (39%) of neonates, Respiratory distress syndrome (Hyaline membrane disease) being the most common cause of respiratory distress. Neonatal sepsis accounted for morbidity in 24% of neonates, with Klebsiella being the most common organism grown in the blood culture. The incidence of congenital anomalies was 2.5%. The neonatal mortality was found to be 11% in our study. Prematurity with Respiratory distress syndrome (Hyaline membrane disease) and perinatal asphyxia were the two most common causes of neonatal mortality in the study. Extremely low birth weight neonates had the highest case fatality rate in the study, which indicates the need to develop an efficient group of professionals in teaching hospitals who will provide highly specialized and focused care to this cohort of vulnerable neonates.Conclusions: Present study has shown respiratory distress, perinatal asphyxia, and sepsis as the predominant causes of neonatal morbidity. All three are preventable causes, and our health-care programs should be directed toward addressing the risk factors in the community responsible for the development of these three morbidities. The preterm and low birth weight babies had significantly high mortality even with standard intensive care; therefore, a strong and effective antenatal program with extensive coverage of all pregnant females specifically in outreach areas should be developed which will help in decreasing preterm deliveries and also lower the incidence of low birth weight babies.

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STUDIES ON HYALINE MEMBRANE DISEASE

PEDIATRICS ◽

10.1542/peds.32.1.10 ◽

1963 ◽

Vol 32 (1) ◽

pp. 10-24

Author(s):

Clara M. Ambrus ◽

David H. Weintraub ◽

Donal Dunphy ◽

John E. Dowd ◽

John W. Pickren ◽

...

Keyword(s):

Placebo Group ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Plasminogen Activator ◽

Premature Infants ◽

Distress Syndrome ◽

Hyaline Membrane Disease ◽

Blood Coagulation Factors ◽

Plasminogen Activator Activity ◽

Hyaline Membrane

In the serum of normal prematures and premature infants with respiratory distress syndrome, plasminogen was absent. In mature newborns plasminogen levels were low, as compared to adults. In the euglobulin fraction of plasma, plasminogen level was highest in mature newborns, lower in healthy prematures, and lowest in prematures with respiratory distress syndrome. Antiplasmin level was exceptionally high in about a fourth of the premature infants with or without respiratory distress syndrome. Plasminogen activator activity was found more often in the blood of infants with respiratory distress syndrome than in normal infants. This may be due to the liberation of tissue activators as a consequence of hypoxia. Because of the absence of the substrate (plasminogen), this activator level may have no significance. Tissue activator activity was found in the lungs of premature infants whether they died of hyaline membrane disease or from other causes. Forty-five infants with respiratory distress were treated in a therapeutic study. Twelve were treated in a preliminary series and 33 in a randomizd, double-blind investigation. Of the latter, 11 were treated with placebo, and 5 (45%) survived; 8 were treated with streptokinase activated human plasmin and 2 (25%) survived; 14 were treated with urokinase activated human plasmin and 12 (86%) survived. Among the infants who died, no definite hyaline membrane disease was found by histopathologic examination in two of the placebo group, one in the streptokinase-plasmin treated group, and the two who died in the urokinase-plasmin group. No significant side-effects of plasmin therapy were seen. Although considerable fibrinolytic and plasminogen-activator activity was generated in many treated patients, there was no significant fall in blood coagulation factors. Intracerebral hemorrhage, which appears to occur often in patients who die with hyaline membrane disease, was not more frequent in the plasmintreated group than in the placebo group.

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Colorless Babies Mature Late

PEDIATRICS ◽

10.1542/peds.66.1.157a ◽

1980 ◽

Vol 66 (1) ◽

pp. 157-157

Author(s):

Howard B. Harris

Keyword(s):

Lower Incidence ◽

Chronic Pulmonary Insufficiency of Prematurity (CPIP)

PEDIATRICS ◽

10.1542/peds.55.1.55 ◽

1975 ◽

Vol 55 (1) ◽

pp. 55-58

Author(s):

Alfred N. Krauss ◽

David B. Klain ◽

Peter A. M. Auld

Keyword(s):

Mortality Rate ◽

Respiratory Distress ◽

Premature Infants ◽

Hyaline Membrane Disease ◽

Supplemental Oxygen ◽

Pulmonary Insufficiency ◽

Radiologic Findings ◽

Sense Of Security ◽

Hyaline Membrane ◽

False Sense

This report describes a syndrome of delayed respiratory distress occurring in premature infants usually under 1,250 gm at birth. Unlike hyaline membrane disease, this syndrome occurs after four to seven days in a previously healthy infant; also unlike hyaline membrane disease, it persists for two to four weeks. Chronic pulmonary insufficiency of prematurity (CPIP) carries a 10% to 20% mortality rate. The infants are frequently apneic, require supplemental oxygen, but lack the radiologic findings of hyaline membrane disease or bronchopulmonary dysplasia. When compared with nondistressed infants of similar birthweight, infants with CPIP demonstrate slowly progressive atelectasis, hypoxemia, and hypercapnia. Recovery is usually complete by 60 days of age. The importance of CPIP is that an awareness of its existence can eliminate a false sense of security, often communicated to anxious parents, during the four-to-seven-day grace period before its appearance is clinically obvious. The physiologic similarities between CPIP and hyaline membrane disease suggest that lack of surfactant may play a role in the pathogenesis of CPIP.

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The Magnitude and Risk Factors of Acute Respiratory Distress Syndrome among Newborn Admitted To Neonatal Intensive Care Unit at Benghazi Medical Center

Asian Journal of Medicine and Health ◽

10.9734/ajmah/2021/v19i1230416 ◽

2021 ◽

pp. 41-61

Author(s):

Munera Awad Radwan ◽

Najia Abdelati El-Mansori ◽

Mufeda Ali Elfergani ◽

Mohanad Abdulhadi Lawgali

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Birth Weight ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Medical Center ◽

Female Gender ◽

Hyaline Membrane Disease ◽

Hyaline Membrane

Background: Hyaline Membrane Disease (HMD)/Respiratory Distress Syndrome (RDS) is the most common lung condition affecting premature babies. The inadequate amount of surfactant causes alveoli to collapse when the baby breathes out. It is hard for your baby to re-inflate the collapsed alveoli when he breathes. The lack of surfactant and resulting inflammation is called. Hyaline Membrane Disease (HMD)/Respiratory Distress Syndrome (RDS). Aim of the Study: To determine the magnitude of Hyaline membrane disease or respiratory distress syndrome and identify the risk factors and complication among newborn babies in neonatal intensive care unit at Benghazi medical center (BMC). Materials and Methods: Case series study. The study was conducted during the period between March 2017 to March 2018 of HMD cases at Benghazi medical center. A convenient sample of 120 cases diagnosed as HMD. Studied variables include the following; gestational age, birth weight, gender, type of pregnancy and type of delivery also the data for mothers such as (diabetes mellitus, preeclampsia hypothyroidism, receiving of Dexamethasone injection and premature rupture of membrane). Also investigation and treatment and finally the outcomes of babies. Statistical Methods: Data were analyzed with SPSS version 17, analysis of associations was made with application Chi - square test for categorical variables comparison, was applied for test of association P <0.25. P was considered statistically significant if ≤ 0.05. Results: Female gender was predominant (52%). Most of cases of HMD were between 1000 -2000 kg. Among the 120 cases we have (15%) sever HMD and the majority of cases have moderate –to sever Hyaline membrane disease 39 (32.5%) whereas very sever HMD were observed in nearly 27% of cases. The risk factors were history of maternal preeclampsia, maternal diabetes mellitus, prematurity and low birth weight babies and neonatal sepsis, all these were found to be very common risk factors of HMD. Pearson chi-square test p value highly significant of female gender with complications of HMD. Our results observed more than half of babies were died. Conclusion: The risk factors were history of maternal preeclampsia, maternal diabetes mellitus, prematurity and low birth weight babies and neonatal sepsis all these were found to be very common risk factors of HMD. Also we concluded that the cases had premature rupture of membrane, which identified as risk factors of hyaline membrane disease. Furthermore, we concluded that highly significant of female gender with complications of HMD, such as Pneumothorax, bronco pulmonary, dysplasia, intra ventricular hemorrhage and congenital heart diseases were common co- morbidities with respiratory distress syndrome, all these could be have an association with the development of hyaline membrane disease, finally we observed more than half of babies were died this is a warning sign for health services.

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