Hyaline membrane disease (HMD) : Definition, Causes, Risk Factors, Pathophysiology, Signs, Symptoms, Diagnosis, Treatment, Prevention & Prophylaxis
Synonyms: Respiratory Distress Syndrome (RDS), Infant Respiratory Distress Syndrome (IRDS), Neonatal Respiratory Distress Syndrome (NRDS), Respiratory Distress Syndrome of newborn, Increasingly Surfactant Deficiency Disorder (SDD)
Definition
- Respiratory Distress Syndrome (RDS) is common in preterm babies less than 34 weeks of gestation.
What is Respiratory Distress?
Respiratory Distress said to be there if any two out of three are present
- Tachypnea (Respiration rate ≥ 60/min.)
- Chest retractions
- Expiratory grunting
Cause
- Deficiency of surfactant.
Risk Factors
- Prematurity (Most common cause)
Note: Surfactant production begins at 20 weeks of gestation & detected in amniotic fluid at 28 weeks of gestation.
- Birth asphyxia
- Multiple pregnancies
- Coexisting malformation e.g. Diaphragmatic hernia
- Infant of diabetic mother (Fetal hyperinsulinemia reduces surfactant production)
- Ceserean section
Clinical Presentation
Respiratory distress (Tachypnea, Chest retractions, Expiratory grunting) : Onset within 6 hr of birth (Immediately or soon after birth)
↓ Progress
Cyanosis, Shock
Clinical Diagnosis
Chest X-Ray : 5 types
- Low lung volume
- Air bronchogram sign (Linear shadow of air in bronchus)
- Reticulo nodular appearance
- Ground glass appearance
- White out lung (Advanced)
Management
1. CPAP (Continuous Positive Airway Pressure)
- First step in management
- Pressure: 5-10 com of H2O
- Acts by decreasing progressive alveolar collapse ⇒ Open partially collapsed alveoli improves oxygenation
- Can be given prophylactically in all neonates less than 28 weeks irrespective of presence or absence of RDS.
2. Surfactant Administration
- Therapy of choice (Best step)
- Given intratracheally by INSURE technique
- Two doses can be given (12-24 hour apart)
- Side effect: Pulmonary haemorrhage
Type of surfactant used
- Natural (More better): Bovine/Porcine
- Synthetic: Surfaxamine
Note: INSURE technique: Intubate Surfactant Extubate technique
3. Ventilation
4. Synchronized Intermittent Mechanical Ventilation (SIMV)
5. High Frequency Oscillometric Ventilation (HFOV)
6. Extra Corporeal Membrane Oxygenation (ECMO)
Prevention & Prophylaxis
- Maternal Steroid Therapy
IUGR Protects against HMD because of high cortisol levels.
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