Hyaline Membrane Disease (HMD) or as known in common terms Respiratory Distress Syndrome (RDS) or Surfactant Deficiency Disorder is one of the most common problems that arise in premature infants or new-borns owing to the need of more oxygen to breathe.
The term Hyaline comes from the Greek word ‘hyalos’ which means glasslike or transparent and hence the syndrome has this name since the membrane surrounding the lungs become glassy or transparent due to the accumulation of dead cells and proteins.
Respiratory Distress Syndrome generally occurs when the lungs do not have enough surfactant. The surfactant is a liquid-like layer that generally consists of phospholipids and lipoproteins. It is produced by the lungs and keeps the alveoli’s open while helping in proper gaseous exchange of oxygen and carbon dioxide. The baby starts to make this surfactant fluid within the mother’s womb at about 26 weeks of pregnancy. In situations, when the baby has a premature birth, there isn’t much of this surfactant fluid to aid in the respiration process which causes the tiny alveoli to collapse with each breath making it difficult for the baby to breathe.
The collapsed alveoli cause the accumulation of damaged cells within the air ducts making the baby work harder to inflate the lungs to breathe. With the worsening of the lung function, the oxygen reaching the lungs reduce, which leads to an increase of carbon dioxide levels in the blood causing acidosis. If left untreated, it can lead to fatal problems causing chronic lung disease i.e. bronchopulmonary dysplasia or chest infection. Also Read: Chest Infection: Causes, Symptoms And Treatment
Hyaline Membrane Disease is often noted in babies who are a premie i.e. taken birth before the 28th week of pregnancy. It is also sometimes noticed, if the child has a twin with a respiratory disorder, if the child was delivered through a C-section, if the baby is suffering from perinatal asphyxia, if the baby has contracted some kind of infection or have cold stress, if the baby is suffering from reduced blood flow during delivery, if the baby is suffering from a condition called patent ductus arteriosus or if the mother is suffering from gestational diabetes. It is also seen in the case of multiple pregnancies (i.e. twins or triplets) or rapid labor.
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The usual signs and symptoms vary from baby to baby and usually develops within the first 24 hours of birth. The common symptoms include:
- Bluish tint of the skin
- Rapid or shallow breathing
- Fast heart rate as in the case of heart rhythm disorders
- Flaring of nostrils
- Grunting sound while breathing
- Reduced urine output
- Chest retractions or pulling in of ribs and breastbone when the baby breathes
Diagnosis and Treatment
The severity of the disease or to what extent the infection has spread that can cause a problem in breathing and lead to some heart condition usually depends upon the gestational age of the baby. The infection is often diagnosed by assessing in the following way which includes:
- Check the colour of the skin and breathing pattern of the baby
- Echocardiography to check for any heart problems
- X-ray of the lungs to check the formation of glasslike layer called a reticulogranular pattern
- Blood gas tests to reveal the level of oxygen, carbon dioxide and acid in arterial blood
Knowing the severity of the infection, the doctor may suggest for either of the following treatment options:
- Ventilation support for the baby.
- Placing a breathing tube into the baby’s windpipe or trachea.
- Oxygen supplementation. Also Read: Oxygen Therapy Prevents Respiratory Failure
- Replacing the surfactant is very helpful for babies at a high risk of RDS.
- Breathing on machine support helps in the continuous flow of oxygen through the alveoli.
- Prescribe medications to ease the pain and calm the baby.