Also called Respiratory Distress Syndrome (RDS), Hyaline membrane disease (HMD) is one of the most common problems in premature babies that cause them to require more oxygen to help in breathing. This problem occurs when the lungs do not have enough surfactant. Surfactant consists of phospholipids and protein . Production of this commences in the amniotic fluid, after 24-28 weeks of pregnancy and this is usually available after 35 weeks of gestation.
This condition worsens in the first 48-72 hours post premature delivery and improves with treatment and almost 90 percent of babies with HMD survive.
Symptoms vary from baby to baby and they usually peak by the third day and begin to self-correct once the baby starts excreting excess water in the form of urine and requires less oxygen and ventilator support to breathe. Some of the commons HMD symptoms are:
- Difficulty in breathing that progressively deteriorates
- Blue coloring of the skin also called cyanosis
- Flaring of nostrils
- Rapid breathing also called tachypnea
- Producing grunting sound when breathing
- Chest retractions which is pulling in at the ribs and sternum during inhalation
Almost 60-80 percent of premature born babies at 28 weeks gestation have the HMD condition. About 25 percent of premature born babies at 30 weeks and about 15-30 percent of those born between 32-36 weeks may have this condition.
While being born premature is the highest risk for HMD, the other factors that predispose into developing this condition are:
- Caucasian or male babies
- Previous delivery history with HMD
- C-section delivery
- Peri-natal asphyxia or lack of air/oxygen before, during or after birth
- Cold stress which is a condition that does not encourage surfactant production
- Peri-natal infection
- Multiple births which are often premature
- Infants of maternal diabetes, in which case too much of insulin in a baby's system can delay surfactant production
- Babies with Patent Ductus Arteriosus which is a congenital heart condition
The extent of HMD in terms of severity, presence of infection or potential risk of heart condition depends on the gestational age and size of the newborn. A combination of the following assessments is how HMD is diagnosed:
- Appearance, color of the skin and breathing efforts indicate the baby's need for oxygen or breathing support
- X-ray of lungs that should reveal a ground glass formation called a reticulogranular pattern
- Blood gases or tests for oxygen, carbon dioxide and acid in arterial blood which should reveal lowered amounts of oxygen and more carbon dioxide
- Echocardiography (EKG) to rule out any heart problems
The usual line of treatment for HMD include the following:
- Placing a breathing tube called Endotracheal Tube( ET) into the newborn's windpipe.
- Mechanical breathing machine like CPAP or Continuous Positive Airway Pressure to do the process of breathing for the newborn
- Supply extra amount of oxygen
- Surfactant replacement with artificial surfactant in the first 6 hours of birth as a rescue method to reduce the severity of HMD
- Medications to help sedate and ease the newborn's pain during treatment