College of Health and Medical Science

Department of pediatrics and child health nursing

Course: Pathophysiology

Instructor: Dr. Addisu (MD, Assistant professor of pathology)

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 HYALINE
MEMBRANE
DISEASE(HMD)
Prepared by: Ebisa S.
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 Respiratory distress
syndrome (RDS)
Or

Hyaline
membrane disease
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Learning outline
• Definition
• Pathophysiology
• Etiology
• Risk factor
• Clinical manifestation
• Differential diagnosis
• diagnosis

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 Objective
At the end of this lesson the students will able to:
• Define what is hyaline membrane disease
• Identify different risk factors of HMD
• Discuss etiology and pathophysiology of HMD or RDS
• Identify clinical manifestation of HMD
• List DDX of HMD

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Respiratory distress syndrome
Definition
Respiratory distress syndrome (RDS), formerly known as
hyaline membrane disease, is a common problem in
preterm infants.
• It is a syndrome in premature infants caused by
developmental insufficiency of pulmonary surfactant
production and structural immaturity in the lungs.

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Etiology and Pathophysiology

Surfactant deficiency( preterm delivery)

 The fetal lung is filled with fluid and provides no
respiratory function until birth.
 In preparation for air breathing, surfactant is expressed in
the lung during the third trimester of pregnancy

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RDS….
• Pulmonary surfactant is a complex system of lipids,proteins
and glycoproteins that is produced in specialized lung cells
called Type II pneumocytes.
• The surfactant is packaged by the cell in structures called
lamellar bodies and extruded into the air space.
• The lamellar bodies then unfold into a complex lining of the
air space.
• This layer reduces the surface tension of the fluid that lines
alveolar air space.
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RDS….
• By reducing surface tension, surfactant prevents the air
spaces from completely collapsing on exhalation.
• In addition, the decreased surface tension allows reopening
of the air space with lower amount of force.
• Therefore, without adequate amount of surfactant , the air
space collapse(atelectasis) and are very difficult to expand
which result in difficult to breath.

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RDS….
The primary cause of RDS is deficiency of pulmonary
surfactant, which is developmentally regulated.
 This surfactant prevent the collapse of terminal air
spaces(the future site of alveolar development)
throughout the normal cycle of inhalation and exhalation.

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 RDS…

• Microscopically, a pulmonary surfactant-deficient lung is characterized by

collapsed air spaces alternating with hyperexpanded areas, vascular
congestion and in time, hyaline membranes.
• Hyaline membranes are composed of fibrin, cellular debris, red blood
cells, rare neutrophils and macrophages.
• They appear as an eosinophilic, amorphous material, lining or filling the
air space and blocking gas exchange. As a result, blood passing through
the lungs is unable to pickup oxygen and unload carbon dioxide.

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RDS…..
• Blood oxygen level falls and carbon dioxide rises, resulting in
rising blood acid level and hypoxia.
• Structural immaturity, as manifested by a decreased number
of gas exchange units and thicker walls, also contributes to
the disease process.

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Incidence
• Infant respiratory distress syndrome (IRDS) is the leading cause of
death in premature infants.
• Despite only 1% of all birth complications being attributed to
respiratory distress syndrome, there is a significantly higher
prevalence in prematurely born babes.
• Incidence rate of IRDS in premature infants born at 30 weeks GA are
at 50%, and rise even higher to 93% for infants born prematurely at
28 weeks of GA.

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 Risk factors
• Increased risk
• Prematurity
• Maternal diabetes
• Multiple births
• Elective cesarean section without labor
• Perinatal asphyxia
• Decreased risk
• Antenatal steroid prophylaxis

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Clinical manifestation
Symptoms:
Babies with HMD may experience:
• Difficulty breathing at birth that worsens over time.
• Cyanosis (bluish skin coloration).
• Flaring of the nostrils.
• Rapid breathing (tachypnea).
• Grunting sounds during breathing.
• Chest retractions (pulling in at the ribs and sternum).

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Differential diagnosis
 Early-onset sepsis
 Bacterial Pneumonia
 Cyanotic heart disease
 Transient tachypnea
 Persistent pulmonary hypertension
 Non-pulmonary systemic disorders, such as hypothermia,
hypoglycemia, anemia, polycythemia, or metabolic
acidosis

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Diagnosis
HMD or RDS is diagnosed through a combination of
assessments, including:
• Physical appearance, color, and breathing efforts.
• Chest X-rays, which often show a unique "ground glass"
appearance.
• Blood gas tests (measuring oxygen, carbon dioxide, and
acidity in arterial blood).
• Echocardiography (to rule out heart problems)

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Treatment
Continuous positive airway pressure (CPAP)
adequate oxygenation and ventilation,
administration of exogenous surfactant.
General supportive measures
 Temprature
 Fluid,metabolic and nutrition
 Circulation and anemia
 Antibiotic when indicated
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Specific interventions are:
Antenatal corticosteroid therapy:
 Are indicated in pregnant women 24-34 weeks' gestation at
high risk of preterm delivery within the next 7 days.
 Optimal benefit begins 24 hrs after initiation of therapy and
lasts seven days.
 Early surfactant therapy:
 prophylactic use of surfactant in preterm newborn <27 weeks'
gestation.
Early CPAP administration in the delivery room.

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Complication
Long term complications include
bronchopulmonary dysplasia (BPD)
neurodevelopmental impairment
retinopathy of prematurity (ROP).
Death

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Reference
• 1. Infant Respiratory Distress Syndrome (Hyaline Membrane Disease)
• 2. Infant respiratory distress syndrome - Wikipedia
• 3. Hyaline Membrane Disease (HMD) - Respiratory Distress Syndrome

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 THANK YOU

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