Patient will present as → a premature infant who is born at 32 weeks and after several hours develops rapid shallow respirations at 60/ min, grunting retractions, and duskiness of the skin. The chest X-ray reveals diffuse bilateral atelectasis, ground glass appearance, and air bronchograms
Hyaline membrane disease (also known as newborn respiratory distress syndrome or RDS) affects premature infants. It occurs when infants are born before the lungs are producing adequate amounts of surfactant
- Surfactant helps to prevent the lungs from collapsing. As the airways collapse, infants will struggle more and more to breathe until they become acidotic and multisystem organ failure begins
- Hyaline membrane disease is the most common cause of respiratory disease in the preterm infant
- Infants less than 30 weeks gestation at birth (most common at 26-28 weeks)
CXR will demonstrate diffuse bilateral atelectasis causing a "ground glass appearance" and air bronchograms
Give antenatal steroid within 24-48 hours of birth - betamethasone IM x 2
- Artificial surfactant can be given through the endotracheal tube
- Mechanical ventilation with positive pressure
Babies may suffer permanent respiratory illness because of hyaline membrane disease, but others make a full recovery and suffer no consequences. The best treatment is maintaining a healthy pregnancy to prevent premature birth.
While tachypnea, grunting, retractions and cyanosis may be signs of neonatal pneumonia, they are primarily late findings of progressive respiratory distress and would not be seen immediately at the time of delivery. A chest x-ray in pneumonia would also most commonly reveal an infiltrate or effusion.
congenital heart disease
While congenital heart disease may present with cyanosis, the chest x-ray will reveal a cardiac abnormality, such as cardiomegaly.
hyaline membrane disease
chronic lung disease of prematurity
Chronic lung disease of prematurity is a complication in about 20% of infants with hyaline membrane disease. It is defined as respiratory symptoms, oxygen requirement and chest x-ray abnormalities at 1 month of age so it cannot be diagnosed at this time in this newborn.
Respiratory distress syndrome
Although spontaneous pneumothorax will present with respiratory distress at birth, the chest x-ray would reveal findings of lung collapse.
Transient tachypnea syndrome
While transient tachypnea syndrome also may present at birth with respiratory distress, the chest x-ray would reveal findings of increased pulmonary vascular markings, perihilar streaking and fluid in the interlobular fissures.
Meconium aspiration syndrome
Meconium aspiration syndrome usually occurs in term or post-term infants. Typical chest x-ray findings include patchy infiltrates, coarse streaking of both lung fields, increased anteroposterior diameter and flattening of the diaphragm.