0 Hyaline Membrane Disease - HMD

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Hyaline Membrane Disease - HMD 

• Exclusively in Preterm (Never in IUGR baby - as they are in stress so release steroids)
• > 30% Neonatal Mortality
• Preterm with respiratory distress.

Normally : Type 2 Pneumocytes produce Pulmonary Surfactant in Alveoli - reduces the surface tension and prevents it from collapsing during expiration.

Surfactant Components :

• Phosphatidyl Choline
• Phosphatidyl Glycerol
• Phosphatidyl ethanolamine
• Phosphatidyl inositol
• Protein A,B,C,D

Term Baby with HMD - if Infant of diabetic mother.

Prenatal Diagnosis : L/S ratio in Amniotic fluid. ( Lecithin / Sphingomyelin )
Normally - L/S >2
but in an Infant of Diabetic Mother , Good L/S is > 3.5

Management Prenatal - IM Betamethasone to mother.
Not Dexa - Because it increases risk of PVL (Periventricular Leuckomalacia)

Benefit occurs only after 24hrs to 7days

PostNatal Diagnosis :

1. Shake Test - 
Amniotic fluid or gastric aspirate + Alcohol (equal amount) , shaken for 20 sec.
Then kept in stand for 20 min

• Term : Layer of bubbles at top of test tube.
• Preterm : Bubbles Absent

2. X-Ray - Ground Glass Appearance / White out lungs.

Baby <28wks - 60 - 80% have HMD

Treatment - 
1. CPAP - Nasal/PEEP - to keep alveoli distended.
2. Definitive treatment - Surfactant - Prophylactic to preterm , Therapeutic /Rescue

• Route : IntraTracheal
• Most commonly used - Survanta (Bovine)
• Others - Curosurf (Porcine) , Infasurf ( Calf )

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