Infant Respiratory Distress Syndrome (Hyaline Membrane Disease)

Hyaline membrane disease (HMD), also called respiratory distress syndrome (RDS), is a condition that causes babies to need extra oxygen and help breathing.

• HMD is one of the most common problems seen in premature babies.
• The more premature the baby, the higher the risk and the more severe the HMD.
• HMD typically worsens over the first 48 to 72 hours and then improves with treatment.
• More than 90 percent of babies with HMD survive.

While each baby may experience symptoms differently, some of the most common symptoms of HMD include:

• Difficulty breathing at birth that gets progressively worse
• Cyanosis (blue coloring)
• Flaring of the nostrils
• Tachypnea (rapid breathing)
• Grunting sounds with breathing
• Chest retractions (pulling in at the ribs and sternum during)

Symptoms of HMD usually peak by the third day and may resolve quickly when your baby begins to diurese (excrete excess water in urine) and needs less oxygen and mechanical help to breathe.

HMD occurs when there is not enough of a substance in the lungs called surfactant. Surfactant is made by the cells in the airways and consists of phospholipids and protein. It begins to be produced in the fetus at about 24 to 28 weeks of pregnancy, and is found in amniotic fluid between 28 and 32 weeks. By about 35 weeks gestation, most babies have developed adequate amounts of surfactant.

HMD is usually diagnosed by a combination of assessments, including:

• Appearance, color, and breathing efforts (these signs indicate your baby's need for oxygen)
• X-rays of lungs: X-rays are electromagnetic energy used to produce images of bones and internal organs onto film. In HMD, they often show a unique “ground glass” appearance called a reticulogranular pattern.
• Blood gasses (tests for oxygen, carbon dioxide, and acid in arterial blood): often show lowered amounts of oxygen and increased carbon dioxide.
• Echocardiography (EKG): may be used to rule out heart problems that could cause symptoms similar to HMD. An electrocardiogram is a test that records the electrical activity of the heart, shows arrhythmias (abnormal rhythms), and detects damage to the heart muscle.

Treatment for HMD may include:

• Placing an endotracheal tube (breathing tube, also called an ET) into your baby's windpipe
• Mechanical breathing machine (to do the work of breathing for your baby)
• Supplemental oxygen (extra amounts of oxygen)
• Continuous positive airway pressure (CPAP): A mechanical breathing machine that pushes a continuous flow of air or oxygen to the airways to help keep tiny air passages in the lungs open
• Surfactant replacement with artificial surfactant: This treatment has been shown to reduce the severity of HMD, and is most effective if started in the first six hours of birth. It may be given as preventive treatment for babies at very high risk for HMD, or used as a “rescue” method. The drug comes as a powder that is mixed with sterile water and given through the ET tube. This treatment is usually administered in several doses.
• Medications (to help sedate and ease your baby's pain during treatment)

At Boston Children’s Hospital, we care for newborn babies who need intensive medical attention in a special area of the hospital called the Neonatal Intensive Care Unit (NICU). The NICU combines advanced technology and trained professionals to provide specialized care for the tiniest patients.