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Definition
Hyaline Membrane Disease (HMD), also known as respiratory distress syndrome (RDS), is a common cause of respiratory failure in preterm infants, particularly those born at 32 weeks' gestation.
Hyaline membrane disease (PMH) is often found in premature babies. Especially if the baby is born of mothers who suffer from disorders of blood perfusion, the uterus during pregnancy such as maternal diabetes, toxemia, hypotension, secio Caesarean or antepartum haemorrhage.
Hyaline Membrane Disease is one cause of death in newborns. Approximately 30% of all neonatal deaths or complications caused by the HMD.
HMD also called Syndrome Gawat Breath (SGP) type 1, ie respiratory distress in preterm infants that occur immediately or shortly after birth, characterized by difficulty breathing (breathing nostrils, breathing type of dyspnea / tachypnea, chest retractions, and cyanosis) that persist or become progressive in 48-96 hours of life and the radiological examination found a uniform pattern and water retikulogranuler bronchogram.
The introduction of exogenous surfactant as a preventive and therapeutic clinical circumstances have changed from the disease and reduce morbidity and mortality from the disease.
HMD in preterm infants is primary, the incidence is inversely related to gestational age and birth weight. Incidence by 60-80% in infants less than 28 weeks, 15-30% of infants 32-36 weeks, 5% in infants less than 37 weeks, and is extremely rare in infants mature.
Increased frequency in women with diabetes, birth before 37 weeks gestation, pregnancies with more than one fetus, birth by cesarean section, the accelerated delivery, asphyxia, cold stress, and a history of previous infants had HMD. (9) In maternal diabetes, decreased levels of surfactant protein, which leads to surfactant dysfunction. Moreover, it can also be caused rupture of the membranes for a long time and the things that cause stress on the fetus such as maternal hypertension / drug abuse, chronic or congenital infection.
Etiology
Failure to develop functional residual capacity (FRC) and the tendency of the affected lung atelectasis to experience associated with a high surface tension and the absence phosphatydilglycerol, phosphatydilinositol, phosphatydilserin, phosphatydilethanolamine and sphingomyelin.
Formation of surfactant affected the normal pH, temperature and perfusion. Asphyxia, hypoxemia, and pulmonary ischemia; caused by hypovolemia, hypotension and cold stress; inhibit the formation of surfactant. Epithelium lining the lungs may also be damaged by high oxygen concentrations and the effects of regulation of respiration, resulting in the reduction of surfactant.
Clinical manifestations
Infants with hyaline membrane disease usually preterm infants are born weighing between 1200 - 2000 g with gestational age between 30-36 weeks. Rarely found in infants weighing more than 2500 g and gestation more than 38 weeks. Clinical symptoms usually begin to look at the first few hours after birth, especially in the age of 6-8 hours. Characteristic symptoms begin to appear at age 24-72 hours and after the baby's condition may worsen or improve. If improved symptoms usually disappear by the end of the first week.
Respiratory problems in infants is mainly caused by atalektasis and decreased lung perforation. This situation will show clinical conditions such as: 1,2,3
1. Dyspnea or hyperpnea.
2. Cyanosis.
3. Suprasternal retraction, epigastric, intercostal.
4. Moans during expiration (grunting).
5. Tachypnea (respiratory rate. 60 x / min).
6. Weakening of breathing air into the lungs.
7. Probably also heard a heart murmur which indicates that the patent arteriosus duktur accompanied the onset.
8. Cardiomegaly.
9. Bradycardia (at PMH weight).
10. Hypotension.
11. Decreased muscle tone.
12. Edem.
PMH symptoms usually peak on day 3. Afterward occurs slowly improved. Repair is often indicated by spontaneous diuresis and ability levels of oxygenation oxygenation with baby baby more rendah.2, 5.6
Weakness is rarely on the first day of illness usually occurs between day 2 and 3 and is accompanied with alveolar air leaks (interstitial emphysema, pneumothorax), pulmonary hemorrhage or interventrikuler.
