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Respiratory Distress Syndrome of the Newborn
Hyaline Membrane Disease


General Considerations

  • Acute pulmonary disorder of the newborn characterized by
    • Generalized atelectasis
    • Intrapulmonary shunting
    • Ventilation-perfusion abnormalities
    • Reduced lung compliance
  • M:F =1.8:1


  • Immature surfactant production (usually begins at 18-20 weeks of gestational age)
    • Causes acinar atelectasis


  • Premature infants
  • Cesarean section
  • Infants of diabetic mothers
  • Perinatal asphyxia

Clinical findings

  • Onset
    • Usually less than 2-5 hours after birth
    • Increases in severity from 24 to 48 hours
    • Then, gradual improvement after 48-72 hours
  • Abnormal retraction of chest wall
  • Cyanosis
  • Expiratory grunting
  • Increased respiratory rate

Imaging findings

  • Typically, diffuse “ground-glass” opacification of both lungs with air bronchograms and hypoaeration
  • Hypoaeration from loss of lung volume (may be counteracted by respiratory therapy)
  • Fine granular pattern
  • Prominent air bronchograms
  • Bilateral and symmetrical distribution


  • Spontaneous clearing within 7-10 days (mild course in untreated survivors)
  • Death in 18%

Acute complications

  • Barotrauma may produce
    • Parenchymal pseudocyst
    • Pulmonary interstitial emphysema
      • Pseudoclearing
        • Lungs appear less because of innumerable small pockets of air in the peribronchial interstitial spaces
    • Pneumomediastinum
    • Pneumothorax
    • Pneumopericardium
    • Pneumoperitoneum
    • Air in the retroperitoneum
    • Subcutaneous emphysema
  • Diffuse opacity
    • Worsening RDS
    • Superimposed pneumonia
    • Massive aspiration
    • Pulmonary hemorrhage
    • Congestive heart failure (from PDA or fluid overload)
      • Persistent patency of ductus arteriosus
        • Oxygen stimulus is missing to close duct
  • Hemorrhage
    • Pulmonary hemorrhage
    • Intracranial hemorrhage
  • Necrotizing enterocolitis
  • Acute renal failures

Chronic complications

  • Lobar emphysema
  • Localized interstitial emphysema
  • Recurrent inspiratory tract infections
  • Retrolental fibroplasia
  • Subglottic stenosis from intubation


  • Supportive
  • Exogenous surfactant via trachea

 hyaline membrane disease

Hyaline Membrane Disease. Diffuse ground-glass appearance to both lungs with a left-sided tension pneumothorax and pneumomediastinum (orogastric tube is in distal esophagus)

respiratory disesae of the newborn

Hyaline Membrane Disease. Diffuse ground-glass appearance to both lungs with multiple air bronchograms (black arrows). An orogastric tube and umbilical venous catheter are present.

Hyaline Membrane Disease

Hyaline Membrane Disease. Diffuse ground-glass appearance to both lungs with hypoaeration and multiple air bronchograms.