Hyaline Membrane Disease: Treatment, Procedure, Cost and Side Effects

Infant respiratory distress syndrome, neonatal respiratory distress syndrome, respiratory distress syndrome of new-born, surfactant deficiency disorder, respiratory illness, respiratory disorder

Hyaline membrane disease, also known as respiratory distress syndrome, refers to a problem commonly faced by premature newborn babies where they may need extra oxygen to help breathing. This syndrome is mainly caused due to insufficient production of pulmonary surfactant as well as structural inefficiency in the lungs. In addition to this, neonatal infection is another factor which may lead to this problem. This syndrome can also be caused due to some genetic problem associated with the production of surfactant related proteins. Hyaline membrane disease is seen to worsen over the initial 48 to 72 hours, after which the condition improves as the treatment proceeds.

The surfactant, consisting mainly of lipids and phospholipids, is usually produced from the cells of the respiratory tract. When this surfactant is released into the lung tissues, it helps by lowering the surface tension within the respiratory tract. Absence or deficiency of surfactant causes the alveoli to collapse with each breath. These damaged cells of the alveoli get collected within the airways and adversely affect breathing ability. Such cells make up what is known as hyaline membrane. The baby tries breathing harder in order to re-inflate the collapsed alveoli.

With the decrease in function of the baby’s lung, the ability of taking in sufficient amount of oxygen decreases, as a result of which more carbon dioxide starts building up in the blood. This can result in increased acid content in blood, leading to a condition called acidosis, which adversely affects the other body organs. If left untreated, the baby gets exhausted while trying hard to breathe and ultimately gives up.

The treatment of such babies suffering from hyaline membrane disease can be effectively done using exogenous lung surfactant along with proper mechanical ventilation.

Since hyaline membrane disease is common among premature babies, it is advised that parents should avoid preterm delivery if possible. Prevention of premature birth of the baby, rules out the risks of this syndrome to a great extent. In cases, where such premature birth cannot be avoided, medical treatment of the pregnant mother with corticosteroids, prior to delivery, can help to reduce the risk and severity of this syndrome in the baby. These steroids should be given to women between their 24th and 34th weeks of pregnancy who have the chances of early delivery.

The symptoms of babies suffering from hyaline membrane disease include difficulty in breathing which may worsen with time, tachypnea, flaring of the nostrils, chest retractions, grunting sounds while breathing as well as cyanosis. These symptoms usually reaches its peak on the third day of treatment and may be resolved quickly once the baby begins to diurese and requires less oxygen and mechanical assistance for breathing.

The treatment of hyaline membrane disease include inserting an endotracheal tube into the baby’s trachea, providing with artificial ventilation and supplemental oxygen, maintaining continuous positive airway pressure (CPAP), medications and administration of artificial (or exogenous) surfactant.

Artificial surfactant has proven to be the most effective in treating this problem if it is administered within the first six hours after birth. Porcine surfactant or bovine surfactant has been found to be highly beneficial in treating hyaline membrane disease. These surfactants are usually given as preventive treatments for most babies who are at a high risk of this disease.

Babies born prior to the completion of their gestation period are highly prone to suffer from hyaline membrane disease. Any premature newborn baby having symptoms like difficulty in breathing which may worsen with time, tachypnea, flaring of the nostrils, chest retractions, grunting sounds while breathing and cyanosis, are suspected to suffer from hyaline membrane disease and are eligible for such treatment.

Mature and healthy born babies, who are born after the completion of their gestation period, usually do not suffer from hyaline membrane disease. Such babies, who do not have the symptoms of this disease, are not eligible for this treatment.

Babies suffering from hyaline membrane disease may at times develop several complications of this disease or problems as side effects associated with the treatment. Similar to any other disease, severe cases often lead to greater risks of complications. Some of the side effects or complications related to the treatment of hyaline membrane disease include pneumomediastinum, pneumothorax, pneumopericardium, chronic lung disease (also known as bronchopulmonary dysplasia) and/or Pulmonary interstitial emphysema (PIE).

‘Pneumomediastinum’ is a condition which occurs due to leakage of air into the mediastinum (the space within the thoracic cavity, posterior to the sternum and between the two pleural sacs that envelope the lungs). When air leaks into the space between the chest wall and the outer tissues of the lungs then such a condition is known as ‘pneumothorax’. On the other hand, air leaking into the pericardium is referred to as ‘pneumopericardium’ and when it gets trapped between the alveoli then such a condition is known as ‘pulmonary interstitial emphysema’. Such side effects may pose serious threat to the new-born baby and requires immediate medical attention.

For babies suffering from hyaline membrane disease, an urgent treatment is highly necessary to prevent further complications. The post treatment guidelines for such premature born babies include proper ventilation along with administration of exogenous surfactant and supplementary oxygen for a period of at least 72 hours after birth or until the period of risk is over and looking out for further symptoms and complications if any. Even after the baby is out of danger, proper diagnosis should be done in order to keep track of the occurrence (or risk) of any other problems related to the side effects of this treatment. In case of further respiratory or pulmonary problems, parents are advised to consult their doctor as soon as possible.

Preterm born babies, who are having problem in breathing or any other symptoms related to hyaline membrane disease, should be treated as soon as possible. A delay in the process of treatment may even prove fatal to the baby. The symptoms of babies suffering from this disease, may reach its peak during the initial 48 or 72 hours of treatment, after which the condition is usually seen to improve. On an average, it takes nearly 5 days for a baby suffering from this disease to recover.

The price of treatment of babies suffering from hyaline membrane disease varies in different parts of India. However, the treatment procedure for this problem is somehow expensive. The average cost of treatment for hyaline membrane disease ranges from Rs. 29,100 to Rs. 58,200. This treatment is available in all leading hospitals in India.

Hyaline membrane disease can be treated best if urgent care is provided to premature born babies. In such cases, the conditions are seen to recover within a few days after the treatment begins. However, such babies are prone to suffer from other complications in future. It is important to keep such children under proper care until they grow up to a certain age. Moreover, in case such children are seen to suffer from any other symptoms in future, then he/she must be immediately taken to a doctor for proper medical treatment.