Monday, May 10, 2010

0 Respiratory distress syndrome (hyaline membrane disease)


Intensive Respiratory Syndrome (previously called hyaline membrane disease) is a state where the air sacs (alveoli) in the baby's lungs could not be kept open because of the high surface tension caused by surfactant deficiency.

So the baby can breathe freely, after birth, the alveoli must remain open and filled with air. Alveoli could be wide open because the existence of a substance called surfactant.
Surfactant is produced by cells in alveoli and surface tension lowering function. Surfactant is produced by the mature lung, ie at 34-37 weeks of pregnancy.

Acute respiratory syndrome almost always occurs in premature infants, the more premature, the greater the likelihood of this syndrome.
Acute respiratory syndrome also tend to be mostly found in infants whose mothers had diabetes.

Very premature babies may not be able to start the process of respiration because without lung surfactant becomes very stiff. Larger babies can begin the process of respiration, because the lungs but tend to collapse, then there was severe respiratory syndrome.


Symptoms include:
- Takipneu (breathing fast)
- Unusual respiratory movements (intercostal retraction, when the air inhaled, the chest wall muscles are interested)
- His breath is short and when the sound of snoring breath
- Nostrils inflate
- Apneu
- Cyanosis (skin and mucous membrane color was blue)
- Edema (swelling of the leg or arm).

The diagnosis is based on:
- Results of physical examination
- Results of blood gas analysis (indicating low oxygen levels and acidosis)
- Chest X-ray
- Lung function test results.

- Complications: Pneumothorax.
The lungs are very stiff and needed to develop more pressure from the baby and the ventilator. As a result of lung rupture so that air can seep into the chest cavity. This air causes the lung to collapse and the occurrence of ventilation and circulation disorders.
Lung collapse (pneumothorax) requiring immediate treatment, namely in the form of spending air from the chest with the help of a needle
- Bleeding in the brain.
The risk of bleeding is reduced if corticosteroids before delivery has been given to the mother.

The risk of severe respiratory syndrome could be reduced if labor can be delayed until the baby's lungs have been able to produce sufficient amounts of surfactant.
If preterm labor is likely to occur, then performed amniocentesis to determine levels of surfactant.

If it is estimated that the baby's lungs have not matured and labor can not be postponed, then corticosteroids given to mothers at least 24 hours before the estimated time of delivery.
Corticosteroids will pass through the placenta and stimulate the formation of surfactant by the fetal lung.

After childbirth, the baby who suffered a mild syndrome only need to be given oxygen. In the more severe syndrome may need to be supported by a ventilator and surfactant drug.

Quaternary ammonium surfactant drug closely resemble the original and can be dropped directly into the baby's trachea through a hose.
These drugs can improve survival rate by reducing the weight of baby syndrome and the risk of complications.
To prevent the syndrome in very premature infants, surfactant drug can be given immediately after the baby is born or given away when the signs of the symptoms started to appear.
Treatment can be continued for several days until the baby starts to produce their own surfactant.


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