Hyaline Membrane Disease

Pediatric Dept.
Atma Jaya University

Insidens

Sering pada bayi prematur

Bayi dengan ibu DM
Kehamilan multipel (Kembar)
Melahirkan dengan cara Sectio Caesarea
Bayi laki laki

Etiology
Defisiensi surfaktan
Surfaktan (Surface active Lipoprotein) *
Dipalmitoylphosphatidylcholine ( lecithin )
Phosphatidylglyserol
Phosphatidyletanolamine
Phosphatidylinositrol
Apoproteins ( SP A, B, C, D )
Cholesterol

Pathophysiology
Diminished surfactant
Impaired cellular
metabolism
Alveolar
hypoperfusion

Progressive atelectasis
Hypoventilation
(V/Q mismatched)
pH , pO2 , pCO2

Pulmonary
vasoconstriction

Hypotension

Clinical manifestation

Tachypnea
Prominent grunting (nafas seperti mengedan)
Intercostal and subcostal retractions
Nasal flaring (pernafasan cuping hidung)
Cyanosis

Diagnosis
History
Clinical manifestation
Chest roentgenogram *

Differential diagnosis

Sepsis
Cyanotic heart disease
Persistent pulmonary hipertension
Aspiration syndrome
Spontaneous pneumothorax

Prevention
Dexamethasone or betamethasone to
women 48 hr before delivery of fetus
between 24 and 34 weeks of gestation.
Artificial surfactant into the trachea of
symptomatic premature infants immediately
after birth or during the first 24 hr of life
reduces the mortality from HMD

Treatment
A.
B.
C.
D.
E.

Surfactant replacement therapy *

Oxygen *
CPAP *
Mechanical ventilation *
Supportive therapy *

Complication

Tracheal intubation
Umbilical catheterization
PDA ( Patent Ductus Arteriosus )
CLD ( Chronic Lung Disease )

Prognosis
Early provision of intensive observation
and care of high risk newborn infants can
reduce the mortality due to HMD
Mortality increases with decreasing
gestational age

THANK YOU

Surfactant *
Reduce the surface tension
Maintain alveolar stability by preventing
the collapse of small air space at end
expiration

Chest roentgenogram *
Reticular granular pattern
Air bronchogram

Surfactant replacement therapy

Survanta ( Bovine surfactant extract )
Exosurf Neonatal ( Syntetics surfactant
consisting of Dipalmitoyl phosphatidylcholine,
emulsifying, & dispersing agents )

Surfactant replacement therapy *

Prophylactic vs Early rescue treatment
No significant difference if Rescue Treatment is
given within 2 hours after birth ( Window of
treatment )

Single Vs Multiple doses

No clinically advantages in administering more
than 2 doses of surfactant
Recommended : 2 dose of surfactant
2 dose of Exosurf or 4 dose of Survanta

Oxygen *
Oxygen is given to maintain pO2 between
50 and 80 mmHg ( > 90 % saturation )
O2 is warmed, humidified, and delivered
through an air-oxygen blender that allows
precise control over the O2 Concentration

CPAP *
Indications
- Infants with RDS who have mild respiratory
distress
- Require an FiO2 < 0,4 to maintain a PaO2
of 50 to 80 mm Hg
- PaCO2 < 50 mm Hg

Mechanical ventilation *
Indications
- PaCO2 > 50 mm Hg or rapidly increasing
- PaO2 < 50 mm Hg or O2 saturation < 90 %
with FiO2 > 0.50
- Severe apnea

Supportive therapy *
Temperature
Fluids and nutrition
Circulation
HR, BP, Peripheral perfusion

Possible infection
Blood cultures and complete blood count