Hyaline membrane disease or respiratory distress syndrome? A new approach for an old disease

Abstract

The term “hyaline membrane disease” refers to the histological aspect of the most frequent pulmonary pathology in preterm newborn patients. The lung of the preterm baby is morphologically and functionally immature. Surfactant deficiency in the immature lungs causes alveolar instability and collapse, capillary edema and the formation of hyaline membrane. Thus, the hyaline membranes are epiphenomena and are not the cause of respiratory failure in infants with immature lungs. This definition is presently used to indicate surfactant deficit alone and should not be used for other causes of respiratory distress. Clinicians prefer to talk of “respiratory distress syndrome” (RDS). Improvement in neonatal treatment has changed the natural course of the illness, its clinical and radiological features and has enabled extremely low birth weight newborns (ELBW) to survive. Alveoli paucity and pulmonary interstitial thickness in ELBW impair gas exchange and may necessitate prolonged ventilation treatment, increasing the risk of ventilator-induced lung injury (VILI) and bronchopulmonary dysplasia (BPD). RDS, therefore, is a complex illness where pulmonary immaturity and surfactant deficit play a role together with other pathological conditions that determine the course of the illness and both short and long-term results. Proceedings of the International Course on Perinatal Pathology (part of the 10 th International Workshop on Neonatology · October 22 nd -25 th , 2014) · Cagliari (Italy) · October 25 th , 2014 · The role of the clinical pathological dialogue in problem solving Guest Editors: Gavino Faa, Vassilios Fanos, Peter Van Eyken