The “pulmonary hyaline membrane” as a manifestation of heart failure in the newborn infant

Abstract

<h2>Summary</h2> The clinical and pathological findings in the newborn premature infant who dies of "pulmonary hyaline membrane disease" are interpreted as manifectations of left-heart failure. This explanation is based upon the fact that the cardiovascular system is not yet ready to make the adjustments required for extrauterine life, and that the failure to make these adjustments imposes an excessive load on a barely marginal pulmonary vascular bed. The unusual findings in this type of decompensation are explained as manifestations of the exceptional features of the newborn infant, such as the possibility of the reopening of fetal channels of circulation. If this interpretation is sound, the principles of treatment for left-heart failure could logically be included in the management of the newborn premature infant even before respiratory difficulty has appeared. Special emphasis is given to the possibility that this syndrome might be prevented if the handling and position of the baby are so planned as to avoid overloading the thoracic veins and pulmonary circulation.