HYALINE MEMBRANE

DISEASE
OF THE NEWBORN
Wenna May S. Ramojal

INTRODUCTION
Hyaline
membrane
diseasealso
known
as
neonatalrespiratory distress syndrome,lung disease of
prematurity, orsurfactant deficiencyrefers to lung
pathology which results from insufficient production of
surfactant.
RDS almost always occurs in newborns born before
37 weeks of gestation. The more premature the baby
is, the greater is the chance of developing RDS. RDS is
more likely to occur in newborns of diabetic mothers.

Surfactant, a mixture of phospholipids and

lipoproteins, is secreted by lung cells. The airfluid interface of the film of water lining the
alveoli of the lung (where the exchange of
oxygen and CO2 occurs) exerts large forces that
cause the alveoli to close if surfactant is
deficient. Lung compliance is decreased, and
the work of inflating the stiff lungs is increased.
The preterm newborn is further handicapped
because his or her ribs are more easily
deformed
(compliant).
Breathing
efforts
therefore result in deep sternal (breastbone)
retractions but poor air entry if the ribs are

Rapid, labored, grunting respirations usually

develop immediately or within a few hours after
delivery, with retractions above and below the
breastbone and flaring of the nostrils. The extent of
atelectasis (lung collapse) and the severity
ofrespiratory failureprogressively worsen.
Not all infants with RDS have signs of respiratory
distress;extremely low birth weightnewborns (i.e., <
1000 g) may be unable to initiate respirations at birth
because their lungs are so stiff; they may fail to
initiate breathing in the delivery room.

The incidence of RDS can be reduced by

assessment of fetal lung maturity to determine the
optimal time for delivery. When a fetus must be
delivered prematurely, giving betamethasone
systemically to the mother for at least 24 hours
before delivery induces fetal surfactant production
and usually reduces the risk of RDS or decreases
its severity.
If untreated, severe RDS can result inmultiple
organ failureand death. However, if the newborn's
ventilation is adequately supported, surfactant
production will begin and RDS will resolve by 4 or 5

Baby Boy L was delivered prematurely via

Normal Spontaneous Vaginal Delivery last
December 10, 2014 with 30 weeks Age of
Gestation, Birth weight of 1.5 kgs., Apgar Score
of 8-9.

OBJECTIVE
General objective:
To know more about Hyaline Membrane

Disease of the Newborn.

Specific objective:
To know the Health History of Baby Boy L.
To identify the precipitating factors of his premature

delivery.
To understand the anatomy and physiology of the

Respiratory System of the Neborn.

To understand the pathophysiology of the said

disease.
To determine the laboratory result of Baby Boy L.
To study about the drugs given to the patient.
To discuss different nursing Care plans in relation to

the patients condition.

DEFINITION OF
DIAGNOSIS
A respiratory disease of the newborn, especially the
premature infant, in which a membrane composed of
proteins and dead cells lines the alveoli (the tiny air
sacs in the lung), makinggas exchangedifficult or
impossible. The word "hyaline" comes from the Greek
word "hyalos" meaning "glass or transparent stone
such as crystal." The membrane in hyaline membrane
disease looks glassy.
Hyaline
membrane
is
now
commonly
calledrespiratory distress syndrome (RDS). It is caused

HISTORY
Baby Boy Ls mother used to have prenatal
every month in their Rural health unit and
shows good finding about the patient.
According to his mother, she didnt took any
drugs during conception just to assure that the
baby will be safe and will have no
abnormalities. Her mother was a plain house
wife and having light chores to do everyday
such us cooking foods for the family, sweeps

Maternal History:
Mother L is 19 years of age from Bukidnon. She is 5 th
among the 7 children. According to her, she was delivered
via NSVD and doesnt have any vaccination during their
time for they live in the farthest part of the province.
Shes currently living with his boyfriend at Magpet where
she have her conception with the patient. She eats well
especially vegetables.
It was December 10, 2014, Wednesday dawn when she
felt labor pain and noticed that there is spotting already and
there is water coming out from her. She was then rushed to
Cotabato Provincial Hospital for immediate treatment and
later on, she delivered a premature baby boy.

Paternal History:
Father L is 24 years of age from Bukidnon also. He is
3rd among the 4 children. According to him, there was
no incidence in their family that was delivered
prematurely. And during his time, his mother used to
go to manghihilot during conception.
He doesnt have any vices and dont used to drink
liquors too. He is currently works as a farmer.

PHYSICAL ASSESSMENT
General Health Survey/ Anthropometric Measurements
Flexed head and extremities
Head, 30cm; chest, 27cm; abdomen 23cm
Length head to heel, 44cm
Weight, 1.5 kgs

Vital Signs
Axillary temperature: 36.8C
Pulse, 140bpm
Respirations, 62cpm, irregular

Apgars
2 and 5

Integumentary
Bluish color of the skin and mucus membranes (cyanosis)

Head/Face
Positive molding but skull appears symmetrical
Fontanels soft and flat

Head, Eyes, Ears, Nose and Throat (HEENT)

React to noise
Ears align with external canthus of eyes

Respiratory
Tachypnea (RR: 67)

Cardiovascular
Cyanotic
Apical pulse, 140 regular
Positive femoral pulses

Gastrointestinal
Positive Bowel sounds
Anus patent
Umbilical cord white with two arteries and 1 vein, intact with no discharges

Genitourinary
Voided

Genitalia
Pink and edematous

Musculoskeletal
10 fingers and 10 toes
No fractures or discolorations

ANATOMY AND
PHYSIOLOGY
The Respiratory System in Babies
What is respiration?
Respiration is the act of breathing in and out.
When you inhale, you take in oxygen. When
you exhale, you give off carbon dioxide.

What makes up the respiratory system?

The respiratory system is made up of the organs
involved in the interchanges of gases and consists of
the:
Nose
Mouth (oral cavity)
Throat (pharynx)
Voice box (larynx)
Windpipe (trachea)
Airways (bronchi)
Lungs

The upper respiratory tract includes the:

Nose
Nasal cavity
Sinuses

The lower respiratory tract includes the:

Voice box (larynx)
Windpipe (trachea)
Lungs
Airways (bronchi and bronchioles)
Air sacs (alveoli)

What is the function of the lungs?

The lungs take in oxygen, which the body's
cells need to live and carry out their normal
functions. They also get rid of carbon dioxide,
a waste product of the cells.
The lungs are a pair of cone-shaped organs
made up of spongy, pinkish-gray tissue. They
take up most of the space in the chest, or the
thorax (the part of the body between the base
of the neck and diaphragm). They are
enveloped in a membrane called the pleura.

The lungs are separated from each other by the

mediastinum, an area that contains the
following:
Heart and its large vessels
Windpipe (trachea)
Esophagus
Thymus gland
Lymph nodes

The right lung has 3 lobes. The left lung has 2 lobes.
When you breathe, the air:
Enters the body through the nose or the mouth
Travels down the throat through the voice box (larynx)
and windpipe
Goes into the lungs through tubes called mainstem
bronchi:
One main stem bronchus leads to the right lung and one to

the left lung

In the lungs, the main stem bronchi divide into smaller
bronchi
Then into even smaller tubes called bronchioles
Bronchioles end in tiny air sacs called alveoli

Breathing in babies
An important part of lung development in babies
is the production of surfactant. This is a substance
made by the cells in the small airways and
consists of phospholipids and protein. By about 35
weeks gestation, most babies have developed
enoughsurfactant. Surfactant is normally released
into the lung tissues where it helps lower surface
tension in the airways. This helps keep the lung
alveoli (air sacs) open. Premature babies may not
have enough surfactant in their lungs and may
have difficulty breathing.

PATHOPHYSIOLOGY

DIAGNOSTIC TEST
Hgt

44mg/dl Neonatal hypoglycemia, defined as a plasma glucose

level of less than 30 mg/dL (1.65 mmol/L) in the first 24
hours of life and less than 45 mg/dL (2.5 mmol/L)
thereafter, is the most common metabolic problem in

Hct
Hmoglobi
n mass

newborns.
2/3 (low) A low hematocrit means the percentage of red blood cells is
203

below the lower limits of normal.

Elevated result.
A high quantity of haemoglobin molecules is important in two
ways. On the one hand it directly increases oxygen transport
(1g haemoglobin can transport 1.39ml of oxygen) and on the
other hand it increases blood volume by facilitating venous
return which is a prerequisite for a high maximal cardiac
output. tHb-mass, therefore, is an important parameter to
assess the aerobic aspect of physical performance.

DIAGNOSTIC TEST
WBC

14.9 x

Platelet
Neutrophils

10/g
162
0.51

Indicates infection.
Normal level.
Lower that normal level. The
lower your neutrophil count,
the more vulnerable you are

Lymphocyt
es

0.39

to infectious diseases.
Higher than normal level

DRUG STUDY

NURSING CARE PLAN

PROGNOSIS
CRITERIA

POOR

1. Duration of
illness

2. Onset of
illness
3.
Precipitating
Factors and
Predisposing
Factor

FAIR

GOOD JUSTIFICATION

He was then admitted two days

immediately after his birth.
The onset of illness is poor because at
his young age, he already suffers from
the said disease.
The
precipitating
factor
and
predisposing factor of the patient was
rate as fair because most of factors that
could contribute to the severity of his
present illness are on precipitating
factor which depends on how his body
will survive to ongoing medication.

PROGNOSIS
CRITERIA

POOR

4. Age

5. Environment

6. Family
support
7. Attitude and
willingness to
take
medications/
compliance to
treatment
regimen

FAIR

GOOD JUSTIFICATION

According to the patients age (30

weeks AOG), his immune system is
weak and needs more intensive care
The environment of the hospital is not that
good for recovery because it is not that
conducive.
Baby Boy Ls family is cooperative enough
about the patients treatment
The patient receives his medication
through IVTT.

Indications:
Score:
1 Poor
2 Fair
3 Good

1x3=3
2x4=8
3x0=0
Total:

IDEAL:

11/7=1.57

Result = Poor

Poor = (1.0 - 1.6)

Fair = (1.7 2.3)
Good = (2.4 3.0)