PEDIATRICS Vol. 24 No. 2 August 1959, pp. 194-204
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THE RESPIRATORY DISTRESS SYNDROME AND ITS SIGNIFICANCE IN PREMATURE INFANTS

William Allen Bauman M.D.1

1 Babies Hospital and Department of Pediatrics, College of Physicians and Surgeons, Columbia University

THE RESPIRATORY distress syndrome of the newborn period is recognized as a clinical entity predominantly afflicting newborn premature infants. Although disorders of the cardiovascular and central nervous systems as well as metabolic derangements are capable of causing a newborn infant to have dyspnea, in those who die the pathologist more frequently finds pulmonary disease. Microscopic examination of the premature infant's lung often discloses atelectasis, emphysema, edema, pneumonia, hemorrhage, aspiration of amniotic debris and the presence of hyaline membrane. In a previous study a significant relationship between respiratory difficulty in early life, pulmonary roentgenographic abnormalities, and the presence of pulmonary hyaline membrane at necropsy was demonstrated.

Curtis has most recently reviewed much of the literature relating to etiology and treatment of "hyaline membrane disease." The clinical manifestations of the syndrome, however, have been infrequently recorded. Miller and Jennison in a survey of more than 4,000 births indicated that the infants who died with hyaline-like material in the lungs had had symptoms characterized by marked respiratory difficulty including retraction of the lower chest wall on inspiration. Parmelee stated that dyspnea was frequently associated with retractions of the rib margins and lower sternum and that there also was grunting and cyanosis to a varying degree. Blystad showed that 15 of 25 dyspneic newborn prematures who died had hyaline membrane formation in the lungs. It is the purpose of this paper to present a clinical appraisal of the respiratory distress syndrome and further to demonstrate its relationship to the presence of pulmonary hyaline membrane at necropsy.

CLINICAL DIAGNOSIS

The newborn premature infant may manifest the respiratory distress syndrome by several physical findings. Characteristically he breathes as if he has glottic obstruction; intercostal retractions accompany strong inspiratory movements.

Submitted on January 28, 1959
Accepted on March 30, 1959




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J. J. Downes, D. Vidyasagar, G. M. Morrow, and T. R. Boggs
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