PEDIATRICS Vol. 35 No. 5 May 1965, pp. 733-742
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PRELIMINARY REPORT

THE PULMONARY HYPOPERFUSION SYNDROME

J. Chu M.D.1, J. A. Clements M.D.2, E. Cotton M.D.3, M. H. Klaus M.D.4, A. Y. Sweet M.D.5, M. A. Thomas M.D.6, and W. H. Tooley M.D.7

1 Departments of Pediatrics, Western Reserve University School of Medicine, and Mt. Sinai Hospital, Cleveland, Ohio.
2 Cardiovascular Research Institute and Department of Pediatrics, University of California Medical Center, San Francisco; Career Investigator, American Heart Association.
3 Department of Pediatrics, University of Colorado Medical School, Denver, Colorado.
4 Departments of Pediatrics, Western Reserve University School of Medicine and Mt. Sinai Hospital, Cleveland, Ohio. Present Address: Department of Pediatrics, Stanford University School of Medicine Palo Alto, California.
5 Departments of Pediatrics, Western Reserve University School of Medicine and Metropolitan General Hospital, Cleveland, Ohio.
6 Department of Pathology, Faculty of Medicine, University of Singapore, Singapore, Malaysia.
7 Cardiovascular Research Institute and Department of Pediatrics, University of California Medical Center, San Francisco, California. Markle Scholar in Academic Medicine.

HYALINE MEMBRANE DISEASE, or idiopathic respiratory distress syndrome, is the commonest cause of death in the newborn. Although it has been the subject of much investigation, its etiology and pathogenetic mechanisms have remained obscure. Accordingly, there are several theories about its causation and many opinions about its optimal therapy, some of these seemingly contradictory. As a result of recent studies, both our own and those of others, we believe that we have gained sufficient new insight into the functional basis of this syndrome to select therapeutic procedures more rationally than before and to suggest that the syndrome be renamed the pulmonary hypoperfusion syndrome.

We believe that the syndrome reflects the calling into action of reflex vasoconstriction which tends to centralize the circulation of the blood when the fetus or newborn infant is subjected to one or more of several stresses, such as hypoxemia, acidemia, hypothermia, and hypovolemia. This type of response has been observed in several animal species and tends to preserve blood flow to the brain, heart, and placenta at the expense of flow to other organs, especially the gut, the kidneys, and the lungs and has survival value in the presence of these stresses. Since the ductus arteriosus is patent in the fetus and newborn infant, however, blood flow to the alveolar capillaries may be virtually cxeluded by pulmonary vasoconstriction, and ischemic damage is more likely in the lungs than in other organs. It is for this reason that we prefer to emphasize the occurrence of pulmonary hypoperfusion in this syndrome.

Submitted on January 18, 1965
Accepted on February 17, 1965




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