PEDIATRICS Vol. 36 No. 2 August 1965, pp. 257-260
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DIAGNOSIS AND TREATMENT: HYALINE MEMBRANE SYNDROME

Clement A. Smith M.D.1

1 Department of Pediatrics, Harvard Medical School, and Boston Lying-In Hospital, Boston, Massachusetts

THE usual introductory note above should sufficiently explain why this short paper is added to the many and longer ones on a subject now actively influenced not only by investigation but also by speculation and innovation.

Few pathological states can confront the conscientious pediatrician with more doubt as to the plan he should follow or with more difficulty in knowing whether his plan is actually effective. Exact diagnosis and evidence of ultimate failure of treatment are available if the infant dies and an autopsy can be performed. But equally exact diagnosis and equally clear evidence that treatment has influenced the outcome are unfortunately not available if the infant recovers. Not only does recovery occur in about half of all cases in which the clinical diagnosis of hyaline membrane syndrome (H.M.S.) is reasonable, but recovery in milder cases may begin within a few hours of onset and is always essentially established within a few days. Clinical (and even chemical) response to therapy is hard to identify with certainty under such rapidly changing conditions. To some extent these same difficulties apply also to the evaluation of measures for prevention.

Clinical Diagnosis

Clinical diagnosis of H.M.S.(for which the reader may substitute other designations, including the idiopathic respiratory distress syndrome (RDS) so long as he recognizes the same syndrome under his designation) should begin with history and physical examination. In the author's hospital, at least one chest roentgenogram is usually included, as well as some or all of the chemical measurements described below. Because laboratory and clinical resources for diagnosis and treatment of so common a condition will necessarily vary, simpler procedures will be presented, although their derivation from more elaborate ones will occasionally be described.