RESPIRATORY ACTIVITY AND FUNCTION IN NEWBORN INFANTS DYING WITH PULMONARY HYALINE MEMBRANES

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Abstract
The respiratory activity and function of 10 newborn infants dying with pulmonary hyaline membranes were compared with those of surviving infants who had severe respiratory insufficiency. Both groups compensated by increasing respiratory rates during the period of respiratory insufficiency. The respiratory rates of the surviving infants rose to higher levels than did those of infants dying with hyaline membranes. Surviving infants were able to compensate satisfactorily even though the tidal volumes were less than normal. Some of the infants dying with hyaline membranes were unable to oxygenate the blood satisfactorily or adjust acid-base balance in spite of the fact they increased their tidal volumes significantly on occasions. Moderate to severe dyspnea was usually present in both groups at birth. Dyspnea usually decreased rapidly and often disappeared entirely in surviving infants during the period the respiratory rates were increasing. Dyspnea generally was maintained from birth onwards in infants dying with hyaline membranes and sometimes increased during the hours preceding their deaths. Most infants dying with hyaline membranes exhibited signs of respiratory insufficiency from birth to death, such as initial apnea and bradypnea, cyanosis and increasing respiratory rates. Evidence of a symptom-free period after birth was exceptional. The immediate causes of death in infants with pulmonary hyaline membranes probably are multiple, and include respiratory acidosis, deficient oxygenation and possibly physical exhaustion due to extreme dyspnea. In comparing respiratory rates of infants with severe respiratory insufficiency, recognition should be given to the fact that infants in the heavier birth-weight groups tend to develop higher respiratory rates than infants who weigh less.

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