Good evening everyone! Let us discuss yesterday’s question. First of all, the answer is A,that is, hyaline membrane disease.
Insure is an acronym which stands for: Intubation, surfactant administration followed by extubation. It is used in the management of hyaline membrane disease or respiratory distress syndrome (RDS),which is the most important complication of prematurity.
Etiology: Because of lack of surfactant, which is secreted by type 2 pneumocytes, and it decreases the surface tension preventing the alveolar collapse. Chemical name of surfactant is DPPC(Dipalmitoyl phosphatidyl choline). Incidence is almost 100 % in less than 28 weeks of gestation.
Clinical features: Presents as respiratory distress within 1st 6 hours of life. Chest x ray shows characteristic ground glass appearance and air bronchograms.
Management: Surfactant administration by Insure technique, 4 alloquiots of 1ml/kg each,followed by CPAP. In case of CPAP failure,move on to mechanical ventilation.
Prevention: Antenatal administration of maternal steroids in the form of either 2 doses of betamethasone 12 hours apart or 4 doses of dexamethasone 6 hours apart intramuscular.
Lung maturity test:
Lecithin to sphingomyelin ratio >2,phosphatidylglycerol levels, lamellar body count and shake test.
Important differential diagnosis: Transient tachypnoea of newborn, which also presents as respiratory distress within 1st 6 hours of life. But it is seen in term babies who are borne through lscs.
I hope this was helpful.
Best wishes!
Dr Manoj Malhotra
MBBS (MAMC) MD pediatrics (LHMC)