La enfermedad de membrana hialina (EMH) es más común en recién nacidos prematuros y se debe a un déficit de surfactante pulmonar. El tratamiento incluye la administración de surfactante exógeno para mejorar la oxigenación y reducir la necesidad de ventilación mecánica. A pesar de los avances en el tratamiento, la EMH sigue asociada a complicaciones agudas y crónicas potencialmente graves.

1. Enfermedad de Membrana Hialina Miguel Mestanza Montoya Mg.G. Médico Pediatra

5. e-medicine. Respiratory Distress Syndrome. June 24, 2005

6. e-medicine. Respiratory Distress Syndrome. June 24, 2005

11. Behrman: Nelson Textbook of Pediatrics, 17th ed. , Copyright © 2004 Elsevier

13. Anatomía Patológica Macroscópicamente: Pulmones con coloración violácea intensa y consistencia parecida al hígado. Microscópicamente se observa extensa atelectasia, congestión de capilares interalveolares y dilatación de los linfáticos Behrman: Nelson Textbook of Pediatrics, 17th ed. , Copyright © 2004 Elsevier

20. DIAGNÓSTICO DIFERENCIAL

30. Drug Name Beractant (Survanta, Alveofact) -- Natural bovine lung extract that lowers surface tension on alveolar surfaces during respiration and stabilizes alveoli against collapse at resting transpulmonary pressures. For ET use only. Pediatric Dose ET: 4 mL/kg (100 mg/kg) divided in 4 aliquots administered at least 6 h apart for 1-4 doses Contraindications Documented hypersensitivity Interactions None reported Pregnancy C - Safety for use during pregnancy has not been established. Precautions Must be warmed to room temperature; administer only under carefully supervised conditions because of risk of acute airway obstruction Marked improvement in oxygenation may occur after administration, hence, decrease oxygen and ventilator pressures (expired tidal volume) as suggested by blood gases; monitor systemic oxygenation to avoid hyperoxia or hypoxia; surfactant may reflux into ET tube (hence, administer it rapidly followed by positive pressure ventilation); monitor heart rate and blood pressure; because ET may rarely become occluded, suction infant's ET tube (preferably using closed suction system) prior to administering surfactant; pulmonary hemorrhage may occur in extremely premature infants (exclude PDA); apnea and nosocomial sepsis may also occur

31. Drug Name Calfactant (Infasurf) -- A natural calf lung extract containing phospholipids, fatty acids, and surfactant-associated proteins B (260 mcg/mL) and C (390 mcg/mL). For ET use only. Pediatric Dose ET: 3 mL/kg (105 mg/kg) q6-12h for 1-4 doses Contraindications Documented hypersensitivity Interactions None reported Pregnancy C - Safety for use during pregnancy has not been established. Precautions Administer only under carefully supervised conditions, because of risk of acute airway obstruction Marked improvement in oxygenation may occur within minutes, hence, wean infant's inspired oxygen and/or ventilator pressure (expired tidal volume) as indicated by blood gases; monitor systemic oxygenation by pulse oxymetry to avoid hypoxia and/or hyperoxia; surfactant may reflux into ET (hence, administer rapidly followed by positive pressure ventilation); cyanosis, bradycardia, or changes in blood pressure have occurred during dosing procedures; because ET rarely may become occluded, suction infant's tube (preferably using a closed system) before administering surfactant

32. Drug Name Poractant (Curosurf) -- Lowers surface tension on alveolar surfaces during respiration and stabilizes alveoli against collapse at resting transpulmonary pressures. Indicated to treat RDS in premature infants. For ET use only. Pediatric Dose ET: 2.5 mL/kg (200 mg/kg); then 1.25 mL/kg (100 mg/kg) at 12-h intervals prn in 2 subsequent doses Contraindications Documented hypersensitivity Interactions None reported Pregnancy C - Safety for use during pregnancy has not been established. Precautions Correction of acidosis, hypotension, anemia, hypoglycemia, and hypothermia recommended before administration; marked improvement in oxygenation may occur within minutes; monitor systemic oxygenation to avoid hyperoxia

33. Drug Name Colfosceril (Exosurf Neonatal) -- Lowers surface tension on alveolar surfaces during respiration and stabilizes alveoli against collapse at resting transpulmonary pressures. For ET use only. Pediatric Dose ET: 5 mL/kg (67.5 mg/kg) q12h for 1-4 doses Contraindications Documented hypersensitivity Interactions None reported Pregnancy C - Safety for use during pregnancy has not been established. Precautions Rapidly affects oxygenation and lung compliance; only for instillation into trachea; surfactant may reflux into ET, hence, administer rapidly followed by ventilation; because ET rarely may become blocked, suction ET (preferably using closed suction system) before surfactant administration; pulmonary hemorrhage may occur in infants weighing <700 g; nosocomial sepsis and apnea also may occur