FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

GREAT-GRANDDAUGHTER SHOULD GROW UP NORMALLY, DESPITE LUNG DISEASE

Question: My great-granddaughter was born with hyaline membrane disease. I know that it is some type of breathing problem because they had her on a breathing machine for a couple of days. The doctors kept her in the hospital a few extra days, too. Now she is home and seems fine except they have her on a monitor. I don't understand much more than this about hyaline membrane disease. Could you please tell me what caused this and if it is something that she will outgrow?

Answer: Hyaline membrane disease is a breathing problem that afflicts about 20,000 newborn babies in the U.S. each year. The basic problem is that the lungs are not sufficiently mature and healthy to let the baby breathe satisfactorily on his or her own. This condition is much more common in children who are born prematurely as well as in full-term babies who have a low birth weight. As you would expect, in both of these conditions the babies are born with increased risk for many problems. Hyaline membrane disease is actually a subgroup of a broader collection of breathing problems labeled respiratory distress syndrome (RDS), and it is among the most life threatening of these.

Babies born weighing between 500 and 1500 grams (about 1 to 3 pounds) are in the group at high risk for RDS. In fact, about 20 percent of these low-weight infants die from breathing problems despite the best care available today. Fortunately, the remaining 80 percent don't. About 78 percent develop as totally normal children with no breathing or other related problems. So, the chances are quite good that your great-granddaughter will "outgrow" her hyaline membrane disease. Only 2 percent of infants that survive RDS continue to have breathing or other health problems as children or adults.

The "breathing machine" you mentioned is standard treatment for babies with RDS. The machine helps the baby breathe until his or her lungs are sufficiently mature and healthy to breathe on their own. Your great-granddaughter has apparently had a mild case of RDS. Perhaps that is because her mother received a medication, dexamethasone, when she started in labor. This medication greatly reduces the chance that a premature baby will have RDS, and, if he or she does develop the disorder, it is likely to be a mild condition. Or perhaps, she only had a mild case even though she wasn't premature or of low-birth weight.

Babies with RDS don't suddenly become healthy. The "breathing machine" is used during that time when the lungs alone are unable to gather sufficient oxygen from the air to sustain life. As the lungs mature and heal, the amount of assistance with breathing can be reduced. After a time the infant gets strong enough to go home, but it is still necessary to keep a close watch on the breathing for a while. That is what the monitor you mentioned is doing. It keeps track of her breathing so that if she stops for more than a moment to take a deep breath or a sigh, the alarm goes off to summon help.

This "high-tech" health care was not available when you were having children. It has made it possible to help many babies who have a difficult start grow into healthy adults. This is what I'd expect for your great-granddaughter. One thing that hasn't changed though, is the need for much love and nurturing for mom and baby. In this regard, your new great-granddaughter is also lucky. She has three generations of family to care for her.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.