Hyaline membrane disease, also called neonatal respiratory distress syndrome, happens when a preterm baby's lungs do not make enough surfactant, so the tiny air sacs collapse. The risk is highest before 34 weeks of pregnancy and in babies of mothers with diabetes.
Key symptoms
- Fast breathing within minutes to hours after birth
- Grunting with each breath
- Nasal flaring and chest retractions
- Bluish color (cyanosis)
- Worsening over the first 48 to 72 hours
What you find on exam
- Respiratory rate above 60 breaths per minute
- Retractions, grunting and reduced breath sounds
- Oxygen saturation and color
- Gestational age, temperature and blood glucose
Tests
- Chest X-ray: ground-glass lungs, air bronchograms, low lung volumes
- Blood gas: low oxygen and high carbon dioxide
- Blood culture and blood count to rule out sepsis
- Glucose and temperature checks
Treatment basics
- Antenatal steroids (betamethasone) for mothers at risk of preterm birth
- Early CPAP in the delivery room
- Surfactant through a breathing tube or a thin catheter
- Mechanical ventilation if CPAP fails
- Warmth, fluids and nutrition; antibiotics until sepsis is ruled out
Red flags
- Pauses in breathing or a slow heart rate
- Rising oxygen needs or rising carbon dioxide
- Sudden worsening (possible pneumothorax)
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Sources: NCSBN 2026 NCLEX-RN Test Plan; NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations. Written by Making Synapses. Making Synapses is not affiliated with these organizations.