1、Hyaline membrane disease， HMDDeficiency of pulmonary surfactant，PSPulmonary alveoli collapse at the end of expirationProgressively aggravated respiratory distress shortly after birthMainly in preterm infantHigher incidence rate with smaller gestational ageInfant of DM mother, cesarean section, the s

2、econd baby of twinsPS are secreted by type II epithelial cells of pulmonary alveoli.Dipalmitoyllecithin（DPPC） is the main substance.Surfactant protein（SP）PS are produced from 1820w till 3536w when lung is mature.PS cover the inner surface of PS cover the inner surface of pulmonary alveoli, which can

3、:pulmonary alveoli, which can: ndecrease alveolar surface tensionnprevent alveoli collapse at the end of expirationnkeep functional residual capacity（FRC）nkeep stable pulmonary alveolus pressure ndecrease fluid exude from capillary to pulmonary alveoliPreterm birthpH of body fluid, body temperature,

4、 volume of pulmonary blood flow and hormone can influence PS secretion.Asphyxia, hypothermia, placenta previa, placental abruption and hypotension of mother, which can influence blood flow of fetus.High level insulin of IDM may resist the promotion effect of adrenal cortex hormone to PS synthesisalv

5、eolar surface tensionalveolus collapse and pulmonary compliancework at inspirationdifficulty at alveolus opening tidal volumealveolar ventilationCO2 retentionrespiratory acidosisV/Ahypoxiametabolic acidosisAlveolar permeability interstitium edemafibrin deposition in the inner surface of alveolieosin

6、philic hyaline membranegas diffusion disorderRespiratory distress 26h after birth:ndyspnea, cyanosis, flaring of alaenasi, inspiratory three-concave sign, expiratory groanProgressively aggravated respiratory distressFlat thorax, low breath sound, wet ralesArterial duct opening at convalescence stage

7、Condition will improve after 3d but the course will longer if complications exist.Laboratory examinations：nfoam testnlecithin/sphingomyelin（L/S）nblood gas analysisChest X ray：nfrosted glass-like changesnair bronchogramnwhite lungcolor Doppler ultraphonic：PPHN, PDAClinical manifestationsChest X ray w

8、et lunggroup B streptococcal pneumoniadiaphragmatic hernianincubationnmonitoring of T, R, HR, BP, blood gasnliquid and nutrition SupplynRectification of acidosisnshut off arterial ductusnantibioticsnoxygen inhalansnconstant positive airway pressure(CPAP) ventilationncommon frequency ventilatornhigh frequency oscillation ventilator, high frequency ejection ventilatornextracorporeal membrane oxygenator (ECMO)nNatural, semisynthesis, artificial synthesisnutilization：pump into airway through intra-tracheal tu