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1、NeonatalRespiratoryDistressSyndrome(NRDS)TongjiHospitalNeonatalRespiratoryDistressSyndrome(NRDS) or:HyalineMembraneDisease(HMD)MostcommoncauseofrespiratoryfailureinthefirstdaysOccurringin1~2%ofnewborninfants(GA26~28w,50%,30~31w,lessthan20~25%)Mortality~50%at20yrsago,Survive80~90%nowHighrisk:
2、IDM,GA<37w,multipreg.,C-section,asphyxia,coldstress,historyofprioraffected,maleorwhiteinfantsLowrisk:chronicorpregnancy-associatedhypertension,maternalopiateaddiction,PROM,antenatalcorticosteroidLungDevelopmentEmbryonicLungDevelopmentFetalLungDevelopment(Pseudoglandular,Canalicular,TerminalS
3、accular)PostnatalLungDevelopmentEmbryonicLungDevelopmentprimitivelungmainbronchilobarbronchisegmentalbronchiFetalLungDevelopmentPseudoglandularStage~7th–16thweekPrimitivebronchialtreeTerminalbronchiolesFetalLungDevelopmentCanalicularStage~16th–24thweekTerminalSaccularStage~24th–36thweekRespi
4、ratorybronchiolesTransitorysacculesandductsPostnatalLungDevelopmentPostnatalDevelopment~birth–8yearAlveolarperiodSecondaryalveolarseptaAlveolarductsandalveoliSurfactantstartsynthesisin20~24wincreasein28~32wmeetdemandsafter35wdoubleinalveolarwithin24hadultlevelafter3~7dhalf-life12~24hrenewin2
5、4~48,>90%reuseSurfactantCompositionPhospholipid90%(neutral5%)saturated50％unsaturated35％Protein10％(albumin5%)SP-A,30~35kDa,18ologomer,hydrophilicD,43kDa,12oligomerSP-B,8kDa,dimer,hydrophobicC,4kDa,dimerFunctionofPulmonarySurfactantDecreasealveolarsurfacetension,reducerespiratoryworkMaintainal
6、veoliinflationandfunctionalresidualcapacityAcceleratelungfluidabsorption,reducealveolareffusionPathogenOpsonization,alveolarmacrophageactivationEffects:improveoxygenation,ameliorateventilation/perfusionanti-inflammationFluidsurfacetensionPressure(P)=2xsurfacetension()radius(r)EtiologyandPat
7、hophysilogySurfactantlowersthesurfacetensionofalveolarmembranePulmonaryimmaturityresultsinsurfactantdeficiencyAlveolicollapseattheendofexpirationleadstorespiratoryfailureSurfactantdeficiencycanariseafterasphyxia/shockandacidosisPathologyatelectasis
