Atelectasis and Hyaline Membrane Disease in Preemies

Definition of Atelectasis in Infants and Preemies

Atelectasis is a condition in which the airways and air sacs in the lung collapse or do not expand properly. Also known as collapsed lung, atelectasis can happen to people of any age, but it's arguably the scariest when it happens to premature babies.

These babies, born before the 37th week of gestation, often fight battles on multiple fronts. Without the benefit of fully developed lungs, one of the battles could be respiratory distress syndrome (RDS). 

Also known as hyaline membrane disease, this syndrome can trigger atelectasis. Although it can place babies at significant risk, the good news is that it can be reversed with treatment.

This article explains what atelectasis is and how it is linked to RDS. It also describes how the condition is diagnosed and treated.

Premature baby being held
Jill Lehmann Photography / Getty Images

What Is Atelectasis?

In normal, healthy people, air passes from the airways into small sacs of the lungs, called alveoli. They play a key role in the body's gas exchange: They allow oxygen to enter the blood while letting carbon dioxide leave it. Usually, the alveoli are lined with alveolar fluid, called surfactant. This fluid keeps the lungs fully expanded.

Too little of this fluid can cause the lungs to collapse, either partially or completely. But too much surfactant isn't a good thing, either. A collapse can occur under this circumstance, too.

Either way, this is what atelectasis is: A condition in which a small or large area of lung tissue collapses. And when this happens, there is a reduced exchange of gases within the lungs.

Clarify Terms

Atelectasis is not a disease. It is the result of a disease or problem in the body.

What Is Hyaline Membrane Disease?

Respiratory distress syndrome (RDS)—also referred to as hyaline membrane disease—may be the culprit behind atelectasis in premature babies. In other words, newborns whose lungs are not fully developed may develop atelectasis due to hyaline membrane disease.

In fact, RDS affects nearly all babies who are born before 28 weeks. (Less often, RDS can affect full-term babies, too.)

RDS is more common in premature babies because their underdeveloped lungs cannot make enough surfactant. As babies deal with RDS, their parents may hear it referred to by several other names besides hyaline membrane disease, including:

  • Infant respiratory distress syndrome
  • Neonatal respiratory distress syndrome
  • Surfactant deficiency

Symptoms

RDS usually develops in the first 24 hours after birth. It is marked by certain telltale symptoms, particularly breathing problems. A lack of oxygen can damage the baby's brain and other organs if not treated promptly. So it's vital to watch for:

  • Grunting sounds
  • Rapid, shallow breathing
  • Sharp pulling inward of the muscles between the ribs when breathing
  • Widening of the nostrils with each breath

In time, RDS may morph into bronchopulmonary dysplasia, or BPD. This is another breathing disorder that may affect premature babies, especially those who require oxygen therapy. These babies are usually born more than 10 weeks early, weigh less than 2 pounds when they enter the world, and have breathing problems.

Younger Children Afflicted

Atelectasis is more common among children under the age of 3 than in older children and adults.

Atelectasis Symptoms

Symptoms of atelectasis may not be as prominent, but they're similar to RDS and may include:

  • A bluish tint to the skin and mucous membranes (cyanosis)
  • Brief pauses in breathing (apnea)
  • Decreased urine output
  • Nasal flaring
  • Rapid breathing
  • Shallow breathing
  • Shortness of breath and grunting sounds while breathing
  • Unusual movements during breathing

Survival Rates are High

The combination of medical advances and better treatments have resulted in higher survival rates among newborns with RDS. These babies may need extra care after going home, but they can flourish.

Atelectasis as a Possible Sign of RDS

In addition to RDS, there are other causes of atelectasis in newborn babies, whether they were born prematurely or at full term. Their small airways may collapse due to:

  • Prematurity: Atelectasis is a relatively common complication of prematurity because premature babies may not have enough surfactant, the fluid that helps keep alveoli open.
  • Meconium aspiration: Meconium is the name for a baby's first stools. If babies pass this stool before birth, it can get in their airways and make them very sick. Meconium can block air from entering the alveoli, causing them to collapse.
  • Pneumonia: A lung infection can cause mucus to fill the lungs. Like meconium, it can keep air from getting into the alveoli and cause them to deflate.
  • Breathing problems: Muscle or neurologic problems that cause difficulty breathing deeply can prevent the airways from filling all the way before they collapse.

Deep Breathing Needed

Atelectasis can also be caused when a baby doesn't breathe deeply enough to allow the alveoli to fill with air.

Diagnosis

Diagnosing atelectasis is a two-step process involving a physical examination followed by tests:

Physical Exam

A healthcare provider must listen for any unusual sounds during a physical exam, including fewer or absent breaths, vibrations, and crackling sounds.

A health history also plays a role in the exam. It may sound unusual to do a health history on a premature baby—someone who is so new to the world—until you consider that a mother's history is taken into consideration, too.

Then a healthcare provider can begin to form a diagnosis. For example, a long or difficult labor is a risk factor for atelectasis. So is a birth injury to the central nervous system.

Tests

Images of the baby's chest will also come into play, including a:

  • Chest x-ray, which may show a "ground glass" appearance in the lungs
  • CT scan (possibly)

Your healthcare provider may also order blood tests to see if the newborn has enough oxygen in the blood. The tests can help determine if an infection is causing the baby's breathing problems.

Obstructive Atelectasis Matters

Atelectasis is common in children who have inhaled a foreign object, such as a small toy, into their lungs.

Treatment

There are a few ways that doctors treat atelectasis in newborns, depending on the presumed cause. Some babies may be positioned in a way that allows fluid to drain or airways to open. In other words, a baby may be placed on their unaffected side so that the lung can re-expand.

Premature babies may be given artificial surfactant to help their alveoli stay open. This procedure can be done through a tube inserted through the baby's trachea.

Respiratory support or breathing treatments with medications can also help keep airways open and allow babies to breathe better. Breathing masks, incentive spirometry (which promotes deep breathing) and mechanical ventilation (if the baby cannot breathe on their own) are among the potential treatment options.

Meanwhile, if a blockage is discovered, it may be removed with a tube that is passed down the throat and into the baby's lungs. Physical or breathing therapy are other treatment options. Medication may be the answer to treat an infection or the underlying condition that caused the collapse in the first place.

Complications

Healthcare providers could have their hands full treating an infant with atelectasis. It could morph into BPD, and severe cases tend to pose even greater complications. For example, babies with hyaline membrane disease can develop chronic lung disease or air leaks medically known as:

  • Pneumomediastinum, or leaks in the two sacs containing the lungs
  • Pneumothorax, or air leaks between the chest wall and the outer tissues of the lungs
  • Pneumopericardium, or leaks into the sac around the heart
  • Pulmonary interstitial emphysema, or air leaks that become trapped between the alveoli

In the meantime, other serious complications to keep an eye out for in the growing child include impaired vision as well as movement, learning, or behavior problems.

Adult Patients Fight on Other Fronts

Atelectasis can take a toll on adult patients, too, by causing low blood oxygen (hypoxemia), pneumonia, or respiratory failure.

How to Prevent Atelectasis

The best way to prevent infant atelectasis (and respiratory distress syndrome) is to prevent—or do everything you possibly can to try to prevent—a preterm birth.

The signs of potential preterm labor ought to surface during the course of thorough prenatal care. But if a preterm labor begins, healthcare providers often use a combination of tactics to try to delay birth. These tactics include bed rest, hydration, and antenatal steroids.

Lungs are one of the last things to develop in a baby, but they're also one of the most crucial to their healthy future.

Summary

Atelectasis is a condition that causes the lungs of premature babies to collapse, which is why it's also known as "collapsed lung" syndrome. It's often triggered by respiratory distress syndrome. A baby who is fighting it may grunt frequently, engage in rapid, shallow breathing, pull the muscles between the ribs inward while breathing, and widen their nostrils with each breath.

These signs all underscore the fact that breathing for these babies is difficult. Diagnosis is straightforward, with a physical exam and X-ray. Treatment depends on the cause, but breathing therapy, physical therapy, or medication are possibilities.

A Word From Verywell

Keep in mind that atelectasis cannot always be prevented. But if you're expecting a baby, you can better your odds of delivering a full-term baby by getting regular prenatal care, eating nutritious foods, and engaging in some form of physical activity. Your healthcare provider can help you define the specifics.

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9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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