Respiratory epithelial cell necrosis is the earliest lesion of hyaline membrane disease of the newborn

The pathogenesis of hyaline membrane disease of the newborn remains conctroversial. In an attempt to identify early morphologic lesions of hyaline membrane disease, the authors reviewed the histologic section of lung of all infants that survived for 12 hours or less and all still-borns on which autopsies had been performed at the Johns Hopkins Hospital between 1975 and 1983. Subjects showing more than trivial autolysis or with major congenital malformations were excluded from the study. Among the 70 live births included in this study, 10 (14%) surviving for 7-12 hours had typical hyaline membranes, which are composed of predominantly necrotic epithelial cells. Nine (13%) subjects surviving for 1-10 hours had hyaline membranes plus intraairway necrotic epithelial cell clumps, and 15 (21%) subjects surviving for 10 seconds to 4 hours had only intraairway necrotic epithelial cell clumps. Among the 44 stillborns, 3 (7%) had intraairway necrotic epithelial cell clumps, and 1 of them given resuscitation had hyaline membranes in addition. The results suggest that the initial lesion of hyaline membrane disease of the newborn is necrosis of respiratory epithelial cells, and that this process may begin before birth.