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MORPHOLOGICAL CHANGES IN THE LUNGS OF PREMATURE
INFANTS WITH HYALINE MEMBRANE DISEASE: A COMPARATIVE
STUDY BASED ON GESTATIONAL AGE
Abdujabborov Jamshidbek
Omonov Jamshid
Tursunboev Ulugbek
Kushboeva Shabnam
Abdurakhmanova Sayyora
https://doi.org/10.5281/zenodo.15192899
Introduction
Preterm birth, defined as the delivery of a fetus before the 37th week of
gestation, presents significant health challenges, including respiratory
complications. One of the most critical conditions affecting premature infants is
hyaline membrane disease (HMD), which is characterized by the formation of
hyaline membranes in the alveoli, leading to respiratory failure. The onset of
HMD is particularly common in infants with very low birth weight (VLBW), and
it is known to be exacerbated by prematurity. The lower the birth weight and
gestational age, the higher the risk of severe forms of HMD, contributing to
increased morbidity and mortality rates in neonates. Despite advancements in
neonatal care, such as high-intensity artificial ventilation and the administration
of exogenous surfactants, the incidence of HMD remains alarmingly high. This
study aims to explore the morphological changes in the lungs of premature
infants who died due to pulmonary insufficiency and to examine how these
changes correlate with gestational age and the severity of the disease.
Materials and Methods
The research was based on autopsy data from 52 premature infants who
died of pulmonary insufficiency. These infants were divided into three groups
based on their gestational age: Group 1 (22-27 weeks), Group 2 (28-32 weeks),
and Group 3 (33-37 weeks). Group 1, consisting of infants who were deeply
premature (22-27 weeks), was considered the control group due to their
extremely low div weight and short survival time post-birth. Medical histories
and autopsy protocols were analyzed to identify prenatal and intranatal risk
factors, and morphometric measurements were conducted on lung tissue
samples. These samples were preserved in 10% neutralized formalin, and
histological examination was performed using hematoxylin-eosin, periodic acid-
Schiff, and van-Gieson staining methods.
The lung tissue was assessed for several key indicators: the percentage of
the alveolar area involved in air exchange, the number of alveoli with hyaline
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membranes, the thickness of the hyaline membrane, the height of alveolar
epithelial cells, and the thickness of the alveolar interstitial tissue. These
variables were measured multiple times, and statistical analysis was performed
to determine significant differences across the groups.
Results
The study revealed distinct morphological differences between the groups,
indicating how gestational age impacts the progression of HMD. In Group 1 (22-
27 weeks), which consisted of the most severely premature infants, the lungs
showed minimal air exchange with the alveolar area occupying only 28.5% of
the total lung area. Hyaline membranes were found in approximately 22.8% of
the lung tissue. These membranes were thin, with an average thickness of 9.6
µm. The alveolar epithelial cells were thick (9.34 µm) and sometimes damaged,
with the alveolar walls thickened due to interstitial tissue accumulation. The
infants in this group displayed severe heart and respiratory failure, with a high
incidence of postnatal asphyxia.
In Group 2 (28-32 weeks), a moderate improvement in lung morphology
was noted, with 48.7% of the lung area involved in air exchange. The number of
alveoli with hyaline membranes increased to 7.8 per field of view, and the
thickness of the hyaline membrane averaged 11.6 µm. The alveolar epithelial
height decreased to 7.18 µm, and the interstitial tissue thickness also reduced to
25.3 µm. Infants in this group had a relatively longer survival time, with death
occurring between 6 to 120 hours post-birth, and showed signs of more
advanced lung development compared to Group 1.
In Group 3 (33-37 weeks), which represented the least premature infants,
the alveolar area engaged in air exchange was the highest (78.4%), with hyaline
membranes found in 6.9 alveoli per field of view. The hyaline membranes were
thickest in this group, averaging 12.7 µm, and the alveolar epithelium was
thinner (6.15 µm) compared to the other groups. Interstitial tissue thickening
was less pronounced (18.3 µm), indicating more mature lung structures. The
infants in this group had the longest survival times, and their lungs exhibited the
most advanced stages of development despite the presence of hyaline
membranes.
Conclusion
The study demonstrated that the severity of morphological changes in the
lungs of premature infants with hyaline membrane disease is closely linked to
gestational age. Infants in the earliest gestational age group (22-27 weeks)
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showed the most severe lung abnormalities, including extensive damage to
alveolar structures and minimal air exchange. As gestational age increased, there
was a clear trend toward improved lung development, with greater air exchange
area, thinner hyaline membranes, and more mature epithelial structures. These
findings emphasize the critical role of gestational age in determining the severity
of HMD and its associated lung damage.
The results suggest that early intervention and improved neonatal care
strategies are crucial in reducing the incidence of severe lung damage in
premature infants. Future research should focus on identifying additional
factors that contribute to the progression of HMD, as well as investigating
potential therapeutic options to mitigate its effects in neonates. Additionally,
further studies are needed to examine the long-term pulmonary outcomes of
preterm infants who survive HMD to better understand the lasting impact of
early respiratory complications.
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