PEDIATRICS A New Way to Treat Hyaline Membrane Disease

Hyaline membrane disease, which afflicts many premature babies and kills an estimated 50,000 in the U.S. every year, was little known to laymen until it claimed its most prominent victim, Patrick Bouvier Kennedy, in the summer of 1963. Doctors have continued to attack the puzzling disease, and last week, Drs. Clara and Julian Ambrus, a husband-and-wife team workinG at Roswell Park Memorial Institute in Buffalo, reported one of the most encouraging approaches yet.

Working with Pediatrician David Weintraub, the doctors studied premature (under 5 1/2 Ibs.) and other small babies with severe breathing difficulties at Buffalo Children's Hospital. Many of those infants, they decided, had several things wrong with them. In the first place, they had probably been starved of oxygen. As a result, they were suffering from tightly constricted small arteries in their lungs.

Perhaps more important, Dr. Clara Ambrus told a pharmacology conference at the University of Pennsylvania, was an imbalance in a series of substances designed by nature to preserve an exquisitely delicate adjustment of clotting and anti-clotting tendencies in the blood. That imbalance allows a fibrous membrane to form in the lungs, and this prevents the "exchange of carbon dioxide and oxygen. Since many small babies suffer from a deficiency of a vital anti-clotting factor, Drs. Ambrus and Dr. Weintraub treated 32 babies with plasmin activated by the potent enzyme urokinase (UK). Their hope was that this might restore the balance of blood factors and prevent formation of the suffocating membrane.

The fluid was injected into the babies' umbilical veins and also incorporated in an aerosol mist that they breathed. Of the 32 infants, no fewer than 23 recovered, for a survival rate of 72%. But among 28 babies with the same problems who did not get the UK-plasmin treatment, only eleven recovered, a rate of 39%.

There is no way to make a positive diagnosis of hyaline membrane disease except at autopsy. But so many critically ill babies who apparently had the disease were helped by the Ambrus treatment that the Buffalo researchers are convinced that it is worth a wider trial.

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