Social Medicine and Health Care 340 History or “rise and Fall” of Yellow Hyaline Membrane Disease

The first cases of Yellow Hyaline Membrane Disease (YHMD) were seen in USA in the beginning of 1965, coinciding with the start of an active intensive care unit for premature infants and the era of prolonged survival of severe cases of respiratory distress syndrome in newborns. The lungs of newborns with YHMD can often be identified grossly by slight yellow discoloration. The yellow color is permanent and does not fade when the lungs are exposed to air, light, or prolonged refrigeration. Microscopically, the bright yellow color is found to be due to myriads of homogeneous, sharply delineated, intensely yellow membranes, most of which are lining the luminal aspects of pink-staining “conventional” hyaline membranes. The most extensive clinical morphological study on YHBD clarified that the more of premature infants survived longer, the more frequent YHMD was diagnosed. Comparison of the population characteristics of the infants in the pink and yellow groups revealed several differences: YHMD newborns were found to be more premature, had smaller autopsy weight and survived longer. The authors reviewed the literature on clinical, morphological and biochemical aspects of YHMD from the first article in 1976 to the last systematic research in 1983. The last cases seen by one of the authors were in 1998 when the economic crisis in Bulgaria led to shortage of surfactant medication in the hospitals. Hopefully, YHMD would remain a condition that is not seen in the practice nowadays and would be discussed only as a phenomenon with historical significance.