Transient Tachypnea of the Newborn

School: medical university Tunisia

Review 2022.

Introduction

Transient tachypnea of the newborn (TTN) is a benign, self-limited condition that can
present in infants of any gestational age shortly after birth. It is caused by a delay in the
clearance of fetal lung fluid after birth, which leads to respiratory distress, and tachypnea.

TTN represents the most common etiology of respiratory distress in term gestation newborns
and sometimes requires admission to the neonatal intensive care unit.

This activity reviews the evaluation and management of transient tachypnea of the newborn.

Etiology

Maternal risk factors include delivery before completion of 39 weeks gestation, a cesarean
section without labor, gestational diabetes, and maternal asthma.

Fetal risk factors include male gender, perinatal asphyxia, prematurity, small for
gestational age, and large for gestational age infants.

Epidemiology

Incidence: 10% of infants delivered between 33 and 34 weeks,

5% between 35 and 36 weeks,

And less than 1% in term infants.

Physical exam:

The condition presents within the first few minutes to hours after birth. The Findings usually
include signs of respiratory distress.

 Tachypnea (respiratory rate greater than 60 per minute)

 Nasal flaring

 Grunting
  Intercostal/subcostal/suprasternal retractions

 Crackles, diminished or normal breath sounds on auscultation

Other occasional exam findings:

 Tachycardia

 Cyanosis

 Barrel-shaped chest because of hyperinflation

Evaluation: TTN is usually a diagnosis of exclusion

Duration of respiratory distress is the principal determinant for diagnosis of TTN. If distress
resolves within the first few hours of birth, it can be labeled as "delayed transition.

After Six hours: "delayed transition», issues with feeding. Requires workup to rule out other
causes of respiratory distress.

 Preductal and postductal saturations: to rule out differential cyanosis.

 Complete blood count (CBC), blood culture, C-reactive protein (CRP), lactate to rule
out neonatal sepsis.

 ABG: hypoxemie.

 Chest x-ray: hyperinflation, prominent perihilar vascular markings, edema of

interlobar septae or fluid in the fissures.

 Echocardiography to rule out congenital cardiac defects in patients with differential

cyanosis or persistent tachypnea for over 4 to 5 days.

Treatment / Management

Help the baby to get enough oxygen and nutrition if he needs it. Treatments might include:

 Extra oxygen

 An intravenous (IV) feeding tube

 Antibiotics (extended unnecessary exposure to antibiotics and prolonged hospital

stays).

Sometimes requires admission to the neonatal intensive care unit. And need for respiratory
support,
Supportive care is the mainstay of treatment.

 Rule of 2 hours: after onset of respiratory distress, if an infant’s condition has not
improved or has worsened or chest x-ray is abnormal, transferring infant to a center
with a higher level of neonatal care. 

 Routine NICU care including cardiopulmonary monitoring, neutral thermal

environment, intravenous (IV) access, blood glucose checks, and observation for
sepsis.

Respiratory

 Oxygen support may be required if pulse oximetry or ABG suggest hypoxemia.

 An oxygen hood is the preferred initial method; CPAP can also be used.

 Concentration should be adjusted to maintain oxygen saturation in low 90s.

 Endotracheal intubation and requirement of ECMO support is usually : in patients

with declining respiratory status.

Nutrition

 Neonates’ respiratory status is the usual determinant for the degree of nutritional
support required.

 Tachypnea of over 80 breaths per minute with associated increased work of

breathing often makes it unsafe for the infant to receive oral feeds. Intravenous (IV)
fluids should be started at 60 to 80 ml per kg per day.

 If respiratory distress is resolving, diagnosis is certain and respiratory rate is less than
80 breaths per minute; enteral feeds can be started slowly with progressive increments
in volume of feeds .

Infectious

 Since TTN may be difficult to distinguish from early neonatal sepsis and pneumonia,
empiric antibiotic therapy with ampicillin and gentamicin should always be
considered.

Differential Diagnosis

 Pneumonia

 Respiratory distress syndrome.

 Aspiration syndromes: meconium, blood or amniotic fluid.

  Pneumothorax; pneumomediastinum

 Left-to-right cardiac shunt defects with failure.

 Persistent pulmonary hypertension

 Subarachnoid hemorrhage, hypoxic-ischemic encephalopathy

 Inborn errors of metabolism.

 Congenital malformations: Congenital diaphragmatic hernia.

Prognosis

Overall prognosis is excellent with most of the symptoms resolving within 48 hours of onset.

In some case reports, malignant TTN: persistent pulmonary hypertension due to a possible
elevation of pulmonary vascular resistance.

Complications

Pneumothoraxes are other rare complications.

Recent evidence also suggests that TTN may be associated with wheezing syndromes later in
childhood.
Keywords: Caesarean section; Neonatal intensive care unit; Newborn. Transient tachypnea
of the newborn, respiratory distress.