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Transient Tachypnea of the Newborn

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Transient Tachypnea of the Newborn

  • See Also
  1. Respiratory Distress in the Newborn
  • Epidemiology
  1. Most common cause of Newborn Respiratory Distress (40% of cases)
  2. Incidence: 5-6 per 1000 births
  • Pathophysiology
  1. Benign cause of Newborn Respiratory Distress
  2. Response to residual alveolar fluid following delivery (delayed reabsorption)
    1. Prostaglandin release typically increases with Vaginal Delivery
    2. Prostaglandins trigger lymphatic dilation and aid alveolar fluid clearance
  3. Surfactant deficiency may play a role
    1. However, surfactant replacement is not indicated
  • Risk Factors
  1. Maternal factors
    1. Ceserean Section delivery
    2. Gestational Diabetes
    3. Maternal Asthma history
  2. Newborn factors
    1. Male gender
    2. Fetal Macrosomia
  • Signs
  1. Tachypnea
    1. Onset: Within 2 hours of delivery
    2. Duration: Hours to Days
      1. Initial higher Respiratory Rates predict a longer course
  1. Diffuse parenchymal infiltrates especially perihilar
  2. Heart with surrounding "wet silhouette"
  3. Intralobar fluid
  4. Hyperexpansion
  • Differential Diagnosis
  1. Respiratory Distress in the Newborn
  • Management
  1. See Respiratory Distress in the Newborn
  2. See Newborn Resuscitation
  3. Supportive care - generally improves spontaneously
  4. Nebulized Albuterol
    1. Reduces TTN duration and need for Supplemental Oxygen
  5. Consider fluid restriction
    1. Stroustrup (2012) J Pediatr 160(1): 38-43 [PubMed]
  6. Avoid potentially harmful or unhelpful measures
    1. Furosemide (Lasix) is not effective
  • Complications
  1. Childhood Asthma higher risk
    1. Birnkrant (2006) Pediatr Pulmonol 41(10): 978-84 [PubMed]
  • Prevention
  1. Avoid cesarean delivery before 39 weeks
  2. If cesarean delivery before 39 weeks cannot be avoided
    1. Corticosteroids (Betamethasone or Dexamethasone) at 48 hours before Cesarean Delivery (37-39 weeks)
  • References
  1. Hermansen (2015) Am Fam Physician 92(11): 994-1002 [PubMed]