Transient Tachypnea of the Newborn – A Diagnosis Of Exclusion

All that follows is from the reference below:*

“[Transient Tachypnea of the Newborn] TTN is respiratory distress due to failure of reabsorption, or delayed clearance of fetal pulmonary alveolar fluid. It affects 1% to 2% of all newborns, primarily full-term infants. There are several perinatal risk factors, including elective caesarean section, excessive administration of fluids to the mother during labour, maternal sedation, male gender, and macrosomia.”*

“TTN is respiratory distress due to failure of reabsorption, or delayed clearance of fetal pulmonary alveolar fluid. It affects 1% to 2% of all newborns, primarily full-term infants. There are several perinatal risk factors, including elective caesarean section, excessive administration of fluids to the mother during labour, maternal sedation, male gender, and macrosomia.” [It is a retrospective diagnosis of exclusion]

CLINICAL PRESENTATION/SIGNS/SYMPTOMS
– First hours of life with respiratory distress:
– Tachypnea (80-120 / min); Recession/retraction/ nasal flaring, grunting,
– Cyanosis which appears to resolve with < 40 % O2
– Barrel chest (symmetric hyperinflation) in some infants                                                             -Normally full term infants, large for gestational age.

INVESTIGATIONS
TTN may be indistinguishable from sepsis (NB pneumonia) or RDS and hence is a diagnosis of exclusion:
– Baseline observations
– Arterial blood gas (look for mild-moderate hypoxemia, mild hypercarbia)
– CXR (AP and Lateral)
– Prominent ill-defined central markings suggestive of vascular engorgement radiating out
from hilum
– Prominence of interlobar fissures (fluid)
– Small pleural effusions may be seen
– Cardiac silhouette may be enlarged.
– FBC and U&Es, glucose, septic screen
– ECG/cardiac USS if suspecting Congenital Heart Disease

MANAGEMENT
TTN follows a benign course. Treatment principles include proper stabilisation, adequate
monitoring and careful evaluation/exclusion of more serious conditions. Most neonates improve within 2-5 days.
– Provide oxygen as required to maintain normal PaO2 levels
– Invasive mechanical ventilation usually not required
– Cover with antibiotics for 48 hours
– Mild fluid restriction
– Commence feeds as soon as infant can tolerate them

*TRANSIENT TACHYPNOEA OF THE NEWBORN (TTN) [PDF]. 2009, WOMEN AND NEWBORN HEALTH SERVICE King Edward Memorial Hospital.

 

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