Transient tachypnea of the newborn

See Newborn Resuscitation for immediate after-delivery resuscitation

Background

• Respiratory distress affects 1% of neonates:
  • Respiratory distress syndrome (hyaline membrane disease) ~50%
  • Transient tachypnea of the newborn ~50%
• Self-limiting disease that resolves with days as retained lung fluid at birth is removed by lymphatics and breathing
• Most common cause of respiratory distress immediately following delivery in late preterm or term infants
• 1/3 of fluid cleared days before birth, 1/3 during active labor, 1/3 during crying/breathing
• Risk factors
  • Prematurity
  • C-section and rapidly born infants (lack of active labor)
  • Infants of diabetic mothers or obese mothers
  • small for gestational age, preterm infants

Newborn Vital Signs

Age	Pulse^	Respiratory Rate	Systolic BP
Preterm < 1 kg	120-160	30-60	36-58
Preterm 1 kg	120-160	30-60	42-66
Preterm 2 kg	120-160	30-60	50-72
Newborn	126-160	30-60	60-70

Min of life	Target sat^^
1 min	60-65%
2 min	65-70%
3 min	70-75%
4 min	75-80%
5 min	80-85%
10 min	85-95%

^Fever directly causes an increase in heart rate of 10 beats per minute per degree centigrade ^^Hyperoxia can be harmful

Clinical Features

• Respiratory distress in first few hours of life
• Tachypnea > 40-60 breaths/min, grunting, flaring, retractions with clear breath sounds (no rales or rhonchi)
• May have cyanosis
• May have "quiet" tachypnea, not appearing in distress
• Increased O2 requirement - > 60% or mechanical ventilation need consideration of other differentials
• Normal CBC
• Normal to mildly abnormal ABGs (acceptable ranges/expected progression below at bottom):
  • Mild respiratory acidosis
  • Mild-mod hypoxemia and mild hypercapnia possible

Differential Diagnosis

Newborn Problems

• Newborn resuscitation
• Hypoxia
  • Primary apnea
  • Secondary apnea
• Hypothermia
• Hypoglycemia
• Meconium aspiration syndrome
• Anemia (abruption)
• Infant scalp hematoma
• Transient tachypnea of the newborn
• Respiratory distress syndrome
• Congenital pneumonia
• Congenital heart disease
• Neonatal sepsis
• Pneumothorax
• Pulmonary hypertension

Diagnosis

• ABG, with consideration of intraarterial line in umbilical artery if FiO2 > 40%
• Continuous pulse oximetry
• CXR - perihilar streaking (lymph system engorgement), fluid in fissures, increase lung volumes with flat diaphragms

Newborn Normal ABG Parameters

Subject	PO2 mmHg	PCO2 mmHg	pH	Bicarb
< 28 wks	50-65	40-50	>7.28	18-24
38-49 wks	50-70	40-50	>7.3	20-24
Term (10 min)	50	48	7.2	-
Term (1 hr)	70	35	7.35	-
Term (1 wk)	75	35	7.4	-
Preterm 1.5 kg	60	38	7.37	-

Management

See also newborn resuscitation

• TTN is a benign, self-limited condition; treat with supportive care
• Supplemental O2, maintain SpO2 > 90%
• If > 40% FiO2 or increasing work of breathing, consider:
  • Nasal CPAP
  • Surfactant replacement
• IV fluids but some suggest fluid restriction in the first day of life, gavage feedings until respiratory rate decreases enough for oral feedings (usually <60)

Disposition

• Admit

See Also

• Newborn resuscitation

References

• Guglani L, Lakshminrusimha S, Ryan R. Transient Tachypnea of the Newborn. Pediatrics in Review. 2008 e59-e65.
• Johnson, Karen E. Transient Tachypnea of the newborn. UpToDate. Aug 30 2021. Accessed via: https://www.uptodate.com/contents/transient-tachypnea-of-the-newborn?search=transient%20tachypnea%20of%20the%20newborn&source=search_result&selectedTitle=1~34&usage_type=default&display_rank=1#H8.