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
  • 1/3 of fluid cleared days before birth, 1/3 during active labor, 1/3 during crying/breathing
  • Risk factors
    • C-section and rapidly born infants (lack of active labor)
    • Infants of diabetic mothers
    • small for gestational age, preterm infants

Differential Diagnosis

Clinical Features

  • Respiratory distress in first few hours of life
  • Tachypnea > 40-60 breaths/min, grunting, flaring, retractions
  • 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 hypercapnea possible

Workup

  • 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

Management

  • Supplemental O2, maintain SpO2 > 90%
  • If > 40% FiO2 or increasing work of breathing, consider:
    • Nasal CPAP
    • Surfactant replacement
  • IV fluids, gavage feedings until RR decreases enough for oral feedings

References

  • Guglani L, Lakshminrusimha S, Ryan R. Transient Tachypnea of the Newborn. Pediatrics in Review. 2008 e59-e65.
  • Transient tachypnea of the newborn - eMedicine
  • Transient tachypnea of the newborn - UpToDate
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 -