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Transient Tachypnea of the Newborn

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Transient Tachypnea of the Newborn

  • See Also
  1. Delayed Transition from Fetal Circulation
  2. Respiratory Distress in the Newborn
  • Epidemiology
  1. Most common cause of Newborn Respiratory Distress (40% of cases)
  2. Responsible for up to 10% of NICU admissions of term infants
  3. 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
  • Precautions
  1. Transient Tachypnea is a diagnosis of exclusion
  2. Carefully consider differential diagnosis (e.g. Pneumonia, Respiratory Distress Syndrome in the Newborn)
  • Risk Factors
  1. Maternal factors
    1. Cesarean Section delivery (esp. elective Cesarean Section without labor, RR 3)
    2. Gestational Diabetes
    3. Maternal Asthma history
    4. Rapid delivery
  2. Newborn factors
    1. Male gender
    2. Fetal Macrosomia
    3. Term and postterm infants
  • Signs
  1. Barrel shaped chest
  2. Tachypnea
    1. Onset: Within 2 to 6 hours of delivery
    2. Duration: Hours to Days (typically resolves within 48 hours)
      1. Initial higher Respiratory Rates predict a longer course
  • Imaging
  1. Chest XRay
    1. Prominent perihilar pulmonary vasculature (sunburst pattern)
    2. Heart with surrounding "wet silhouette"
    3. Intralobar fluid
    4. Lung Hyperexpansion
    5. Imaging findings may persist up to 7 days (lagging clinical improvement)
  2. Bedside Lung Ultrasound
    1. B-Line Artifacts suggest interstitial fluid
  • Differential Diagnosis
  1. See Respiratory Distress in the Newborn
  2. See Neonatal Distress Causes
  3. Delayed Transition from Fetal Circulation
    1. Respiratory Rate 60 to 80 breaths/min
    2. Mild increased work of breathing
    3. Improves rapidly after first 4 hours (contrast with TTN which typically lasts up to 48 hours)
  • Management
  1. See Respiratory Distress in the Newborn
  2. See Newborn Resuscitation
  3. Supportive care - generally improves spontaneously
  4. Mixed efficacy (but do not appear to reduce hospitalization lengths)
    1. Nebulized Albuterol
      1. Reduces TTN duration and need for Supplemental Oxygen
    2. Consider fluid restriction
      1. Stroustrup (2012) J Pediatr 160(1): 38-43 [PubMed]
  5. Avoid potentially harmful or unhelpful measures
    1. Furosemide (Lasix) is not effective
  • Complications
  1. Aspiration risk when Respiratory Rate >80 breaths/min
  2. 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. Buel (2026) Am Fam Physician 113(1): 35-41 [PubMed]
  2. Hermansen (2015) Am Fam Physician 92(11): 994-1002 [PubMed]