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Transient Tachypnea of the Newborn
Updated: Jun 4, 2009
Introduction
Background
Transient tachypnea of the newborn appears soon after birth. It may be accompanied by chest retractions, by expiratory grunting, or by cyanosis. (This last manifestation can be relieved with minimal oxygen.) Recovery usually is complete within 3 days.1
Radiologically, this syndrome frequently is termed wet lung disease. In the medical literature, discussions concerning transient tachypnea of the newborn also can be found under the following names: retained fetal lung liquid, retention of fetal lung fluid, respiratory distress syndrome type II, transient respiratory distress of the newborn, and neonatal retained fluid syndrome.
In a case-control study, infants delivered vaginally at 37 weeks or later, from 2005 through 2007, were analyzed to identify factors associated with transient tachypnea of the newborn. The incidence of transient tachypnea was found to be significantly associated with nulliparity; a history of infertility therapy, such as in vitro fertilization; augmentation of labor; nonreassuring fetal status; vacuum/forceps delivery; and a low Apgar score (<7) at 1 and 5 minutes. The factor most strongly associated with the incidence of transient tachypnea of the newborn was a low Apgar score at 1 minute.2
Pathophysiology
During fetal life, the lungs are expanded with an ultrafiltrate of the fetal serum. In the course of neonatal transition, this ultrafiltrate must be removed and replaced with air. The classic explanation for how this occurs was that passage through the birth canal would, by squeezing the thorax, help eliminate the liquid in the lungs, with the remaining fluid being removed by pulmonary capillaries and the lymphatics. Currently, however, the bulk of this clearance is thought to be mediated by transepithelial sodium reabsorption through sodium channels in the alveolar epithelial cells, with only a limited contribution from mechanical factors and Starling forces. Changes in the hormonal milieu of the fetus and its mother, brought about mainly by the onset of spontaneous labor, prepare the fetus for the neonatal transition to air breathing.2,3,4,5,6
Neonate at age 6 hours. Overaeration and streaky, bilateral, pulmonary interstitial opacities and prominent perihilar interstitial markings are seen along with mild cardiomegaly.
Same patient as in Picture 1 at age 2 days. Cardiomegaly has disappeared. Pulmonary parenchymal abnormalities are diminishing, but perihilar, streaky markings persist.
Same patient as in Pictures 1 and 2 at age 4 days. Normal heart size and clear lungs are seen.
Transient tachypnea of the newborn occurs when the liquid in the lung is removed slowly or incompletely; this phenomenon correlates with a decreased thoracic birth squeeze or diminished respiratory effort in the newborn. Transient tachypnea has been identified as occurring with cesarean birth and infant sedation. Longer labor intervals, macrosomia of the fetus, and maternal asthma also have been associated with a higher frequency of transient tachypnea of the newborn.
Frequency
United States
Incidence of transient tachypnea is 11 per 1000 live births.
Mortality/Morbidity
By definition, transient tachypnea of the newborn entails no mortality or morbidity. However, it prolongs the neonate's hospital stay and is associated with an increased risk of asthma development during childhood. If radiographic resolution is not complete by the third day or if respiratory symptoms persist longer than 5 days, an alternative diagnosis should be sought (see Differentials).
Sex
Transient tachypnea occurs more frequently in males.
Age
Transient tachypnea is seen in neonates, usually those born at term.
Anatomy
The lungs usually are affected diffusely and symmetrically. The condition is commonly accompanied by a small pleural effusion.
Presentation
Mild or moderate respiratory distress typically is present at birth or within 6 hours after birth.
Tachypnea (ie, respiratory rate exceeding 60/min) may be accompanied by chest retractions, expiratory grunting, or cyanosis. Cyanosis can be relieved with minimal oxygen.
Neonate at age 6 hours. Overaeration and streaky, bilateral, pulmonary interstitial opacities and prominent perihilar interstitial markings are seen along with mild cardiomegaly.
Same patient as in Picture 1 at age 2 days. Cardiomegaly has disappeared. Pulmonary parenchymal abnormalities are diminishing, but perihilar, streaky markings persist.
Same patient as in Pictures 1 and 2 at age 4 days. Normal heart size and clear lungs are seen.
The clinical course of transient tachypnea is relatively benign when compared with the severity suggested by chest films. Radiographic resolution by the second or third day characterizes this entity and differentiates it from other possible disorders. Respiratory symptoms persist for 2-5 days (see Image 2, Image 3).7,8
Preferred Examination
Standard chest radiography is the preferred radiologic examination.
Limitations of Techniques
Initially, it may be difficult to distinguish transient tachypnea from other causes of respiratory distress of the newborn.
Differential Diagnoses
Hyaline Membrane Disease
Meconium Aspiration
Pneumonia, Neonatal
Other Problems to Be Considered
Respiratory distress syndrome
Congenital lymphangiectasia
Congenital heart disease
Polycythemia
Cerebral hyperventilation
Anemia/hypovolemia
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References
Hermansen CL, Lorah KN. Respiratory distress in the newborn. Am Fam Physician. Oct 1 2007;76(7):987-94. [Medline].
Takaya A, Igarashi M, Nakajima M, Miyake H, Shima Y, Suzuki S. Risk factors for transient tachypnea of the newborn in infants delivered vaginally at 37 weeks or later. J Nippon Med Sch. Oct 2008;75(5):269-73. [Medline].
Birnkrant DJ, Picone C, Markowitz W. Association of transient tachypnea of the newborn and childhood asthma. Pediatr Pulmonol. Oct 2006;41(10):978-84.
Jain L, Eaton DC. Physiology of fetal lung fluid clearance and the effect of labor. Semin Perinatol. Feb 2006;30(1):34-43.
Riskin A, Abend-Weinger M, Riskin-Mashiah S. Cesarean section, gestational age, and transient tachypnea of the newborn: timing is the key. Am J Perinatol. Oct 2005;22(7):377-82.
Kasap B, Duman N, Ozer E, Tatli M, Kumral A, Ozkan H. Transient tachypnea of the newborn: predictive factor for prolonged tachypnea. Pediatr Int. Feb 2008;50(1):81-4. [Medline].
Jain L, Dudell GG. Respiratory transition in infants delivered by cesarean section. Semin Perinatol. Oct 2006;30(5):296-304.
Chen A, Shi LP, Zheng JY, Du LZ. [Clinical characteristics and outcomes of respiratory distress syndrome in term and late-preterm neonates]. Zhonghua Er Ke Za Zhi. Sep 2008;46(9):654-7. [Medline].
Copetti R, Cattarossi L. The 'double lung point': an ultrasound sign diagnostic of transient tachypnea of the newborn. Neonatology. 2007;91(3):203-9. [Medline].
Cleveland RH. A radiologic update on medical diseases of the newborn chest. Pediatr Radiol. 1995;25(8):631-7. [Medline].
Demissie K, Marcella SW, Breckenridge MB, Rhoads GG. Maternal asthma and transient tachypnea of the newborn. Pediatrics. Jul 1998;102(1 Pt 1):84-90. [Medline].
Kuhn JP, Fletcher BD, DeLemos RA. Roentgen findings in transient tachypnea of the newborn. Radiology. Mar 1969;92(4):751-7.
Miller MJ, Fanaroff AA, Martin RJ. Respiratory disorders in preterm and term infants. In: Fanaroff AA, Martin RJ, eds. Neonatal-Perinatal Medicine: Diseases of the Fetus and Infant. 6th ed. St Louis, Mo: Mosby-Year Book;1997:1040-65.
Newman B. Imaging of medical disease of the newborn lung. Radiol Clin North Am. Nov 1999;37(6):1049-65. [Medline].
Rawlings JS, Smith FR. Transient tachypnea of the newborn. An analysis of neonatal and obstetric risk factors. Am J Dis Child. Sep 1984;138(9):869-71. [Medline].
Rawlings JS, Wilson JL, Garcia J. Radiological case of the month. Wet lung syndrome (transient tachypnea of the newborn). Am J Dis Child. Dec 1985;139(12):1233-4. [Medline].
Shaw D. The chest. In: Carty H, Shaw D, Brunelle F, Kendall B, eds. Imaging children. Edinburgh: Churchill Livingstone;1994:1-165.
Whitsett JA, Pryhuber GS, Rice WR. Acute respiratory disorders. In: Avery GB, Fletcher MA, MacDonald MG, eds. Neonatology: Pathophysiology and Management of the Newborn. 4th ed. Philadelphia, Pa: Lippincott-Raven;1994:429-52.
Further Reading
Related eMedicine topics
Transient Tachypnea of the Newborn (from Pediatrics: Cardiac Disease and Critical Care Medicine)
Neonatal Resuscitation
Assisted Ventilation of the Newborn
Hypoxic-Ischemic Brain Injury in the Newborn
Neonatal Seizures
Clinical guidelines
Application of Continuous Positive Airway Pressure to Neonates via Nasal Prongs, Nasopharyngeal Tube, or Nasal Mask — 2004 Revision & Update
Clinical trials
Study Protocol Evaluating Transient Tachypnoea of the Newborn in Term and Near Term Neonates
Antenatal Corticoid Therapy for Late Preterm Babies
Keywords
transient tachypnea of the newborn, neonatal transient tachypnea, wet lung disease, retained fetal lung liquid, retention of fetal lung fluid, respiratory distress syndrome type II, transient respiratory distress of the newborn, neonatal retained fluid syndrome
