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Transient Tachypnea of the Newborn Clinical Presentation

  • Author: KN Siva Subramanian, MD; Chief Editor: Ted Rosenkrantz, MD  more...
 
Updated: Jun 10, 2014
 

History

The maternal history in transient tachypnea of the newborn (TTN) consists of cesarian delivery without labor or precipitous delivery.

Signs of respiratory distress (eg, tachypnea, nasal flaring, grunting, retractions, hypoxia, increased oxygen requirement and cyanosis in extreme cases) become evident shortly after birth.

The disorder is indeed transient, usually resolved within 72 hours after birth.

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Physical

Physical findings include tachypnea with variable grunting, flaring, and retractions.

The infant usually does not appear to be in acute distress and often is described as having "quiet" tachypnea.

Extreme cases may exhibit severe hypoxia and cyanosis.

A study investigating the risk factors for duration of tachypnea in patients with transient tachypnea of the newborn reported that peak respiratory rate of more than 90 breaths per minute during the first 36 hours of life was associated with prolonged tachypnea lasting more than 72 hours.[6]

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Causes

The disorder results from delayed absorption of fetal lung fluid following delivery. Transient tachypnea of the newborn is commonly observed following birth by cesarean delivery.

Cesarean delivery

Cesarean delivery is associated with increased risk of transient tachypnea of the newborn regardless of whether the cesarean delivery was preceded by labor or not. Labor prior to cesarean delivery is not protective of transient tachypnea of the newborn.[7]

Studies using lung mechanical measurements were performed in infants born by either cesarean or vaginal delivery. Milner et al noted that the mean thoracic gas volume was 32.7 mL/kg in infants born vaginally and 19.7 mL/kg in infants born via cesarean delivery.[8] Important to note is that chest circumferences were the same. Milner et al noted that the infants born via cesarean delivery had higher volumes of interstitial and alveolar fluid compared with those born vaginally, even though the overall thoracic volumes were within the reference range.

Epinephrine release during labor affects fetal lung fluid. In the face of elevated epinephrine levels, the chloride pump responsible for lung liquid secretion is inhibited, and the sodium channels that absorb liquid are stimulated. As a result, net movement of fluid from the lung into the interstitium occurs.[9, 10] Therefore, cesarian delivery without labor and subsequent lack of this normal surge of counter-regulatory hormones limit the excursion of pulmonary fluid.

Maternal asthma and smoking

Demissie et al performed a historical cohort analysis on singleton live deliveries in New Jersey hospitals from 1989-1992.[11] After controlling for confounding effects of important variables, infants of mothers with asthma were more likely to exhibit transient tachypnea of the newborn than infants of mothers in the control group.

Schatz et al studied a group of 294 pregnant women with asthma and a group of 294 pregnant women without asthma.[12] Both groups had normal pulmonary function test results and were matched for age and smoking status. transient tachypnea of the newborn was found in 11 infants (3.7%) of mothers with asthma and in 1 infant (0.3%) of a mother from the control group. No significant differences between asthmatic and matched control subjects in other transient tachypnea of the newborn risk factors were observed.

Prematurity

Late preterm infants are at higher risk of developing transient tachypnea of the newborn compared with full-term infants, probably because of immaturity of ENaC transition, lack of lamellar bodies for surfactant production, and overall lung epithelium immaturity.[13, 14]

Male sex and macrosomia

Male sex and macrosomic infants born to diabetic mothers have been associated with increased risk of transient tachypnea of the newborn.

Other factors

Excessive maternal sedation, perinatal asphyxia, and elective cesarean delivery without preceding labor, low Apgar scores, and prolonged rupture of membranes are frequently associated with transient tachypnea of the newborn.

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Contributor Information and Disclosures
Author

KN Siva Subramanian, MD Professor of Pediatrics and Obstetrics/Gynecology, Chief of Neonatal Perinatal Medicine, Hospital Ethicist, Medstar Georgetown University Hospital

KN Siva Subramanian, MD is a member of the following medical societies: American Academy of Pediatrics, American Association for the Advancement of Science, American Society for Parenteral and Enteral Nutrition, New York Academy of Sciences, American College of Nutrition, American Society of Law, Medicine & Ethics, Southern Society for Pediatric Research

Disclosure: Nothing to disclose.

Coauthor(s)

Stephen D Kicklighter, MD Clinical Assistant Professor, Department of Pediatrics, Division of Neonatology, North Carolina State University and Wake Medical Center

Stephen D Kicklighter, MD is a member of the following medical societies: American Academy of Pediatrics, National Perinatal Association

Disclosure: Nothing to disclose.

Monisha Bahri, MBBS, MD Attending Physician, Department of Neonatalogy, Washington Hospital Center

Monisha Bahri, MBBS, MD is a member of the following medical societies: American Academy of Pediatrics, Medical Council of India, Indian Academy of Pediatrics

Disclosure: Nothing to disclose.

Ashish O Gupta, MD Fellow in Neonatal-Perinatal Medicine, Division of Neonatal-Perinatal Medicine, MedStar Georgetown University Hospital

Ashish O Gupta, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Association of Physicians of Indian Origin

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Brian S Carter, MD, FAAP Professor of Pediatrics, University of Missouri-Kansas City School of Medicine; Attending Physician, Division of Neonatology, Children's Mercy Hospital and Clinics; Faculty, Children's Mercy Bioethics Center

Brian S Carter, MD, FAAP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Hospice and Palliative Medicine, American Academy of Pediatrics, American Pediatric Society, American Society for Bioethics and Humanities, American Society of Law, Medicine & Ethics, Society for Pediatric Research, National Hospice and Palliative Care Organization

Disclosure: Nothing to disclose.

Chief Editor

Ted Rosenkrantz, MD Professor, Departments of Pediatrics and Obstetrics/Gynecology, Division of Neonatal-Perinatal Medicine, University of Connecticut School of Medicine

Ted Rosenkrantz, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, Eastern Society for Pediatric Research, American Medical Association, Connecticut State Medical Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

References
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A supine anteroposterior chest radiograph of an infant with transient tachypnea of the newborn (TTN). Note the reticular appearance of the film with mild cardiomegaly and obvious interstitial fluid.
 
 
 
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