Transient Tachypnea of the Newborn Clinical Presentation

  • Author: KN Siva Subramanian, MD; Chief Editor: Ted Rosenkrantz, MD   more...
 
Updated: Jan 13, 2010
 

History

  • The maternal history in transient tachypnea of the newborn (TTN) consists of caesarian delivery without labor or precipitous delivery.
  • Signs of respiratory distress (eg, tachypnea, nasal flaring, grunting, retractions, cyanosis in extreme cases) become evident shortly after birth.
  • The disorder is indeed transient, with resolution usually occurring within 72 hours after birth.
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Physical

  • Physical findings include tachypnea with variable grunting, flaring, and retracting.
  • The infant is often described as having "quiet" tachypnea.
  • Extreme cases may exhibit 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.[3]
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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
    • Studies using lung mechanic 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.[4] Importantly, 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. Therefore, caesarian delivery without labor and the subsequent lack of this normal surge in counter-regulatory hormones limits 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.[5] 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.[6] 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.
  • Male sex and macrosomia: These have also 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 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, 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 College of Nutrition, American Society for Parenteral and Enteral Nutrition, American Society of Law, Medicine & Ethics, New York Academy of Sciences, and Southern Society for Pediatric Research

Disclosure: Nothing to disclose.

Coauthor(s)

Monisha Bahri, MBBS, MD  Fellow in Neonatal/Perinatal Medicine, Department of Neonatology, Georgetown University Hospital

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

Disclosure: Nothing to disclose.

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

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

Disclosure: Nothing to disclose.

Specialty Editor Board

Steven M Donn, MD  Professor of Pediatrics, University of Michigan Medical School; Director, Division of Neonatal-Perinatal Medicine, Department of Pediatrics, CS Mott Children's Hospital, University of Michigan Health System

Steven M Donn, MD is a member of the following medical societies: American Pediatric Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Brian S Carter, MD, FAAP  Professor of Pediatrics (Neonatology), Vanderbilt University School of Medicine; Director, Neonatal Follow-up Program, Monroe Carell Jr Children's Hospital at Vanderbilt

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 Society for Bioethics and Humanities, American Society of Law, Medicine & Ethics, National Hospice and Palliative Care Organization, and Southern Society for Pediatric Research

Disclosure: Nothing to disclose.

Carol L Wagner, MD  Professor of Pediatrics, Medical University of South Carolina

Carol L Wagner, MD is a member of the following medical societies: American Academy of Pediatrics, American Chemical Society, American Medical Women's Association, American Public Health Association, American Society for Bone and Mineral Research, American Society for Clinical Nutrition, Massachusetts Medical Society, National Perinatal Association, and Society for Pediatric Research

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 Medical Association, American Pediatric Society, Connecticut State Medical Society, Eastern Society for Pediatric Research, and Society for Pediatric Research

Disclosure: Nothing to disclose.

References

  1. [Guideline] Ramachandrappa A, Jain L. Elective cesarean section: its impact on neonatal respiratory outcome. Clin Perinatol. Jun 2008;35(2):373-93, vii. [Medline].

  2. Venkatesh VC, Katzberg HD. Glucocorticoid regulation of epithelial sodium channel genes in human fetal lung. Am J Physiol. 1997;273:L227. [Medline].

  3. 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].

  4. Milner AD, Saunders RA, Hopkin IE. Effects of delivery by caesarean section on lung mechanics and lung volume in the human neonate. Arch Dis Child. 1978;53(7):545-8. [Medline].

  5. 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]. [Full Text].

  6. Schatz M, Zeiger RS, Hoffman CP, et al. Increased transient tachypnea of the newborn in infants of asthmatic mothers. Am J Dis Child. Feb 1991;145(2):156-8. [Medline].

  7. Kao B, Stewart de Ramirez SA, Belfort MB, Hansen A. Inhaled epinephrine for the treatment of transient tachypnea of the newborn. J Perinatol. Mar 2008;28(3):205-10. [Medline].

  8. Keszler M, Carbone MT, Cox C, et al. Severe respiratory failure after elective cesarean delivery: a potential precentable condition lending to extracorporeal membrane oxygenation. Pediatrics. 1992;89:670. [Medline].

  9. Liem JJ, Huq SI, Ekuma O, Becker AB, Kozyrskyj AL. Transient tachypnea of the newborn may be an early clinical manifestation of wheezing symptoms. J Pediatr. Jul 2007;151(1):29-33. [Medline].

  10. Birnkrant DJ, Picone C, Markowitz W, El Khwad M, Shen WH, Tafari N. Association of transient tachypnea of the newborn and childhood asthma. Pediatr Pulmonol. Oct 2006;41(10):978-84. [Medline].

  11. Bland RD. Lung fluid balance during development. NeoReviews. 2005;6(6):e255-e267.

  12. Dani C, Reali MF, Bertini G, Wiechmann L, Spagnolo A, Tangucci M, et al. Risk factors for the development of respiratory distress syndrome and transient tachypnoea in newborn infants. Italian Group of Neonatal Pneumology. Eur Respir J. Jul 1999;14(1):155-9. [Medline].

  13. Elias N, O'Brodovich H. Clearance of fluid from airspaces of newborns and infants. NeoReviews. 2006;7(2):e88-e94.

  14. Fanaroff AA, Martin RJ. Neonatal-Perinatal Medicine: Diseases of the fetus and infant. 8th ed. 2006.

  15. Helve O, Andersson S, Kirjavainen T, Pitkanen OM. Improvement of Lung Compliance during Postnatal Adaptation Correlates with Airway Sodium Transport. American Journal of Respiratory and Critical Care Medicine. 2006;173:448-452. [Medline].

  16. Jain L, Eaton DC. Physiology of fetal lung fluid clearance and the effect of labor. Semin Perinatol. Feb 2006;30(1):34-43. [Medline].

  17. Lewis V, Whitelaw A. Furosemide for transient tachypnea of the newborn. Cochrane Database Syst Rev. 2002;(1):CD003064. [Medline].

  18. 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].

  19. Wiswell TE, Rawlings JS, Smith FR, Goo ED. Effect of furosemide on the clinical course of transient tachypnea of the newborn. Pediatrics. May 1985;75(5):908-10. [Medline].

 
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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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