eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Neonatology

Transient Tachypnea of the Newborn: Differential Diagnoses & Workup

Author: KN Siva Subramanian, MD, Professor of Pediatrics and Obstetrics/Gynecology, Chief of Neonatal Perinatal Medicine, Director of Nurseries, Georgetown University Hospital
Coauthor(s): Monisha Bahri, MBBS, MD, Fellow in Neonatal/Perinatal Medicine, Department of Neonatology, Georgetown University Hospital; Stephen D Kicklighter, MD, Clinical Assistant Professor, Department of Pediatrics, Division of Neonatology, University of North Carolina at Raleigh and Wake Medical Center
Contributor Information and Disclosures

Updated: Sep 16, 2009

Differential Diagnoses

Congenital Pneumonia
Pulmonary Hypertension, Persistent-Newborn
Meconium Aspiration Syndrome
Respiratory Distress Syndrome
Neonatal Sepsis
Pneumomediastinum
Pneumothorax

Other Problems to Be Considered

Congenital heart disease
Cerebral hyperventilation
Metabolic acidosis

Workup

Laboratory Studies

The following studies are indicated in transient tachypnea of the newborn (TTN)

  • ABG
    • An ABG assessment is important to ascertain the degree of gas exchange and acid-base balance.
    • Consider an intraarterial catheter, such as an umbilical artery catheter, if the infant's inspired fraction of oxygen exceeds 40%.
    • Hypoventilation is very uncommon, and partial carbon dioxide tensions are usually normal because of the tachypnea. However, a rising carbon dioxide tension in an infant with tachypnea may be a sign of fatigue and impending respiratory failure or a complication such as a pneumothorax.
  • Pulse oximetry
    • Continuously monitor infants with pulse oximetry for assessment of oxygenation.
    • Pulse oximetry allows the clinician to adjust the level of oxygen support needed to maintain appropriate saturation.

Imaging Studies

  • Chest radiography
    • Chest radiography is the diagnostic standard for transient tachypnea of the newborn.
    • The characteristic findings include prominent perihilar streaking, which correlates with the engorgement of the lymphatic system with retained lung fluid, and fluid in the fissures. Small pleural effusions may be seen. Patchy infiltrates have also been described.
    • Follow-up chest radiography may be necessary if the clinical history suggests meconium aspiration syndrome or neonatal pneumonia or if respiratory status worsens.

More on Transient Tachypnea of the Newborn

Overview: Transient Tachypnea of the Newborn
Differential Diagnoses & Workup: Transient Tachypnea of the Newborn
Treatment & Medication: Transient Tachypnea of the Newborn
Follow-up: Transient Tachypnea of the Newborn
Multimedia: Transient Tachypnea of the Newborn
References
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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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Further Reading

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Keywords

transient tachypnea of the newborn, TTN, transient tachypnea of newborn, respiratory distress syndrome type II, RDS, retained lung fluid syndrome, wet lung, noninfectious acute respiratory disease, cesarean delivery, treatment, diagnosis

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Contributor Information and Disclosures

Author

KN Siva Subramanian, MD, Professor of Pediatrics and Obstetrics/Gynecology, Chief of Neonatal Perinatal Medicine, Director of Nurseries, 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 and 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.

Medical Editor

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.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Brian S Carter, MD, FAAP, Professor of Pediatrics (Neonatology), Vanderbilt University School of Medicine; Co-director, Pediatric Advance Comfort Team, 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 and Ethics, National Hospice and Palliative Care Organization, and Southern Society for Pediatric Research
Disclosure: Nothing to disclose.

CME Editor

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.

 
 
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