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Transient Tachypnea of the Newborn Follow-up

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

Transfer

An appropriately trained support staff is needed to treat infants with transient tachypnea of the newborn. Infants with transient tachypnea of the newborn and pneumonia or meconium aspiration may have similar clinical presentations. Therefore, staff members must be competent in recognizing worsening respiratory distress or impending failure and must be able to appropriately resuscitate the infant.

Transfer is generally indicated by the need for a higher level of observation and/or care.

Hein et al have recommended the “rule of 2 hours,” whereby the newborn is observed for 2 hours after the onset of respiratory distress. The baby may be referred to a higher facility if the chest radiograph does not appear normal, the baby is worsening clinically, the baby requires more than 40% oxygen to maintain normal oxygen saturation, or there is no improvement after 2 hours of all feasible interventions.[25]

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Deterrence/Prevention

Schedule elective cesarean delivery until 39 weeks' gestation or later or wait for the onset of spontaneous labor.

Also, consider establishing fetal maturity as appropriate for elective cesarean delivery prior to 39 weeks' gestation.

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Complications

Some infants may develop hypoxia, respiratory fatigue, and acidosis. Occasionally, air leaks (eg, a small pneumothorax or pneumomediastinum) may be seen in infants who have increased work of breathing. Hence, any infant who does not follow the typical course of transient tachypnea of the newborn and develops any concerning symptoms must be re-evaluated.

Infants delivered by elective cesarean section prior to 39 weeks' gestation may develop pulmonary hypertension and may require extracorporeal membrane oxygenation (ECMO).[26]

Several reports suggest that transient tachypnea of the newborn is a risk factor for future wheezing syndromes in childhood and may not be as transient as previously thought. Although Liem et al hypothesize that genetic and environmental interactions synergistically predispose these children for future wheeze, prospective studies are required to better define this association.[27]

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Patient Education

Inform parents that transient tachypnea of the newborn is usually a self-limited disorder and is not life threatening.

New data link transient tachypnea of the newborn to the later development of childhood asthma. Birnkrant et al studied the association between childhood asthma and transient tachypnea of the newborn in a nested cohort of 2137 term newborns who were subsequently diagnosed with asthma and a similar number of birthday-matched controls.[28] After adjustment for confounding factors, transient tachypnea of the newborn was significantly associated with the diagnosis of childhood asthma. The adjusted odds ratio was 1.5 (95% CI, 1.13-1.99; P = .005). The association of transient tachypnea of the newborn and asthma was statistically strongest among nonwhite male infants whose mothers lived at an urban address and did not have asthma. Thus, parents should be made aware that their child has a small risk of subsequently developing childhood asthma, especially if the child is male.

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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.

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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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