Transient Tachypnea of the Newborn Follow-up

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

Further Inpatient Care

  • After resolution of transient tachypnea of the newborn (TTN), focus further inpatient care on routine newborn management.
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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.
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Deterrence/Prevention

  • Schedule elective cesarean section until 39 weeks' gestation or later or wait for the onset of spontaneous labor.
  • Also, consider establishing fetal maturity as appropriate for elective cesarean section 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 reevaluated.
  • Infants delivered by elective cesarean section prior to 39 weeks' gestation may develop pulmonary hypertension and may require extracorporeal membrane oxygenation (ECMO).[8]
  • 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.[9]
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Prognosis

  • Transient tachypnea of the newborn is a self-resolving disorder with excellent prognosis.
  • However, transient tachypnea of the newborn is associated with subsequent respiratory morbidity with a significantly increased risk of a wheezing disorder in childhood.
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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.[10] 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, 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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