Transient Tachypnea of the Newborn Treatment & Management

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

Medical Care

  • Medical care of transient tachypnea of the newborn (TTN) is supportive. As the retained lung fluid is absorbed by the infant's lymphatic system, the pulmonary status improves.
  • Supportive care includes intravenous fluids and gavage feedings until the respiratory rate has decreased enough to allow oral feedings. Supplemental oxygen to maintain adequate arterial oxygen saturation, maintenance of thermoneutrality, and an environment of minimal stimulation are the therapies necessary in these infants. ABG assessments should be periodically repeated, especially if the infant's condition worsens. Similarly, chest radiography should be repeated if clinical decompensation is observed.
  • As transient tachypnea of the newborn resolves, the infant's tachypnea improves, oxygen requirement decreases, and chest radiography shows resolution of the perihilar streaking.
  • Infants with transient tachypnea of the newborn may have signs that last from a few hours to several days. Rarely, an infant develops a worsening picture of respiratory distress after several days. This may require more aggressive support including the use of continuous positive airway pressure (CPAP) or mechanical ventilation.
  • A clinical trial that examined the role of inhaled epinephrine for the treatment of transient tachypnea of the newborn found no adverse events when inhaled epinephrine was administered to full-term newborns with moderate-to-severe transient tachypnea of the newborn.[7] More importantly, they did not detect any difference in rate of resolution of tachypnea in placebo and inhaled epinephrine groups. At this time, inhaled epinephrine is not recommended for infants with transient tachypnea of the newborn.
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Consultations

  • Infants with transient tachypnea of the newborn occasionally may require consultation by a neonatologist.
  • Consider this consultation if the fraction of inspired oxygen exceeds 40%, if metabolic acidosis or respiratory acidosis is present, if CPAP or mechanical ventilation is required, if the infant begins to display fatigue (periodic breathing or apnea), or if the infant fails to improve by age 48-72 hours.
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Diet

  • Infants with transient tachypnea of the newborn are generally supported by intravenous fluids or gavage feedings.
  • Infants with significant distress have poor bowel motility and require intravenous therapy.
  • Oral feedings are withheld until the respiration has improved.
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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

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  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].

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  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].

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  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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