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Transient Tachypnea of the Newborn Treatment & Management

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

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.[16] 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.

While furosemide is a strong diuretic and is known to cause lung fluid resorption, oral use of this medication has not shown any benefit in either the severity or duration of the illness or length of hospitalization. Administering furosemide intravenously, or even to the mother before cesarean delivery, might have a more powerful effect and may merit investigation. This, however, is not recommended as a standard treatment at this time.[17]

Genetic variations in the beta-adrenergic receptor–encoding genes leading to decreased function at the receptor level has been proposed as the link between transient tachypnea of the newborn and future predisposition to asthma in some patients. However, inhaled beta-agonists are currently not recommended as standard therapy in transient tachypnea of the newborn.[18] In a recent study, inhaled salbutamol therapy did not shorten the duration of tachypnea significantly in infants diagnosed with transient tachypnea of the newborn.[19] However, inhaled beta-agonists are currently not recommended as standard therapy in transient tachypnea of the newborn.

Few biochemical markers have been shown to be effective in predicting the severity of transient tachypnea of the newborn, such as lactate, lactate dehydrogenase (LDH),[20] and plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP).[21]

Respiratory rate at 36 hours (>90 breaths/minute, RRpeak) was found to be associated with 7.04-fold of prolonged tachypnea and longer duration of hospitalization.[22]

After resolution of transient tachypnea of the newborn, focus further inpatient care on routine newborn management, including temperature regulation and feeding.

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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, 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.

References
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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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