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

Transient Tachypnea of the Newborn: Treatment & Medication

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

Treatment

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.

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.

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.

Medication

The use of medications in transient tachypnea of the newborn (TTN) is minimal. Empiric antibiotics are often used for 48 hours after birth, until sepsis has been ruled out. Diuretics have not been shown to be beneficial.

Antibiotics

These agents are used when sepsis is clinically suggested. Antibiotics generally consist of a penicillin (usually ampicillin) and an aminoglycoside (usually gentamicin). Choices are based on local flora and antibiotic sensitivities. Dosage amounts and intervals are based on postmenstrual age (PMA), measured in weeks, and postnatal age, measured in days.


Ampicillin (Omnipen-N)

A penicillin antibiotic with activity against gram-positive and some gram-negative bacteria. Ampicillin binds to penicillin-binding proteins (PBPs), inhibiting bacterial cell wall growth.

Adult

Pediatric

Dosage amount is 50 mg/kg/dose IV; dosage intervals are as follows:
PMA <29 wk and postnatal age 0-28 days: q12h
PMA <29 wk and postnatal age >28 days: q8h
PMA 30-36 wk and postnatal age 0-14 days: q12h
PMA 30-36 wk and postnatal age >14 days: q8h
PMA 37-44 wk and postnatal age 0-7 days: q12h
PMA 37-44 wk and postnatal age >7 days: q8h
PMA >45 wk and all postnatal ages: q6h

Probenecid increases the serum concentration of ampicillin

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Dose adjustments may be necessary in patients diagnosed with renal failure


Gentamicin (Garamycin)

Provides gram-negative aerobic coverage. Gentamicin also provides synergistic activity with penicillins against gram-positive bacteria including group B Streptococcus and Enterococcus. Gentamicin inhibits protein synthesis by irreversibly binding to bacterial 30S and 50S ribosomes.
Given as IV infusion by syringe pump over 30 min. Administer as separate infusion from penicillin-containing compounds.
IM injection is associated with variable absorption, especially in VLBW infants.

Adult

Pediatric

PMA <29 wk and postnatal age 0-7 days*: 5 mg/kg IV q48h
PMA <29 wk and postnatal age 8-28 days*: 4 mg/kg IV q36h
PMA <29 wk and postnatal age >28 days*: 4 mg/kg IV q24h
PMA 30-34 wk and postnatal age 0-7 days: 4.5 mg/kg IV q36h
PMA 30-34 wk and postnatal age >7 days: 4 mg/kg IV q24h
PMA >34 wk and all postnatal ages: 4 mg/kg IV q24h
*Use this dosage regimen in patients with significant asphyxia or PDA or who are receiving treatment with indomethacin

Amphotericin B, cyclosporine, cephalosporins, and furosemide may increase the risk of renal toxicity

Pregnancy

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Nephrotoxicity and ototoxicity may be associated with prolonged elevated trough concentrations (monitor levels to minimize the risk of toxicity and to optimize therapy);obtain peak 30 min after end of infusion and trough just prior to next dose; therapeutic serum concentrations:
Peak: 5-12 mcg/mL
Trough: 0.5-1 mcg/mL

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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