Medication Summary

The use of medications in transient tachypnea of the newborn (TTN) is minimal. It is difficult to rule out sepsis or pneumonia clinically, in the presence of signs of respiratory distress, especially in the absence of risk factors for infection in the infant. Therefore, empiric antibiotics are often used for 48 hours after birth, until sepsis has been ruled out.

Studies suggest that routine use of empirical antibiotics may not be warranted in late preterm and full-term infants with transient tachypnea of the newborn in the absence of specific infectious risk factors and a negative C-reactive protein.^[32]Infants who received antibiotics stayed longer in the hospital.^{[33, 34]}

Diuretics^[28]and inhaled corticosteroids^[35]have not been shown to be beneficial.

Class Summary

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)

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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.

Gentamicin

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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.

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Media Gallery

Transient Tachypnea of the Newborn. 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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Author

Siva Subramanian, MD, FAAP Emeritus Chief of Neonatal-Perinatal Medicine, Medstar Georgetown University Hospital; Professor Emeritus of Pediatrics and Obstetrics, Senior Ethicist, Pellegrino Center for Clinical Bioethics, Georgetown University Medical Center

Siva Subramanian, MD, FAAP is a member of the following medical societies: American Pediatric Society, American Association for the Advancement of Science, American College of Nutrition, American Pediatric Society, American Society for Parenteral and Enteral Nutrition, Southern Society for Pediatric Research

Disclosure: Nothing to disclose.

Coauthor(s)

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.

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.

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.

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.