Approach Considerations
Prevention
Schedule elective cesarean delivery until 39 weeks' gestation or later or wait for the onset of spontaneous labor. Also, consider establishing fetal maturity as appropriate for elective cesarean delivery prior to 39 weeks' gestation.
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.
Hein et al have recommended the “rule of 2 hours,” whereby the newborn is observed for 2 hours after the onset of respiratory distress. The baby may be referred to a higher facility if the chest radiograph does not appear normal, the baby is worsening clinically, the baby requires more than 40% oxygen to maintain normal oxygen saturation, or there is no improvement after 2 hours of all feasible interventions. [26]
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. [27] 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. [28]
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. [29] In one study, inhaled salbutamol therapy did not shorten the duration of tachypnea significantly in infants diagnosed with transient tachypnea of the newborn. [30] However, inhaled beta-agonists are not recommended as standard therapy in transient tachypnea of the newborn.
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. [31]
After resolution of transient tachypnea of the newborn, focus further inpatient care on routine newborn management, including temperature regulation and feeding.
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.
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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.
