Laboratory Studies

The following studies are indicated in transient tachypnea of the newborn (TTN).

Arterial blood gas (ABG)

An ABG assessment is important to ascertain the degree of gas exchange and acid-base balance.

Consider an intraarterial catheter, such as an umbilical artery catheter, if the infant's inspired fraction of oxygen exceeds 40%.

Hypoventilation is very uncommon, and partial carbon dioxide tensions are usually normal because of the tachypnea. However, a rising carbon dioxide tension in an infant with tachypnea may be a sign of fatigue and impending respiratory failure or a complication such as a pneumothorax.

Pulse oximetry

Continuously monitor infants with pulse oximetry for assessment of oxygenation.

Pulse oximetry allows the clinician to adjust the level of oxygen support needed to maintain appropriate saturation.

Persistently increased oxygen requirement (FiO₂>40%) may be an indication for surfactant replacement.

Other tests

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),^[21]and plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP).^[22]

Levels of ischemia-modified albumin (IMA) appear to have potential as markers for predicting transient tachypnea of the newborn and disease severity. A study of 47 infants with this condition found significantly higher levels in infants with transient tachypnea of the newborn relative to control infants without respiratory symptoms, as well as in infants on nasal continuous positive airway pressure (CPAP) compared to those on supplemental oxygen therapy.^[23]

Chest radiography

Chest radiography is the diagnostic standard for transient tachypnea of the newborn.

The characteristic findings include prominent perihilar streaking, which correlates with the engorgement of the lymphatic system with retained lung fluid, and fluid in the fissures. Small pleural effusions may be seen. Patchy infiltrates have also been described.

Follow-up chest radiography may be necessary if the clinical history suggests meconium aspiration syndrome or neonatal pneumonia or if respiratory status worsens.

Lung ultrasonography

One study showed the utility of lung sonogram in diagnosing transient tachypnea of the newborn with sensitivity and specificity of 100%. Copetti et al described the sonographic landmark finding of transient tachypnea of the newborn as “double lung point”.^[24]

Lung ultrasonography appears to be useful in neonates with suspected or confirmed coronavirus disease 2019 (COVID-19). In a 2020 study that comprised data from 27 infants, investigators reported the following findings^[25]:

Infants who had pulmonary symptoms but were negative for COVID-19 presented with transient tachypnea of the newborn and respiratory distress syndrome.
In these COVID-19-negative infants, lung ultrasonography some showed a pattern with A lines, few B lines, a thin linear pleural line, and no pleural effusion (normal), whereas others showed coalescent B lines and areas of opacity.
Of infants positive for COVID-19, the lung sonograms in two revealed several coalescent B lines, pleural thickening, and areas of opacity.

Echocardiography

Echocardiogram is warranted in an infant with persistent tachypnea for more than 5-6 days to rule out congenital cardiac anomalies and cardiac function.

Treatment & Management

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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.