View source for Transient tachypnea of the newborn

''See [[Newborn Resuscitation]] for immediate after-delivery resuscitation''

==Background==
*Respiratory distress affects 1% of neonates:<ref>Jain L, Eaton DC. Physiology of fetal lung fluid clearance and the effect of labor. Semin Perinatol. 2006;30(1):34-43. PMID 16549212</ref>
**[[Respiratory distress syndrome]] (hyaline membrane disease) ~50%
**Transient tachypnea of the newborn ~50%
*Self-limiting disease that resolves with days as retained lung fluid at birth is removed by lymphatics and breathing
*Most common cause of respiratory distress immediately following delivery in late preterm or term infants 
*1/3 of fluid cleared days before birth, 1/3 during active labor, 1/3 during crying/breathing
*Risk factors
**Prematurity
**C-section and rapidly born infants (lack of active labor)
**Infants of diabetic mothers or obese mothers
**small for gestational age, preterm infants

{{Newborn vital signs}}

==Clinical Features==
*[[shortness of breath (peds)|Respiratory distress]] in first few hours of life
*Tachypnea > 40-60 breaths/min, grunting, flaring, retractions with clear breath sounds (no rales or rhonchi)
*May have cyanosis
*May have "quiet" tachypnea, not appearing in distress
*Increased [[hypoxia|O2 requirement]] - > 60% or mechanical ventilation need consideration of other differentials
*Normal CBC
*Normal to mildly abnormal [[ABG]]s (acceptable ranges/expected progression below at bottom):
**Mild [[respiratory acidosis]]
**Mild-mod [[hypoxemia]] and mild [[hypercapnia]] possible

==Differential Diagnosis==
{{Newborn DDX}}

==Diagnosis==
*ABG, with consideration of intraarterial line in umbilical artery if FiO2 > 40% 
*Continuous pulse oximetry
*[[CXR]] - perihilar streaking (lymph system engorgement), fluid in fissures, increase lung volumes with flat diaphragms

{{Newborn Normal ABG Parameters}}

==Management==
''See also [[newborn resuscitation]]''
*TTN is a benign, self-limited condition; treat with supportive care
*Supplemental [[O2]], maintain SpO2 > 90%
*If > 40% FiO2 or increasing work of breathing, consider:
**Nasal [[CPAP]]
**Surfactant replacement
*[[IV fluids]] but some suggest fluid restriction in the first day of life, gavage feedings until respiratory rate decreases enough for oral feedings (usually <60)

==Disposition==
*Admit

==See Also==
*[[Newborn resuscitation]]

==References==
*Guglani L, Lakshminrusimha S, Ryan R. Transient Tachypnea of the Newborn. Pediatrics in Review. 2008 e59-e65.
*Johnson, Karen E. Transient Tachypnea of the newborn. UpToDate. Aug 30 2021. Accessed via: https://www.uptodate.com/contents/transient-tachypnea-of-the-newborn?search=transient%20tachypnea%20of%20the%20newborn&source=search_result&selectedTitle=1~34&usage_type=default&display_rank=1#H8.

[[Category:Pediatrics]]
[[Category:OBGYN]]
[[Category:Pulmonary]]