Transient tachypnea of the newborn: Difference between revisions
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**Infants of diabetic mothers | **Infants of diabetic mothers | ||
**small for gestational age, preterm infants | **small for gestational age, preterm infants | ||
==Clinical Features== | ==Clinical Features== | ||
*Respiratory distress in first few hours of life | *[[shortness of breath (peds)|Respiratory distress]] in first few hours of life | ||
*Tachypnea > 40-60 breaths/min, grunting, flaring, retractions | *Tachypnea > 40-60 breaths/min, grunting, flaring, retractions | ||
*May have "quiet" tachypnea, not appearing in distress | *May have "quiet" tachypnea, not appearing in distress | ||
*Increased O2 requirement - > 60% or mechanical ventilation need consideration of other differentials | *Increased [[hypoxia|O2 requirement]] - > 60% or mechanical ventilation need consideration of other differentials | ||
*Normal CBC | *Normal CBC | ||
*Normal to mildly abnormal | *Normal to mildly abnormal [[ABG]]s (acceptable ranges/expected progression below at bottom): | ||
**Mild respiratory acidosis | **Mild respiratory acidosis | ||
**Mild-mod hypoxemia and mild | **Mild-mod hypoxemia and mild hypercapnia possible | ||
{| class="wikitable" | {| class="wikitable" | ||
|- | |- | ||
| Line 46: | Line 37: | ||
| Preterm 1.5 kg || 60 || 38 || 7.37 || - | | Preterm 1.5 kg || 60 || 38 || 7.37 || - | ||
|- | |- | ||
==Differential Diagnosis== | |||
*Congenital [[pneumonia]] | |||
*[[Congenital heart disease]] | |||
*Meconium aspiration | |||
*[[Neonatal sepsis]] | |||
*[[Pneumothorax]] | |||
*[[Pulmonary hypertension]] | |||
*[[Respiratory distress syndrome]] (RDS) | |||
==Workup== | ==Workup== | ||
| Line 53: | Line 53: | ||
==Management== | ==Management== | ||
*Supplemental O2, maintain SpO2 > 90% | ''See also [[newborn resuscitation]]'' | ||
*Supplemental [[O2]], maintain SpO2 > 90% | |||
*If > 40% FiO2 or increasing work of breathing, consider: | *If > 40% FiO2 or increasing work of breathing, consider: | ||
**Nasal CPAP | **Nasal [[CPAP]] | ||
**Surfactant replacement | **Surfactant replacement | ||
*IV fluids, gavage feedings until RR decreases enough for oral feedings | *[[IV fluids]], gavage feedings until RR decreases enough for oral feedings | ||
==Disposition== | |||
*Admit | |||
==See Also== | |||
*[[Newborn resuscitation]] | |||
==References== | ==References== | ||
Revision as of 18:09, 4 October 2019
See Newborn Resuscitation for immediate after-delivery resuscitation
Background
- Respiratory distress affects 1% of neonates:
- 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
- 1/3 of fluid cleared days before birth, 1/3 during active labor, 1/3 during crying/breathing
- Risk factors
- C-section and rapidly born infants (lack of active labor)
- Infants of diabetic mothers
- small for gestational age, preterm infants
Clinical Features
- Respiratory distress in first few hours of life
- Tachypnea > 40-60 breaths/min, grunting, flaring, retractions
- May have "quiet" tachypnea, not appearing in distress
- Increased O2 requirement - > 60% or mechanical ventilation need consideration of other differentials
- Normal CBC
- Normal to mildly abnormal ABGs (acceptable ranges/expected progression below at bottom):
- Mild respiratory acidosis
- Mild-mod hypoxemia and mild hypercapnia possible
Differential Diagnosis
- Congenital pneumonia
- Congenital heart disease
- Meconium aspiration
- Neonatal sepsis
- Pneumothorax
- Pulmonary hypertension
- Respiratory distress syndrome (RDS)
Workup
- 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
Management
See also newborn resuscitation
- Supplemental O2, maintain SpO2 > 90%
- If > 40% FiO2 or increasing work of breathing, consider:
- Nasal CPAP
- Surfactant replacement
- IV fluids, gavage feedings until RR decreases enough for oral feedings
Disposition
- Admit
See Also
References
- Guglani L, Lakshminrusimha S, Ryan R. Transient Tachypnea of the Newborn. Pediatrics in Review. 2008 e59-e65.
- Transient tachypnea of the newborn - eMedicine
- Transient tachypnea of the newborn - UpToDate
| Subject | PO2 mmHg | PCO2 mmHg | pH | Bicarb |
|---|---|---|---|---|
| < 28 wks | 50-65 | 40-50 | >7.28 | 18-24 |
| 38-49 wks | 50-70 | 40-50 | >7.3 | 20-24 |
| Term (10 min) | 50 | 48 | 7.2 | - |
| Term (1 hr) | 70 | 35 | 7.35 | - |
| Term (1 wk) | 75 | 35 | 7.4 | - |
| Preterm 1.5 kg | 60 | 38 | 7.37 | - |