Transient tachypnea of the newborn: Difference between revisions

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==Background==
==Background==
*Respiratory distress affects 1% of neonates:
*Respiratory distress affects 1% of neonates:
**RDS (hyaline membrane disease) ~50%
**[[Respiratory distress syndrome]] (hyaline membrane disease) ~50%
**TTN ~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
*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
*1/3 of fluid cleared days before birth, 1/3 during active labor, 1/3 during crying/breathing
*Risk factors
*Risk factors
**Prematurity
**C-section and rapidly born infants (lack of active labor)
**C-section and rapidly born infants (lack of active labor)
**Infants of diabetic mothers
**Infants of diabetic mothers or obese mothers
**SGA, preterm infants
**small for gestational age, preterm infants


==Differential Diagnosis==
{{Newborn vital signs}}
*Congenital [[pneumonia]]
*[[Congenital heart disease]]
*Meconium aspiration
*[[Neonatal sepsis]]
*[[Pneumothorax]]
*[[Pulmonary hypertension]]
*[[Respiratory distress syndrome]] (RDS)


==Clinical Features==
==Clinical Features==
*Respiratory distress in first few hrs 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 with clear breath sounds (no rales or rhonchi)
*May have cyanosis
*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 abnl ABGs (acceptable ranges/expected progression below at bottom):
*Normal to mildly abnormal [[ABG]]s (acceptable ranges/expected progression below at bottom):
**Mild respiratory acidosis
**Mild [[respiratory acidosis]]
**Mild-mod hypoxemia and mild hypercapnea possible
**Mild-mod [[hypoxemia]] and mild [[hypercapnia]] possible
{| class="wikitable"
 
|-
==Differential Diagnosis==
! Subject !! PO2 mmHg !! PCO2 mmHg !! pH !! Bicarb
{{Newborn DDX}}
|-
| < 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 || -
|-


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


==Treatment==
==Management==
*Supplemental O2, maintain SpO2 > 90%
''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:
*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]] 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==
==References==
*Guglani L, Lakshminrusimha S, Ryan R. Transient Tachypnea of the Newborn. Pediatrics in Review. 2008 e59-e65.
*Guglani L, Lakshminrusimha S, Ryan R. Transient Tachypnea of the Newborn. Pediatrics in Review. 2008 e59-e65.
*Transient tachypnea of the newborn - eMedicine
*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.
*Transient tachypnea of the newborn - UpToDate


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

Latest revision as of 16:49, 29 April 2022

See Newborn Resuscitation for immediate after-delivery resuscitation

Background

  • Respiratory distress affects 1% of neonates:
  • 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[1]

Age Pulse^ Respiratory Rate Systolic BP
Preterm < 1 kg 120-160 30-60 36-58
Preterm 1 kg 120-160 30-60 42-66
Preterm 2 kg 120-160 30-60 50-72
Newborn 126-160 30-60 60-70
Min of life Target sat^^
1 min 60-65%
2 min 65-70%
3 min 70-75%
4 min 75-80%
5 min 80-85%
10 min 85-95%

^Fever directly causes an increase in heart rate of 10 beats per minute per degree centigrade[2] ^^Hyperoxia can be harmful

Clinical Features

  • 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 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):

Differential Diagnosis

Newborn Problems

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

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 -

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

References

  1. ↑ National-Model-EMS-Clinical-Guidelines-23Oct2014
  2. ↑ Davies P, Maconochie I. The relationship between body temperature, heart rate and respiratory rate in children. Emerg Med J. 2009 Sep;26(9):641-3. doi: 10.1136/emj.2008.061598.
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