Transient tachypnea of the newborn

See Newborn Resuscitation for immediate after-delivery resuscitation

Background

• Respiratory distress affects 1% of neonates:
  • RDS (hyaline membrane disease) ~50%
  • TTN ~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
  • SGA, preterm infants

DDx

• Congenital pna
• Congenital heart disease
• Meconium aspiration
• Neonatal sepsis
• PTX
• Pulmonary HTN
• Respiratory distress syndrome (RDS)

Clinical Features

• Respiratory distress in first few hrs of life
  • Tachypnea > 40-60 breaths/min
  • Increased O2 requirement - > 60% or mechanical ventilation need consideration of other differentials
  • Normal repeat ABGs (references below):

Subject	Age	PO2 mmHg	PCO2 mmHg	pH
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	1 wk	60	38	7.37