Transient tachypnea of the newborn
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
Newborn Problems
- Newborn resuscitation
- Hypoxia
- Primary apnea
- Secondary apnea
- Hypothermia
- Hypoglycemia
- Meconium aspiration syndrome
- Anemia (abruption)
- Infant scalp hematoma
- Transient tachypnea of the newborn
- Respiratory distress syndrome
- Congenital pneumonia
- Congenital heart disease
- Neonatal sepsis
- Pneumothorax
- Pulmonary hypertension
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 | - |