Introduction
Transient tachypnea of the newborn is a common, benign, and self-limited condition. It can occur in infants of any gestational age but is more common in babies born before 39 weeks of gestation, particularly in cases of elective cesarean deliveries without labor. There are several other risk factors in addition to cesarian delivery, a few of which include prematurity, male sex, macrosomia, twin gestation, maternal asthma, and maternal diabetes.
Presentation
Newborns present with respiratory distress within minutes to hours after birth. In addition to tachypnea (i.e., a respiratory rate faster than 60 breaths per minute), signs on inspection may include grunting, nasal flaring, chest retractions, increased anterior-posterior diameter of the chest (a.k.a., barrel-shaped chest), and in severe cases, cyanosis, which if present would respond well to oxygen supplementation. Chest auscultation typically reveals normal breath sounds; however, breath sounds may be diminished, and crackles can be present. Other than that, there should not be any evidence of systemic illness or infection.
Investigations
Characteristic chest x-ray findings include mild hyperinflation, perihilar streaking, and fluid within the interlobar fissures. There may also be small pleural effusions and a slightly enlarged cardiac silhouette. Depending on the severity of the condition, it may be reasonable to initially defer the chest x-ray for a brief period of observation. Improvement during this time may obviate the need for imaging studies. Further workup is determined on a case-by-case basis and may include arterial blood gas analysis, glucose screening, and a septic screen, amongst other investigations.
Management
Management is supportive; for example, it is vital to ensure adequate nutrition and maintain thermoneutrality. Despite the benign nature of the condition, these newborns are often admitted to NICU for continuous cardiopulmonary monitoring, respiratory support, intravenous fluids, or orogastric tube feeding. Antibiotics are also frequently provided since transient tachypnea of the newborn can be hard to distinguish from early neonatal sepsis and pneumonia clinically.
Prognosis
Signs and symptoms often resolve within 12 to 72 hours. Resolution of symptoms within this timespan confirms the diagnosis. Alternatively, evaluation for other causes of respiratory distress is prudent if symptoms persist beyond 72 hours after birth or if the newborn requires intubation or a FiO2 greater than 0.40.
Video Lecture
This video will discuss general concepts regarding the presentation, evaluation, and management of transient tachypnea of the newborn. References are listed in the description below.
References
1. Eunice Hagen, Alison Chu, Cheryl Lew; Transient Tachypnea of the Newborn. Neoreviews March 2017; 18 (3): e141–e148.
2. Guglani, L.; Lakshminrusimha, S.; Ryan, R. M. (2008). Transient Tachypnea of the Newborn. Pediatrics in Review, 29(11), e59–e65. doi:10.1542/pir.29-11-e59
3. Demissie K, Marcella SW, Breckenridge MB, Rhoads GG. Maternal asthma and transient tachypnea of the newborn. Pediatrics 1998;102:84-90.
4. Riskin A, Abend-Weinger M, Riskin-Mashiah S, Kugelman A, Bader D. Cesarean section, gestational age, and transient tachypnea of the newborn: timing is the key. Am J Perinatol. 2005;22(7):377-82.