Transient tachypnea of the newborn

• 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

• 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

• 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

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 respiratory rate decreases enough for oral feedings

• Admit

• Newborn resuscitation

• Guglani L, Lakshminrusimha S, Ryan R. Transient Tachypnea of the Newborn. Pediatrics in Review. 2008 e59-e65.