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Transient Tachypnea of the Newborn

Transient Tachypnea of the Newborn is a topic covered in the 5-Minute Pediatric Consult.

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Basics

Description

  • Early onset of tachypnea (respiratory rate >60 breaths/minute) in the newborn following an uneventful delivery
  • Symptoms of respiratory distress including mild retractions, expiratory grunting, and nasal flaring may occur. Cyanosis is rarely involved.

Epidemiology

  • Estimated 4 to 6 per 1,000 live births
  • Incidence is likely underestimated.
  • Most common cause of respiratory distress in newborns
  • Higher in males

Risk Factors

  • Early gestation
  • Cesarean section delivery (with or without preceding labor)
  • Male gender
  • Maternal diabetes
  • Macrosomia
  • Low birth weight
  • Maternal history of asthma
  • Unexplained transient tachypnea of the newborn (TTN) in individuals belonging to the same family suggests a genetic predisposition.

General Prevention

  • Vaginal delivery should be recommended in the absence of maternal or fetal indications for cesarean section.
  • Elective cesarean section before 39 weeks’ gestation should be avoided.

Pathophysiology

Transient pulmonary edema due to delayed clearance of fetal lung fluid

Etiology

  • During fetal life, pulmonary epithelial cells are secretory, delivering chloride into the alveolar space.
  • Sodium and water follow chloride into the alveoli, establishing and maintaining fetal lung fluid.
  • During labor and delivery, fetal lung fluid is absorbed through a variety of proposed mechanisms:
    • Epithelial cells transition from secretory cells to absorptive cells in response to circulating epinephrine levels, which trigger opening of epithelial sodium channels (ENaC).
    • Compression of the fetal thorax from uterine contractions and passage through the vaginal canal contributes to removal of fluid from the lungs through the pulmonary circulation.
    • Prostaglandin-mediated dilation of lymphatic vessels occurs with resultant absorption of interstitial lung fluid into the lymphatic system.
  • TTN occurs when there is inadequate fluid clearance from the lungs.
  • It is believed that this excess interstitial lung fluid contributes to decreased lung compliance.

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Citation

Cabana, Michael D., editor. "Transient Tachypnea of the Newborn." 5-Minute Pediatric Consult, 8th ed., Wolters Kluwer, 2019. Pediatrics Central, peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/618144/all/Transient_Tachypnea_of_the_Newborn.
Transient Tachypnea of the Newborn. In: Cabana MD, ed. 5-Minute Pediatric Consult. 8th ed. Wolters Kluwer; 2019. https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/618144/all/Transient_Tachypnea_of_the_Newborn. Accessed April 22, 2019.
Transient Tachypnea of the Newborn. (2019). In Cabana, M. D. (Ed.), 5-Minute Pediatric Consult. Available from https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/618144/all/Transient_Tachypnea_of_the_Newborn
Transient Tachypnea of the Newborn [Internet]. In: Cabana MD, editors. 5-Minute Pediatric Consult. Wolters Kluwer; 2019. [cited 2019 April 22]. Available from: https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/618144/all/Transient_Tachypnea_of_the_Newborn.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Transient Tachypnea of the Newborn ID - 618144 ED - Cabana,Michael D, BT - 5-Minute Pediatric Consult UR - https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/618144/all/Transient_Tachypnea_of_the_Newborn PB - Wolters Kluwer ET - 8 DB - Pediatrics Central DP - Unbound Medicine ER -