Transient Tachypnea of the Newborn
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.
There's more to see -- the rest of this topic is available only to subscribers.
Citation
Cabana, Michael D., editor. "Transient Tachypnea of the Newborn." Select 5-Minute Pediatrics Topics, 7th ed., Wolters Kluwer Health, 2015. Medicine Central, im.unboundmedicine.com/medicine/view/Select-5-Minute-Pediatric-Consult/14077/all/Transient_Tachypnea_of_the_Newborn.
Transient Tachypnea of the Newborn. In: Cabana MDM, ed. Select 5-Minute Pediatrics Topics. Wolters Kluwer Health; 2015. https://im.unboundmedicine.com/medicine/view/Select-5-Minute-Pediatric-Consult/14077/all/Transient_Tachypnea_of_the_Newborn. Accessed October 10, 2024.
Transient Tachypnea of the Newborn. (2015). In Cabana, M. D. (Ed.), Select 5-Minute Pediatrics Topics (7th ed.). Wolters Kluwer Health. https://im.unboundmedicine.com/medicine/view/Select-5-Minute-Pediatric-Consult/14077/all/Transient_Tachypnea_of_the_Newborn
Transient Tachypnea of the Newborn [Internet]. In: Cabana MDM, editors. Select 5-Minute Pediatrics Topics. Wolters Kluwer Health; 2015. [cited 2024 October 10]. Available from: https://im.unboundmedicine.com/medicine/view/Select-5-Minute-Pediatric-Consult/14077/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 - 14077
ED - Cabana,Michael D,
BT - Select 5-Minute Pediatrics Topics
UR - https://im.unboundmedicine.com/medicine/view/Select-5-Minute-Pediatric-Consult/14077/all/Transient_Tachypnea_of_the_Newborn
PB - Wolters Kluwer Health
ET - 7
DB - Medicine Central
DP - Unbound Medicine
ER -