Table Of Contents
Transient Tachypnea of the Newborn (TTN)
Mild, temporary respiratory distress d/t retained fluid in the foetal lungs – which is a function of how the baby was delivered. It is a self-limited condition resolves within 72 hours. MCC of neonatal respiratory distress.
- Cause
- Retained fetal lung fluid (should have been absorbed into circulation during labor)
- Risk factors
- Large premature infant
- Term infant born by precipitous delivery
- Diabetic mother
- Perinatal asphyxia
- Short second stage of labor (delivery stage)
- C/S (in which ROM has not occurred)
- Excessive maternal sedation
- Rule of 1/3
- 1/3 reabsorbed during late gestation
- 1/3 mechanically expelled during birth (vaginal delivery)
- 1/3 during crying
- Investigations
- Chest-Xray
- Retained fluid manifesting as interstitial opacification, perihilar streaking and opacity along interlobar fissures
- Hyperinflation
- Small pleural effusion (occassionaly)
- Chest-Xray
- Treatment
- Nasal CPAP (in the presence of cyanosis/hypoxia)
- Empiric antibiotics (Penicillin and Gentamicin) or at least 48 hours until neonatal sepsis has been ruled out.
- Monitor for signs of clinical deterioration.
- Resolves spontaneously within 12-24 hours
Chest X-ray showing interstial opacification in both lungs, which is characteristic of TTN. The patient is slightly rotated
Differentiating TTN from NRDS
| Feature | Transient Tachypnea of the Newborn (TTN) | Neonatal Respiratory Distress Syndrome (NRDS) |
|---|---|---|
| Pathophysiology | Delayed clearance of lung fluid | Surfactant deficiency → Alveolar collapse |
| Gestational Age | Term or late preterm (≥35 weeks) | Preterm (<34 weeks) |
| Risk Factors | C-section, maternal diabetes, macrosomia, inadequate thoracic squeeze | Prematurity, maternal diabetes, perinatal asphyxia |
| Onset of Symptoms | Within hours after birth | Immediately after birth |
| Respiratory Rate | Tachypnea (>60 bpm) | Tachypnea (>60 bpm) |
| Oxygen Requirement | Minimal, resolves in 24-72 hours | Progressive hypoxia, needs CPAP or mechanical ventilation |
| CXR Findings | Hyperinflation, fluid in fissures, perihilar streaking | Ground-glass opacities, air bronchograms, low lung volume |
| Treatment | Supportive (O₂, CPAP if needed) | Surfactant, CPAP, ventilation if severe |
