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Transient tachypnea - newborn

  • Definition
    • Transient tachypnea is a breathing disorder seen shortly after delivery in full-term or late preterm babies.

      • Transient means it is short-lived (most often less than 24 hours).
      • Tachypnea means rapid breathing (faster than most normal newborns, who breathe 40 to 60 times per minute).
  • Alternative Names
    • TTN; Wet lungs - newborns; Retained fetal lung fluid; Transient RDS; Prolonged transition; Neonatal - transient tachypnea

  • Causes
    • As the baby grows in the womb, the lungs make a special fluid. This fluid fills the baby's lungs and helps them grow. When the baby is born at term, chemicals released during labor tell the lungs to stop making this special fluid. The baby's lungs start removing or reabsorbing it.

      The first few breaths a baby takes after delivery fill the lungs with air and help to clear most of the remaining lung fluid.

      Leftover fluid in the lungs causes the baby to breathe rapidly. It is harder for the small air sacs of the lungs to stay open.

      Transient tachypnea is more likely to occur in babies who were:

      • Born before 38 weeks gestation
      • Delivered by C-section, especially if labor has not already started
      • Born to a mother with diabetes
      • Male
  • Symptoms
    • Newborns with transient tachypnea have breathing problems soon after birth, most often within 1 to 2 hours.

      Symptoms include:

      • Bluish skin color (cyanosis)
      • Rapid breathing, which may occur with noises such as grunting
      • Flaring nostrils or movements between the ribs or breastbone known as retractions
  • Exams and Tests
    • The mother's pregnancy and labor history are important to make the diagnosis.

      Tests performed on the baby may include:

      • Blood count and blood culture to rule out infection
      • Chest x-ray to rule out other causes of breathing problems
      • Continuous monitoring of the baby's oxygen levels, breathing, and heart rate

      The diagnosis of transient tachypnea is most often made after the baby is monitored for 1 or 2 days. If the condition goes away in that time, it is considered to be transient.

  • Treatment
    • Your baby will be given oxygen to keep the blood oxygen level stable. Your baby will often need the most oxygen within a few hours after birth. The baby's oxygen needs will begin to decrease after that. Most infants with transient tachypnea improve in less than 12 to 24 hours.

      Very rapid breathing can cause the baby to feed poorly. Fluids and nutrients will be given through a vein until your baby improves. Your baby may also receive antibiotics until the health care provider is sure there is no infection. Rarely, babies with transient tachypnea will have lung problems that last for as long as a week or so.

  • Outlook (Prognosis)
    • The condition most often goes away within 24 to 48 hours after delivery. In most cases, babies who have had transient tachypnea have no further problems from the condition. They will not need special care or follow-up other than their routine checkups.

      Late preterm babies (born about 2 to 6 weeks before their due date) who have been delivered by C-section without labor may be at risk for a more severe form known as "malignant TTN."

  • References
    • Carlo WA, Ambalavanan N. Respiratory tract disorders. In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 101.

      Greenberg JM, Narendran V, Schibler KR, et al. Neonatal morbidities of prenatal and perinatal origin. In: Creasy RK, Resnick R, Iams JD, et al, eds. Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice. 7th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 72.