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Transient Tachypnea of the Newborn (TTN)

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by

Basma Abadel

on 13 April 2014

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Transcript of Transient Tachypnea of the Newborn (TTN)

Transient Tachypnea of the Newborn (TTN)


Investigations
“ Wet lung disease “
Diffuse and symmetrical
Hyperinflation with flat diaphragms
Mild cardiomegaly,
Engorgement of the lymphatic system with retained lung fluid > Prominent vascular markings
Fluid in the interlobar fissures
Pleural effusions may be present
Alveolar edema (fluffy densities)

Differential Diagnosis
Congenital Pneumonia
Meconium Aspiration Syndrome
Respiratory Distress Syndrome (RDS)
Neonatal Sepsis

Pneumomediastinum
Pneumothorax
Persistent Pulmonary Hypertension
Congenital heart disease
Polycythemia
Anemia/hypovolemia
Objectives
Definition of TTN
Epidemiology
Pathophysiology
Clinical Features
Risk Factors
Diagnosis
Differential Diagnosis
Summary
References

Clinical Features of TTN
At the time of birth & within 2 h. after delivery
Tachypnea (RR > 60 b/min.)
Nasal flaring, expiratory grunting
Mild intercostal and subcostal retractions
Increased anterior-posterior diameter
Breath sounds typically are clear

6-h. of age
Overinflation , streaky bilateral
Pulmonary interstitial opacities
Prominent perihilar interstitial markings
Mild cardiomegaly

2-day of age
Cardiomegaly has disappeared
Pulmonary parenchymal abnormalities are diminishing
But perihilar, streaky markings persist
Risk Factors of TTN
Preterm
C/S without labor
NOT experienced all of the stages of labor and subsequent lack of appropriate catecholamine
Their lung fluid was not squeezed out from the lung as they didn’t pass through the birth canal
IDM
Asthmatic mothers & smokers
Excessive maternal sedation
Perinatal asphyxia

Done by :
Basma Ali Abadel
Pediatric Resident (R1)

Definition of TTN
TTN is a parenchymal lung disorder characterized by pulmonary edema resulting from delayed resorption and clearance of fetal alveolar fluid, usually resolves over a 24 to 72-hour period


Epidemiology
United States :
1% of infants have some form of RD that is NOT associated with infection.
Respiratory distress includes both RDS & TTN
Of this 1%, approximately 33-50% have TTN

Mortality/Morbidity : self-limited
Sex : Risk is equal in both males & females
Age : TTN presents as RD in full-term or near-term infants


Pathophysiology
Fetal lung fluid secretion

Fetal lung fluid absorption

Clinical Significance of Inadaquate lung ENaC
Term
Mature surfactant pathways BUT have not yet developed adequate ENaC > TTN

Preterm
BOTH immature surfactant & ENaC > RDS


4-day of age
Normal heart size & clean lung
Respiratory Distress Syndrome (RDS)
M/C in preterm
Present in first 2-8 hours of life
CXR :
“ground-glass” appearance
Bell-shaped thorax
Bilateral & symmetrical
Hypoaeration 
Air bronchogram > peripherally
Fine granular pattern
Air-distended bronchioles & ducts
Background of atelectasis of alveoli
Tx. : CPAP & Surfactant via EET
Congenital Pneumonia
Intrauterine infection (M/C GBS +ve )
Present afebrile, metabolic acidosis (+-) septicemia and shock

CXR :
Patchy airspace disease
Perihilar streaky pattern (TTN)
Diffuse, relatively homogeneous infiltrates resembling ground-glass (RDS)
Pleural effusion may occur
Term infant with findings of “RDS” should be considered to have pneumonia until proven otherwise

Tx. : Appropriate antibiotic, O2

Meconium Aspiration Syndrome
M/C in FT & post-term
Present immediately & severe

CXR :
Patchy areas of atelectasis & emphysema from air-trapping (coarse nodular opacities)
Hyperinflation of lungs
Spontaneous pneumothorax & pneumomediastinum (25%)
No air bronchograms
Clearing usually quick if mostly water; days-weeks if mostly meconium

Tx. : Supportive , O2 & AB

Management of TTN
Supportive
Maintaining a neutral thermal environment
Oral feedings are withheld until the respiration has improved
Provide nutrition through OGT feeding or IVF
Furosemide does NOT affect the clinical course

Fluid restriction may be beneficial in the management of severe TTN
For preterm infants, the standard fluid management consisted of an intake of 80 mL/kg and restricted fluid therapy as 60 mL/kg for the first day of life.
For term infants, standard therapy was 60 mL/kg and restricted fluid therapy 40 mL/kg for the first day of life


It’s NOT TTN if :
Metabolic acidosis or respiratory acidosis is present
Infants who require persistently high oxygen concentration (> 60 %)
CPAP or mechanical ventilation is required
Infant begins to display fatigue (periodic breathing or apnea)
If tachypnea persists longer than 4 -6 h. or if the initial CBC & differential are abnormal > blood C/S & begin empiric
Infant fails to improve by age 48-72 hours
Radiographic resolution is not complete by the 3rd day or if respiratory symptoms persist longer than 5 days
Summary
Transient tachypnea of the newborn (TTN) is a common cause of respiratory distress in the immediate newborn period
Risk factors for TTN include prematurity, birth by cesarean delivery, maternal diabetes, and maternal asthma
The typical presentation of TTN is onset of tachypnea within 2 hours after delivery
Symptoms generally resolve after 12 to 24 hours but may persist as long as 72 hours in severe cases
Diagnosis of TTN is by exclusion of other differentials
TTN is a benign self-limited condition, management is supportive

References
Thank You :)
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