Transient Tachypnea of New born (TTN)

INTRODUCTION:
  • Fetal lungs are filled with liquid that is crucial for normal lung growth. 
  • A delay in fluid clearance leads to ineffective gas exchange and results in respiratory distress. This impermanent condition of retained fetal lung fluid is known as transient tachypnea of the newborn (TTN). 
ETIOLOGY:
  • Malformation
  • RDS
  • Air leak 
  • Sepsis
  • Metabolis M
  • MAS
  • Pneumonia
  • CHD
  • CDH
  • PPHN
RISK FACTORS:
  • Delivery before completing 39 weeks of gestation
  • Cesarean section without labor
  • Prematurity
  • Male sex
  • Large for gestational age
  • Small for gestational age
  • Perinatal asphyxia
  • Maternal asthma
  • Maternal gestational diabetes
CLINICAL PRESENTATION:
  • They have signs of respiratory distresssuch as
  1. tachypnea (respiratory rate >60 breaths/min),
  2. nasal flaring,
  3. grunting, and intercostal, subcostal, and/or suprasternal retractions.
  4. On auscultation, breath sounds may be diminished, crackles may be appreciated, or lung fields may be clear. Tachycardia may often be associated.
DIAGNOSIS:
  • X-ray:
  1. Prominent pulmonary vascular markings and fluid lines in the fissures
  • Ultrasound:
  1. Regular pleural line
  2. Numerous B lines
  3. Coalescent B lines in the basies of the lungs
MANAGEMENT:
  • General management
  • Respiratory:Noninvasive respiratory support (eg, nasal cannula, nasal CPAP) and may need supplemental oxygen to maintain normal oxygen saturation levels. If a newborn is requiring FiO2 greater than 0.40 or endotracheal intubation, there is increased likelihood of another cause of the child’s distress and reevaluation is necessary. 
  • Nutrition and hydration:Receive nutrition via gavage feeding, IV solution, or a combination of both
  • Medications:Diuretic therapy , inhaled racemic epinephrine, and inhaled b2-agonists
Exam Question
  • Newborn with an early onset of dyspnea with chest retractions, expiratory grunting and cyanosis following an uneventful normal preterm labor. On examination no cardiac murmurs are heard and the lungs appear clear. On a plain X-ray there is evidence of prominent pulmonary vascular markings and fluid lines in the fissures. The cyanosis improves with minimal oxygen. The most probable diagnosis is Transient tachypnea of the newborn
  • Transient Tachypnea of New born (TTN) is due to delayed clearance of lung fluids
  • X – ray may show prominent vascular markings with prominent interlobar fissure
  • A diabetic female at 39 weeks of gestation delivered a baby by elective cesarean section. Soon after birth the baby developed respiratory distress. Chest X-ray shows opacity in right middle lobe fissure. The diagnosis is Transient Tachypnea of New born (TTN)
  • Transient tachypnea of new born (TTN) is commonly seen in Elective caesarean section
  • Onset of respiratory distress is immediately after birth and it rarely lasts beyond 48 hrs
  • Respiratory rate in a 2 month old, to label it tachypnea is 60
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