Transient tachypnea of the newborn

See Newborn Resuscitation for immediate after-delivery resuscitation

Background

Respiratory distress affects 1% of neonates:
- Respiratory Distress Syndrome (hyaline membrane disease) ~50%
- Transient tachypnea of the newborn ~50%
Self-limiting disease that resolves with days as retained lung fluid at birth is removed by lymphatics and breathing
1/3 of fluid cleared days before birth, 1/3 during active labor, 1/3 during crying/breathing
Risk factors
- C-section and rapidly born infants (lack of active labor)
- Infants of diabetic mothers
- small for gestational age, preterm infants

Respiratory distress in first few hours of life
Tachypnea > 40-60 breaths/min, grunting, flaring, retractions
May have "quiet" tachypnea, not appearing in distress
Increased O2 requirement - > 60% or mechanical ventilation need consideration of other differentials
Normal CBC
Normal to mildly abnormal ABGs (acceptable ranges/expected progression below at bottom):
- Mild respiratory acidosis
- Mild-mod hypoxemia and mild hypercapnea possible

ABG, with consideration of intraarterial line in umbilical artery if FiO2 > 40%
Continuous pulse oximetry
CXR - perihilar streaking (lymph system engorgement), fluid in fissures, increase lung volumes with flat diaphragms

Supplemental O2, maintain SpO2 > 90%
If > 40% FiO2 or increasing work of breathing, consider:
- Nasal CPAP
- Surfactant replacement
IV fluids, gavage feedings until RR decreases enough for oral feedings

Guglani L, Lakshminrusimha S, Ryan R. Transient Tachypnea of the Newborn. Pediatrics in Review. 2008 e59-e65.
Transient tachypnea of the newborn - eMedicine
Transient tachypnea of the newborn - UpToDate

Subject	PO2 mmHg	PCO2 mmHg	pH	Bicarb
< 28 wks	50-65	40-50	>7.28	18-24
38-49 wks	50-70	40-50	>7.3	20-24
Term (10 min)	50	48	7.2	-
Term (1 hr)	70	35	7.35	-
Term (1 wk)	75	35	7.4	-
Preterm 1.5 kg	60	38	7.37	-