Critical topic in paediatrics

1. PAEDIATRICS AND CHILD HEALTH
• NEONATOLOGY
• Transient Tachypnea of the Newborn (TTN)
Dr. Chongo Shapi
- Bsc.HB, MBChB.
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2. Introduction
• TTN is a syndrome that is caused by transient
pulmonary oedema due to delayed (slow)
absorption of fetal lung fluid by lymphatics
• This results in:
1. Decreased pulmonary compliance (increased
pulmonary resistance)
2. Decreased tidal volume (TV)
3. Increased dead space
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Dr. Chongo Shapi, BSc.HB, MBChB, CUZ.
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3. Introduction
• In severe cases, retained fetal fluid can interfere
with the normal postnatal fall in pulmonary
vascular resistance
• This leads to persistent pulmonary hypertension
of the newborn (PPHN)
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Dr. Chongo Shapi, BSc.HB, MBChB, CUZ.
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4. Clinical Manifestations
• TTN usually follows uneventful normal preterm
(near term) or term vaginal delivery or cesarean
delivery
• Diagnosis is by physical exam findings:
a. Early onset of tachypnea (increased RR > 60 b/m)
b. Chest retractions
c. Nasal flaring
d. Expiratory grunting
e. Occasionally, cyanosis that is relieved by minimal
oxygen (<40%). If not think of another diagnosis
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Dr. Chongo Shapi, BSc.HB, MBChB, CUZ.
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5. • TTN usually develop within 2-6 hour after delivery
commonly after caesarean section
• Patients usually recover rapidly within 3 days:
a. Lungs clear without rales or rhonchi
b. CXR shows:
- Prominent pulmonary vascular markings
- Fluid in the intralobar fissures
- Overaeration
- Flat diaphragms
- Rarely, pleural effusions
c. Hypercapnia and acidosis are uncommon
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6. Risk factors for TTN
• Precipitous labour
• Macrosomia
• Elective CS
• Maternal narcotic administration
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Dr. Chongo Shapi, BSc.HB, MBChB, CUZ.
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7. TTN vs RDS
• Distinguishing the disease from RDS may be
difficult
• The distinctive features of TTN are sudden
recovery of the infant and the absence of x-ray
findings of RDS
• RDS on CXR: ground glass appearance
- Hypoaeration
- Diffuse reticulogranular pattern
- Air bronchograms
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Dr. Chongo Shapi, BSc.HB, MBChB, CUZ.
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8. RDS
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Dr. Chongo Shapi, BSc.HB, MBChB, CUZ.
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9. Differential diagnosis
• Respiratory distress syndrome (RDS)
• Meconium Aspiration Syndrome (MAS)
• Congenital pneumonia
• Neonatal Sepsis
• Persistent Pulmonary Hypertension of the
Newborn (PPHN)
• Pneumothorax
• Pneumomediastinum
• Cyanotic congenital heart disease (CCHD)
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Dr. Chongo Shapi, BSc.HB, MBChB, CUZ.
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10. Treatment
• Treatment is supportive
• There is no evidence for the use of oral furosemide in
this disorder
• Severe respiratory morbidity and mortality have
been reported in infants born by elective CS who
initially present with signs and symptoms of TTN
• These infants develop refractory hypoxemia due to
pulmonary hypertension and require extracorporeal
membrane oxygenation ( ECMO) support
• The term “malignant TTN” has been used to describe
this condition
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11. The End!
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Dr. Chongo Shapi, BSc.HB, MBChB, CUZ.
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