Transient tachypnea of the newborn (TTN) is a clinical syndrome characterized by tachypnea in the first few hours after birth due to delayed absorption of fetal lung fluid. TTN is usually self-limiting and resolves within 12-72 hours with supportive care such as supplemental oxygen or CPAP. A diagnosis of TTN requires excluding other potential causes of respiratory distress through evaluation including chest x-ray, lung ultrasound, and laboratory tests. Risk factors include late prematurity and cesarean delivery without labor. Prognosis is typically excellent as TTN is self-limiting with no long-term effects.

1. TRANSIENT TACHYPNEA OF NEWBORN
PRESENTER – DR. SHIV KUMAR SHAH
JUNIOR RESIDENT, DEPARTMENT OF PEDIATRICS
MODERATOR- DR BAIDHNATH THAKUR

2. OBJECTIVES
• INTRODUCTION
• CLINICAL MANIFESTATION
• PATHOPHYSIOLOGY
• RISK FACTOR
• DIAGNOSIS
• MANAGEMENT

3. INTRODUCTION
• Is a clinical syndrome of a self-limited tachypnea
• Associated with delayed clearance of fetal lung fluid
• most common cause of respiratory distress
• 0.5%to 4% late preterm and term neonates
• Symptoms start within the first several hours after birth

4. CLINICAL MANIFESTATION
• SIGN OF RESPIRATORY DISTRESS
• -Tachypnea
• Chest retractions
• Grunting
• cyanosis

5. Cont….
• Infants may have barrel shaped chest
• Palpable liver and spleen
• On Auscultaion- reveals good air entry, crackles may be appreciated

6. PATHOPHYSIOLOGY
• During fetal life, the lung epithelium is responsible for production of a
substantial volume of alveolar fluid, a process that is essential for normal fetal
lung growth
• With parturition , increased levels of epinephrine, glucocorticoids, and other
hormones cause the lung lung epithelia to transition from a secretory to a
resorptive phenotype
• Activated endothelial sodium channels(Enac) at the apical surface of lung type
II epithelial cells transport sodium and water from the alveolar space into type
II cells

7. Cont…..
• Sodium is then actively moved from the type II cell into the interstitium by
sodium-potassium pumps
• Causing passive movement of water which is then resorbed into the
pulmonary secretion and lymphatics
• Ineffective expression or activity of ENaC and NA+, K+-ATPase, which slows
absorption of fetal lung fluid and results in decreased pulmonary
compliance and impeded gas exchange

8. RISK FACTOR
• Twin gestation
• Maternal asthma
• Late prematurity
• Precipitous delivery
• Gestational diabetes
• Cesarean delivery without labor

9. DIAGNOSIS
• Diagnosis of TTN requires the exclusion of other potential
etiologies

10. Radiographic evaluation
(chest xray)
• Prominent perihilar streaking (Sunburst pattern )
• Coarse fluffy densities
• Mild cardiomegaly
• Hyperaeration with widening of inter-costal space
• Mild pleural effusion
• Radiographic findings improve by 12 to 18 hours and resolves by 48-
72 hour of life

11. LUNG ULTRASOUND
• Differentiate TTN from RDS with good specificity
• Absence of consolidation
• Replacement of A lines by B lines
• Numerous compact B lines producing white lung
• Double lung point sign

12. Laboratory Evaluation
• CBC and appropriate cultures to rule out pneumonia/sepsis
• Arterial blood gas- mild hypoxemia and mild respiratory acidosis

13. Differential diagnosis
• Pneumonia/sepsis
• Respiratory distress syndrome
• Pulmonary hypertension
• Meconium aspiration
• Cyanotic congenital heart disease
• CNS injury- sub arachnoid hemorrhage, HIE
• Pnemothorax
• Polycythemia
• Metabolic acidosis

14. Treatment
• Suportive with supplemental oxygen as needed
• May need CPAP
• Respiratory distress severe- investigate and exclude serious illness
• May treated with antibiotics until blood culture report negative
• Relative restricted fluid intake- decrease duration of respiratory
support in severe cases of TTN

15. COMPLICATION
• Although self-limited process - must be prepared for advance
respiratory support and complication associated with condition that
mimic TTN

16. Prognosis
• By definition, TTN is self limited process with no risk of recurrence
and prognosis is excellent
• No significant long term residual effects

17. SUMMARY
• Transient tachypnea of the newborn (TTN) is a self limited
disorder,with symptoms resolving in 12 -72 hours
• TTN should be a diagnosis of exclusion
• It mimics the early presentation of serious respiratory,cardiac or
infectious disorders in newborns
• Management is supportive, may need oxygen therapy, CPAP,
• Antenatal steroids in anticipated late preterm bith ameliorate the risk
of TTN

18. REFERENCES
• CLOHERTY AND STARK’S MANUAL OF NEONATAL CARE
• NELSON TEXTBOOK OF PEDIATRICS
• AVERY’S DISEASE OF THE NEW BORN