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Transient Tachypnea of the Newborn – Breathing Difficulty After Birth

What is the transient tachypnea of the newborn?

Transient tachypnea of the newborn also known as TTN is a respiratory disorder of the newborn. In this disorder, there is a temporary increase in the respiratory rate of the newborn. It usually occurs in the first hour of birth. Mostly it is a mild disorder and usually settles without any treatment within the three days.

It comprises of two terms:

  • Transient means ‘temporary’ usually within 24 hours.
  • Tachypnea means ‘an increase in respiratory rate’ i.e. greater than 30 per min.

What causes the Transient Tachypnea of the Newborn?

Babies don’t breathe as long as they are inside the mother’s womb. When they are born there is fluid inside their lungs which is absorbed over the period of a couple of days. It occurs due to hormonal changes.

After birth, the baby starts breathing and absorbs oxygen from the lungs and this fluid hinders oxygen absorption. Babies breathe at a faster rate to compensate for it causing tachypnea of the newborn. This explains why this happens earlier in life and resolves gradually.

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Babies at risk for TTN

Premature babies who are born before 27 weeks are at a greater risk of having TTN after birth. This happens because the lungs are immature at this time and it takes more time to settle.

Incidence

Luckily, TTN is not a common disorder and only occurs in 3 to 5 babies per 1,000 babies born at term. However, the rate is slightly higher in premature babies up to 10 per 1,000 births. Similarly, the incidence is also greater after the cesarean section as compared to normal vaginal delivery.

Other factors that increase the risks for the baby include a diabetic mother and male gender.

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Symptoms of the transient tachypnea of the newborn

A newborn with TTN usually presents with the following symptoms:

  • Baby is breathing at a faster rate and can be greater than 60 breaths per min.
  • You can hear a grunting sound as the baby breathes.
  • There is a flaring of the nostrils.
  • The breathing is with a lot of effort as evident by the pulling in of the ribs.

You can easily miss these symptoms for other diseases. Although this condition is mild most of the times it is better to consult a doctor if your baby is having these symptoms.

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How long does the transient tachypnea of the newborn last?

TTN is a mild breathing difficulty that is more pronounced in the early period of life especially the first hour of the birth. During this first hour, the baby requires medical help and close monitoring. However, as time progresses it starts resolves. Mostly it requires no treatment or intervention and the condition settles on its own within 3 days.

However, in some cases, the disease can progress into a severe respiratory disorder and can be fatal if neglected. Treatment and intervention are needed in such cases and the disease takes longer to settle.

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How to diagnose a newborn with TTN?

The diagnosis of this disease comprises of both clinical and radiological examination.

Clinical

If a newborn is having respiratory difficulty one should have the suspicion of TTN besides other serious conditions like pneumonia and respiratory distress syndrome. However, the improvement of the symptoms as the time progresses strengthens the diagnosis.

Radiological

  • Chest X-ray is a safe and painless procedure that greatly helps in making a diagnosis. An X-ray shows a streak of fluid in the lungs along with hyperinflation of the lungs. Moreover, the absence of specific features of pneumonia and respiratory distress also supports the diagnosis.
  • Ultrasound chest can confirm the presence of the fluid in the lungs which has a better sensitivity than X-ray.

Oxygenation

TTN is characterized by the lack of oxygenation which makes the baby tachypneic. This can be assessed by pulse oximeter which is a painless test. However, for better results, we require arterial blood gases which show the oxygen saturation.

Complete Blood Count

A complete blood picture can indicate infection to help with the diagnosis.

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How to treat transient tachypnea of the newborn?

TTN baby requires close monitoring. Although the disease resolves on its own, we can provide supportive treatment to the baby. It can progress to severe respiratory disease if ignored. The baby has to be monitored carefully for the heart rate, respiratory rate, and oxygen saturation. Some of the therapies that can be given include:

·         Oxygen

The baby is oxygen hungry thus applying oxygen through a face mask or nasal cannula will help the baby a lot. It reduces the baby’s respiratory effort and decreases the rate as well.

·         Continuous Positive Airway Pressure

Giving too much oxygen to the baby is also a trouble if the tachypnea is not settled. This can cause the lungs to collapse and strop the respiratory drive. This can be devastating.

TTN can be picked easily from the arterial blood gases and treated by applying the continuous positive airway pressure. This removes the extra oxygen and keeps the lung patent. You can repeat CPAP again and again as per requirement.

·         IV Fluids

Keeping the baby hydrated helps with the condition and also prevents the sugar from dropping because of extra respiratory effort.

Also Read: Premature Baby Complications – What To Expect As Parents

When to get a consultation?

Here are a few signs which require immediate consultation from a doctor:

  • Condition not improving after three days.
  • Breathing getting worse instead of improving with time.
  • The baby is having difficulty breathing along with the increased rate.

Also Read: When Can Babies Sleep With a Pillow?

Transient tachypnea of the newborn, what is new?

TTN is a hot topic of research nowadays. The use of corticosteroids in the antenatal period helps in the reduction of the fluid in the lung at the time of the birth. Similarly, the use of furosemide also helps with the quick reduction of the fluid from the lungs after birth.

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