What is Transient Tachypnea of the Newborn?
Transient tachypnea of the newborn (TTN) is a harmless condition that goes away on its own and can appear in babies of any age, shortly after they’re born. It happens when there’s a delay in the clearing of fluid from a baby’s lungs after birth, which can lead to issues with breathing and an increased rate of breathing, also known as tachypnea. In a nursery, this often raises concerns when trying to diagnose newborn babies who are having difficulty breathing.
What Causes Transient Tachypnea of the Newborn?
There are some risks linked to the mother that can affect the baby’s health. These include giving birth before reaching 39 weeks of pregnancy, having a cesarean section (a surgical procedure to deliver the baby) without going into labor first, having high blood sugar levels during pregnancy (known as gestational diabetes), and the mother having asthma.
Other risks relate to the baby itself. These include being male, suffering from a lack of oxygen during birth (known as perinatal asphyxia), being born prematurely, being smaller than expected for the stage of pregnancy (known as small for gestational age), and being larger than expected for the stage of pregnancy (known as large for gestational age).
Risk Factors and Frequency for Transient Tachypnea of the Newborn
The chances of incidence, or occurrence, of a certain condition in newborns varies greatly based on their age at birth, more specifically, their gestation age. Here’s what the data shows:
- About 10% of babies born between 33 and 34 weeks of gestation might be affected.
- The risk drops to approximately 5% for infants delivered between 35 and 36 weeks.
- In contrast, less than 1% of full-term babies, i.e., those born after the 37th week, might face the issue.
Signs and Symptoms of Transient Tachypnea of the Newborn
This condition usually shows up within the first few minutes to hours after a baby is born. It often comes with signs of struggle in breathing, and sometimes other symptoms as well.
These common symptoms include:
- Rapid breathing (more than 60 breaths per minute)
- Flaring of the nostrils
- Grunting sounds
- Indentations in the chest between the ribs, below the ribs, or above the breastbone when breathing
- Crackling sounds or faint or normal sounds when listening to the lungs
Occasionally, other symptoms may be noticed, such as:
- Rapid heartbeat
- Blue or purple skin color
- Rounded, puffed-out chest due to overinflation of the lungs
Testing for Transient Tachypnea of the Newborn
If a newborn is experiencing difficulty breathing, how long it’s been going on can be a key clue in figuring out the problem. If it started soon after birth and wraps up within a few hours, doctors might decide it’s just a “delayed transition.” It’s sort of a gray area between that and a condition called transient tachypnea of the newborn (TTN), which basically means fast breathing. At about the 6-hour mark, doctors could lean more towards TTN because the baby might start having trouble feeding and need more treatment.
However, it’s not as simple as just watching the clock. TTN is typically a diagnosis you land on after ruling out other possibilities. If a newborn is still breathing too quickly after 6 hours, a more detailed evaluation might be necessary to figure out if something else is causing the trouble.
This further investigation might include:
* Measurements of the oxygen level in the blood before and after it’s gone through the heart (called preductal and postductal saturations). This can help rule out different types of low oxygen levels (cyanosis).
* Running complete blood count, blood culture, the C-reactive protein test, and the lactate test. All these would help rule out neonatal sepsis, a serious bloodstream infection that can occur in newborns.
* A test called an Arterial Blood Gas (ABG) analysis could be used if doctors think the baby isn’t getting enough oxygen (hypoxemia) or is losing too much carbon dioxide (hypocapnia) due to the fast breathing. If carbon dioxide levels are too high (hypercapnia), it could mean the baby is tired or there’s an air leak.
* A chest x-ray might also be taken which could show overinflated lungs, increased blood vessel visibility near the center of the lungs, extra fluid or inflammation in the space between the lobes of the lungs.
Doctors might also consider some other tests:
* If the baby is unusually tired and has a buildup of acid in the body, a blood test for ammonia levels might be done to check for inborn flaws of metabolism, which are rare genetic disorders affecting the body’s metabolism.
* Lastly, if there’s different cyanosis or the baby has ongoing fast breathing for over 4 to 5 days, an echocardiogram (an ultrasound of the heart) could be performed to make sure there are no issues with the baby’s heart.
Treatment Options for Transient Tachypnea of the Newborn
TTN, or Transient Tachypnea of the Newborn, is a temporary breathing problem often seen in babies born early. As the issue typically gets better on its own, the main focus of treatment is to support the baby’s symptoms as much as possible.
If a baby is struggling to breathe or showing signs of stress two hours after birth, or if they require high levels of oxygen or their chest X-ray shows abnormalities, they may need to be moved to a specialized care center equipped to handle complex newborn concerns. Regular neonatal care, including heart and lung monitoring, maintaining a warm environment, having an intravenous (IV) line placed for fluid and medications, checking blood glucose levels, and watching for infections, should be provided.
If tests show that the baby doesn’t have enough oxygen in their blood, oxygen therapy might be required. Oxygen can be given in several ways, such as by placing a plastic hood over the baby’s head or by using a nasal cannula (a device that provides oxygen through two small tubes in the nostrils). The level of oxygen should be adjusted to keep the baby’s oxygen saturation levels in the low 90s.
In very severe cases, a breathing tube may be needed to make sure the baby gets enough oxygen. The baby’s blood should be tested frequently for oxygen levels, and oxygen saturation should be monitored continuously until the baby’s breathing improves.
The extent of care for nutrition greatly depends on the baby’s breathing condition. If the baby is breathing too quickly or showing signs of distress, it may not be safe for them to eat normally. These babies should not be fed anything by mouth, and IV fluids should be started. Gradually, once the breathing distress is resolving and the baby’s breathing rate has dropped, feeding can begin slowly and progress gradually until the baby’s breathing is completely normal again.
Because it can be hard to tell the difference between TTN and serious infections like sepsis and pneumonia in newborns, the baby might need to receive antibiotics like ampicillin and gentamicin in the beginning until we can confirm the diagnosis.
Some studies have looked into giving furosemide or racemic epinephrine, to babies with TTN, but so far, these treatments haven’t shown to make a difference in how long the baby has rapid breathing or stays in the hospital. However, salbutamol, a medicine that can be breathed in, has shown some promise in reducing symptoms and shortening hospital stays. More research is still needed to understand how helpful it truly is and whether it is safe.
What else can Transient Tachypnea of the Newborn be?
When a child has respiratory problems, doctors will think about a number of possible causes. These could include:
- Pneumonia
- Respiratory distress syndrome
- Diseases caused by inhaling substances like meconium, blood or amniotic fluid
- Pneumothorax, which is when air gets into the space around the lungs
- Heart defects which lead to a left-to-right cardiac shunt and can lead to heart failure
- Persistent high blood pressure in the lungs
- Problems with the central nervous system, which could be because of bleeding in the area around the brain or damage due to a lack of oxygen
- Inborn defects of metabolism, which are genetic conditions that affect how the body converts food into energy
- Congenital malformations such as a hole in the diaphragm (congenital diaphragmatic hernia) or benign lumps in the lung (cystic adenomatoid malformations)
What to expect with Transient Tachypnea of the Newborn
In general, the outlook is very good with most symptoms disappearing within 48 hours of starting.
In a few individual cases, there have been reports of severe TTN in newborns where they develop a consistent high blood pressure inside the lungs. This is speculated to be possibly due to an increase in the resistance of blood flow within the lungs because of leftover lung fluid.
Possible Complications When Diagnosed with Transient Tachypnea of the Newborn
Other unusual complications include air leaks and collapsed lungs.
Research over time has indicated a link between Transient Tachypnea of the Newborn (TTN) and later development of asthma.
Noted Complications and Associations:
- Air leaks
- Collapsed lungs
- Transient Tachypnea of the Newborn (TTN) potentially leading to asthma
