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TRANSIENT TACHYPNEA OF NEWBORN CARE
Category: Child Health
Abstract : Medical Care: • Medical care is supportive. As the retained lung fluid is absorbed by the infant's lymphatic system, the pulmonary status improves. • Supportive care includes intravenous fluids and gavage feedings (until the respiratory rate has decreased enough to allow oral feedings). Supplemental oxygen to maintain adequate arterial oxygen saturation, maintenance of thermo
Medical Care:
• Medical care is supportive. As the retained lung fluid is absorbed by the infant's lymphatic system, the pulmonary status improves.
• Supportive care includes intravenous fluids and gavage feedings (until the respiratory rate has decreased enough to allow oral feedings).
Supplemental oxygen to maintain adequate arterial oxygen saturation, maintenance of thermoneutrality, and an environment of minimal stimulation are the therapies necessary for these infants.
• As TTN resolves, the infant's tachypnea improves, oxygen requirement decreases, and the CXR shows resolution of the perihilar streaking.
• Infants with TTN may have signs that last from a few hours to several days. Rarely, an infant may develop a worsening picture of respiratory distress after several days. This may require more aggressive support including the use of continuous positive airway pressure (CPAP) by nasal prongs or endotracheal tube, or mechanical ventilation.
Consultations: Infants with TTN occasionally may require consultation by a neonatologist. Consider this consultation if the fraction of inspired oxygen exceeds 40%, if metabolic or respiratory acidosis is present, if CPAP or mechanical ventilation is required, if the infant begins to display fatigue (periodic breathing or apnea), or if the infant fails to improve by age 48-72 hours.
Diet: Infants with TTN generally are supported by intravenous fluids or gavage feedings. Oral feedings are withheld until the respiratory rate is consistently normal (<60 bpm). The use of medications for TTN is minimal. Aside from the use of antibiotics for a period of 36-48 hours after birth until sepsis has been ruled out, no further pharmacotherapy generally is prescribed. Diuretics have not been shown to be beneficial.
Drug Category: Antibiotics -- Used when sepsis is clinically suggested. Antibiotics generally consist of a penicillin (usually ampicillin) and an aminoglycoside (usually gentamicin) or a cephalosporin (usually cefotaxime). Choices are based on local flora and antibiotic sensitivities.
Further Inpatient Care:
• After resolution of TNN, focus further inpatient care on routine newborn management.
• No further medical therapy concerning the infant's pulmonary function is required.
Transfer:
• When managing an infant with TTN, it is important to have appropriately trained support staff. Infants with TTN and pneumonia or meconium aspiration may have similar clinical presentations. Therefore, staff members must be competent in recognizing worsening respiratory distress or impending failure and must be able to appropriately resuscitate the infant.
• Transfer generally is indicated by the need for a higher level of observation and/or care.
Complications:
• Few potential complications exist.
• Gross et al noted a population of 55 pregnancies after which newborns developed TTN compared to 355 pregnancies after which respiratory distress did not occur. Neonatal complications and procedures often associated with prematurity were found to be significantly increased in the infants who developed TTN. Therefore, potential complications can occur in these patients. Carefully monitor infants for signs of worsening respiratory distress.
Prognosis:
• Prognosis is excellent.
• Asthma: Schaubel et al looked at neonatal characteristics as risk factors for preschool asthma. The study demonstrated that infants with TTN are at an increased risk for hospitalization from asthma during the preschool years.
Patient Education:Inform parents that TTN is usually a self-limited disorder and is not life threatening.
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