Case Files Paediatrics 48 Transient Tachypnea Of The Newborn

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1. Transient Tachypnea of the Newborn (TTN)?

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a. Slow absorption of fetal lung fluid w/resultant tachypnea.
b. The condition more commonly is associated w/C-section deliveries.
c. Self-limited condition usually occurring in a term infant after an uneventful C-section (more commonly) or vaginal birth.
d. It is felt to be caused by slow absorption of fetal lung fluid.

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2. Progression of TTN?

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a. Infants w/TTN develop respiratory distress shortly after birth w/tachypnea, mild retractions, nasal flaring, and in more severe case grunting and cyanosis.
b. Most infants w/TTN have resolution of their tachypnea in 24-48 hours.

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3. Complications of Transient Tachypnea of the Newborn (TTN)?

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a. Oxygen saturation drop and supplemental oxygen is required.
b. Rarely does the oxygen requirement exceed 40%.
c. In the rare, more severe cases of TTN consideration for ongoing increased pulmonary

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4. Chest radiograph for TTN reveals?

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a. Perihilar streaking and fluid in the fissures.
b. Lungs are aerated.

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5. Tx of TTN?

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a. Supportive care: Supplemental oxygen if necessary.

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6. Meconium Aspiration Syndrome?

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a. Aspiration of meconium during delivery resulting in respiratory distress.
b. Radiographic findings including hyperinflation w/patchy infiltrates.
c. As meconium may plug small airways, areas of air trapping are often present and may lead to the development of pneumothorax.

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7. Respiratory Distress Syndrome?

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a. A condition seen in premature infants resulting from surfactant deficiency.
b. Radiographic findings including a characteristic reticulonodular “ground glass” pattern w/air bronchograms and decreased aeration.

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8. Presentation of Infants w/RDS?

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a. Usually born premature (<34 wks GA).
b. Have a deficiency of surfactant.
c. Shortly after birth they present w/symptoms of respiratory distress, including:
i. Poor oxygenation
ii. Grunting
iii. Retracting
iv. Poor air movement.

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9. Radiographic findings w/RDS?

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a. Reticulonodular pattern w/air bronchograms
b. Decreased aeration of the lungs!

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10. Tx of RDS?

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a. Supportive care includes supplemental oxygen as needed to maintain oxygen saturation of 90-95%
b. And
c. IV fluids or nasogastric feeding to maintain hydration as the degree of tachypnea usually precludes oral feedings.
d. Exogenous surfactant is available and is administered by the resuscitation .

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11. Congenital Diaphragmatic Hernia (CDH)?

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a. The condition of herniation of abdominal contents through the posterolateral foramen of Bochdalek into the thoracic cavity.
b. The incidence is ~1/5000 live births.

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12. Extracorporeal Membrane Oxygenation (ECMO)?

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a. A system using a modified heart-lung machine utilized in severe pulmonary failure.
b. Cannulation of the carotid artery and jugular vein is required to link the neonate to the system.

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13. Tx of a depressed infant w/thick meconium?

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a. Endotracheal intubation w/direct suction.
b. Bag-and-mask ventilation or endotracheal intubation w/o suction may increase the volume of meconium aspirated.

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14. Signs of Pneumothorax?

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a. Excessive light transmission by transillumination on one side with hyperresonance on that side.
b. Infants w/meconium aspiration and respiratory distress are at higher risk for pneumothorax, esp. if high PEEP is used for oxygenation.

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