Question

A 28-year-old mother gave birth to a 2.8 kg female by cesarean section at 36 weeks’ gestation. Apgar scores were 6 at 1 minute and 9 at 5 minutes. The baby developed tachypnea with a respiratory rate of 93 breaths per minute soon after birth and had moderate work of breathing with mild nasal flaring and retractions. The patient was placed on 1 L/min of oxygen by nasal cannula and was transferred to the neonatal intensive care unit. The assessment revealed: heart rate 158 beats per minute; respiratory rate 80 breaths per minute; blood pressure 65/45 mm Hg. The infant was well perfused and breath sounds were clear to auscultation. The remainder of the assessment was unremarkable. A chest radiograph was obtained which revealed normal lung expansion, fluid in the horizontal fissures and increased pulmonary vascularity. Differential diagnosis of transient tachypnea of the newborn was made. Over the next 24 hours the infant’s respi- ratory status worsened. Supplemental oxygen by high-flow nasal cannula was initiated at an FiO2 of 40% to maintain oxygen saturations >92%. By day 3 the patient’s status improved, a high-flow nasal cannula therapy was ordered. Within 6 hours the infant did not require any additional oxygen support. Vital signs were as follows: heart rate 145 beats per minute; respiratory rate 50 breaths per minute; blood pressure 60/40 mm Hg; and oxygen saturation >95% on room air. There were no further complications with respiratory function, and the patient was discharge to go home.

1. How soon does TTN present after birth?

Answer 1

Transient Tachypnea of the new born(TTN) is a mild breathing problem.It affects babies soon after birth and lasts upto 3 days.The problem usually goes away on its own.Treatment may include supplemental oxygen,blood tests,and continuous positive airway pressure.

Cause: Before birth,a developing fetus doesn’t use the lungs to breath- all oxygen comes from the blood vessels of the placenta.During this time,the baby’s lungs are filled with fluid.

As the baby’s due date nears, the lungs begin to absorb the fluid.Some fluid also may be squeezed out during birth as the baby passes through the birth canal Afterward delivery,as a baby breathes for the first time,the lungs fill with air and more fluid is pushed out.Any remaining fluid is then coughed out or slowly absorbed through the blood stream and lymphatic system.

Babies with TTN have extra fluid in their lungs or the fluid leaves too slowly.So they must breath faster and harder to get enough oxygen into the lungs.

TTN is more common in

• premature babies,
• babies born by rapid vaginal deliveries or C-sections without labor.
• babies whose mothers have asthma or diabetes.