Transient tachypnea

Definition Transient tachypnea is a respiratory problem that occurs in 1% to 2% of newborns. It occurs when fluid does not leave the lungs as quickly as it should after birth. Babies born with this condition usually recover within three days of birth. Causes Before birth, a babys lungs are normally filled with amniotic fluid. During labor, chemical signals tell the lungs to start removing the fluid. When the baby passes through the birth canal, the chest is squeezed. That pressure may help clear some of the fluid from the lungs. After birth, the baby may also cough some of the fluid out. Once the baby starts to breathe, air fills the lungs and helps clear out any remaining fluid. Fluid might not clear from lungs quickly enough if : The baby doesnt respond well to the chemical signals during labor Fluid isnt squeezed out of the lungs in the birth canal

Risk Factors A risk factor is something that increases your chance of getting a disease or condition. The following factors increase your childs chance of developing transient tachypnea: Cesarean delivery Large baby Delayed cord clamping Rapid vaginal delivery Excess maternal fluid administration Sex: male

Symptoms If your newborn experiences any of these symptoms do not assume it is due to transient tachypnea. These symptoms may be caused by other health conditions. Symptoms include: Rapid, labored breathing (over 60 breaths per minute) Grunting or moaning sounds when exhaling Flaring of the nostrils Retractionswith each breath, the chest appears to sink in between the ribs or under the ribcage

Cyanosisskin has a bluish tinge around the mouth and nose PATHOPHYSIOLOGY The process of clearing fetal alveolar fluid begins before term birth and continues through labor and after delivery. During late gestation, in response to increased concentrations of catecholamines and other

hormones, the mature lung epithelium switches from actively secreting chloride and liquid into the air spaces to actively reabsorbing sodium and liquid (figure 1) [4,5]. Increased oxygen tension at birth enhances the capacity of the epithelium to transport sodium and increases gene expression of the epithelial sodium channel [5]. Reduced gene expression of this channel contributes to the inability of immature lungs to switch from fluid secretion to absorption and can be upregulated by glucocorticoids [5]. Passive resorption of liquid also occurs after birth because of differences among the oncotic pressure of air spaces, interstitium, and blood vessels. The majority of water transport across the apical membrane is thought to occur through aquaporin 5 (AQP5) water channels [6]. Failure of fluid clearance to occur results in excess lung liquid. The liquid fills the air spaces and moves into the interstitium, where it pools in perivascular tissues and interlobar fissures until it is cleared by the lymphatics or absorbed into small blood vessels. The excess lung water in TTN results in decreased pulmonary compliance. Tachypnea develops to compensate for the increased work of breathing associated with reduced compliance. In addition, accumulation of fluid in the peribronchiolar lymphatics and interstitium promotes partial collapse of the bronchioles with subsequent air trapping. Continued perfusion of poorly ventilated alveoli leads to hypoxemia, and alveolar edema reduces ventilation, sometimes resulting in hypercapnia. Diagnosis The doctor will look at your pregnancy and labor history. He or she will also examine your baby and perform diagnostic tests. Tests may include: Blood tests, such as: Complete blood countto look for signs of infection, such as pneumonia Blood cultureto look for signs of infection Blood gas determinationto check the oxygen level in the babys blood; may be repeated throughout the hospital stay Chest x-ray a radiograph of the lungs used to check for causes of respiratory problems Pulse-oximetry monitoringa piece of tape containing an oxygen sensor is placed on the babys foot. It is connected to a monitor that tells the doctor how well the lungs are working. Often, transient tachypnea isnt diagnosed until the symptoms go away, usually by three days after birth. Treatment Talk with your doctor about the best treatment plan for your child. Supportive care and close monitoring are the mainstays of treatment. Additional treatment options include the following: Supplemental oxygenthe baby receives extra oxygen through a mask or nasal prongs. Continuous positive airway pressure (CPAP)a tube is placed in the babys nose. A breathing machine pushes a continuous flow of air or oxygen into the airways to keep them open.

Antibioticsintravenous (IV) antibiotics may be given to the baby until test results show that he or she doesnt have an infection. Supplemental feedingswhen struggling to breathe, it can be difficult for an infant to nurse. In such a case, an IV line that delivers fluids, glucose, and electrolytes is utilized. Ventilator supportin rare cases, a machine is used to help the baby breathe.

A day or two after birth, the childs breathing should improve. By the third day of life, all symptoms of transient tachypnea should disappear. Prevention There are no guidelines for preventing transient tachypnea because the exact cause is not known. But there are several things you can do to help ensure you will give birth to a healthy baby: Eat a healthful diet, one that is low in saturated fat and rich in whole grains, fruits, and vegetables. Have regular prenatal check-ups. Dont smoke. If you smoke, quit. Avoid drugs and alcohol.