Transient Tachypnea of the Newborn (TTN)

What is transient tachypnea of the newborn (TTN)?

TTN is when a newborn has extra fluid in his lungs. This extra fluid causes the baby to:

• breathe rapidly (more than 60 times a minute) shortly after birth
• pull in his chest wall with each breath (retractions)
• occasionally have a bluish tinge around the lips (cyanosis), because the baby needs extra oxygen.

Another name for TTN is retained lung fluid.

What causes TTN?

While inside the mother, a baby's lungs are normally filled with fluid. After birth, the baby takes his first breath and the lungs fill with air, replacing the fluid. The baby's blood absorbs the lung fluid, or the baby coughs the fluid out. The absorption process usually takes several hours.

Some babies have extra fluid or absorb the fluid too slowly. The fluid makes the lungs stiff, causing the baby to breathe faster and harder than normal. As the fluid is absorbed, it becomes easier to breathe and the baby's breathing rate becomes normal.

The process of labor and vaginal birth squeezes the baby's chest wall and prepares the lungs for the first breath. Babies born by cesarean section (C-section) without labor or babies born after fast labors are more likely to have TTN.

How is it diagnosed?

To find the cause of the breathing problem the baby has blood tests and a chest x-ray. The blood tests include a complete blood count (CBC), a blood culture to look for signs of infection, and a blood gas determination. This last test shows the level of oxygen in the blood so your doctor knows whether the baby needs to be given extra oxygen.

What is the treatment?

• Special care nursery (SCN)

  When newborns have breathing problems they are taken to the SCN for observation and treatment. They are placed on a warming bed. They are attached to a cardiorespiratory monitor, which continuously records their heart rate and respiratory (breathing) rate. Often the babies are also attached to a monitor that measures the oxygen level in the skin. This monitor is called a pulse oximeter.

• Oxygen

  If the baby's lips are bluish or the blood gas and pulse oximeter readings suggest the baby needs extra oxygen, he is placed in a plastic hood into which extra oxygen is blown.

  Most babies with TTN will not need any extra oxygen. Some will need only a small to moderate amount of extra oxygen. The most reliable signs that the lung fluid is leaving the lungs are that the baby needs less oxygen and the breathing rate comes down to normal in 24 to 48 hours.

• IV fluids

  If a baby breathes over 80 times a minute or is working hard to breathe, he cannot coordinate sucking, swallowing, and breathing at the same time. The baby is given fluids through a vein in the hand or foot (an IV) to prevent dehydration and to keep the blood sugar levels normal. As soon as the breathing rate is normal, the baby will be allowed to nurse.

• IV antibiotics

  Every newborn with breathing problems is suspected of having an infection because the difference between pneumonia and TTN cannot be detected in the early stages. For this reason the baby is given intravenous (IV) antibiotics after blood has been drawn for tests. The medication is continued until the results of the blood tests confirm that there is no infection. This usually takes 48 to 72 hours.

How long will it last?

Babies who have TTN recover completely within 24 to 72 hours after birth and have no long-lasting side effects.