Transient Tachypnea of the Newborn

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

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 gets 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 C-section, or babies born after fast labors are more likely to have TTN. It is also more common in babies born to mothers with diabetes.

How is it diagnosed?

TTN is usually diagnosed based on how the baby looks and how he sounds. A chest X-ray may help make the diagnosis. A blood gas test shows how much oxygen is in the blood. This can help the doctor decide if baby has TTN and if he needs to be given oxygen. Other lab tests check for infection to make sure that the breathing problems are not caused by something other than TTN.

What is the treatment?

• Special care nursery (SCN)

  A baby who has breathing problems is placed on a warming bed in the special care nursery (SCN). He is attached to a monitor that continuously measures his heart and breathing rates. The baby is also attached to a pulse oximeter that records the amount of oxygen in his skin.

• Oxygen

  If the baby's lips are bluish or the blood gas and pulse oximeter readings show low levels of oxygen, he is given extra oxygen.

  Most babies with TTN will not need any extra oxygen. Some will need only a small to moderate amount of extra oxygen. As the lung fluid leaves the lungs, the baby needs less oxygen and the breathing rate comes down to normal in 12 to 72 hours.

• IV fluids

  If a baby breathes over 60 to 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 or drink from a bottle.

• IV antibiotics

  Every newborn with breathing problems is suspected of having an infection. After blood has been drawn to test for pneumonia, the baby is given IV antibiotics. The medicine is continued until the results of the blood tests show that there is no infection. This usually takes 48 to 72 hours.

How long will it last?

Babies who have TTN usually recover completely within 12 to 24 hours after birth but can take up to 72 hours. They have no long-lasting side effects.