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Recent Advances in Pathophysiology and Management of Transient Tachypnea of Newborn

Journal of Perinatology volume 41, pages 6–16 (2021)Cite this article

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Abstract

Transient tachypnea of newborn (TTN) results from failure of the newborn to effectively clear the fetal lung fluid soon after birth. TTN represents the most common etiology of respiratory distress in term gestation newborns and sometimes requires admission to the neonatal intensive care unit. TTN can lead to maternal-infant separation, the need for respiratory support, extended unnecessary exposure to antibiotics and prolonged hospital stays. Recent evidence also suggests that TTN may be associated with wheezing syndromes later in childhood. New imaging modalities such as lung ultrasound can help in the diagnosis of TTN and early management with distending pressure using continuous positive airway pressure may prevent exacerbation of respiratory distress.

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Fig. 1: Illustration detailing mechanisms of lung fluid secretion and clearance during fetal gestation and after birth.
Fig. 2: Airway liquid retention and role of respiration.
Fig. 3: Risk factors, symptoms and signs, management of transient tachypnea of the newborn and associated childhood respiratory complications.
Fig. 4: Differential diagnosis of transient tachypnea of the newborn with associated roentgenograms.
Fig. 5: X-ray findings of transient tachypnea of the newborn.
Fig. 6: Lung ultrasound as a diagnostic tool for newborn lung pathology.

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Article 08 April 2021

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Acknowledgements

The authors would like to thank J.L. Ruoss, MD, I. Prelipcean, MD and D. Rajdekar from the University of Florida for their contribution of Fig. 6.

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Authors and Affiliations

  1. Department of Pediatrics, University of California Davis, UC Davis Children’s Hospital, Sacramento, CA, USA

    Ziad Alhassen, Payam Vali & Satyan Lakshminrusimha

  2. Department of Pediatrics, Emory University, Children’s Healthcare of Atlanta, Atlanta, GA, USA

    Lokesh Guglani

  3. Department of Pediatrics, Case Western Reserve University, UH Rainbow Babies & Childrenʼs Hospital, Cleveland, OH, USA

    Rita M. Ryan

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  1. Ziad Alhassen
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Correspondence to Ziad Alhassen.

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Conflict of interest

PV is supported by NIH grant (1R03HD09299-01). SL is supported by NIH grant (5R01HD072929-08). ZA, LG, and RMR have no financial relationships to disclose relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. The use of antenatal betamethasone, diuretics and beta-agonists are not approved by the FDA in the prevention or treatment of TTN.

Content specifications

Understand the pathophysiology that underlines Transient Tachypnea of Newborn (TTN). Recognize the clinical manifestations of TTN and the imaging modalities that may help in the diagnosis of TTN. Understand the benefits in providing Continuous Positive Airway Pressure (CPAP) for TTN. Recognize the possible long-term association of TTN with wheezing-related syndromes.

Education gap

It can be challenging to diagnose TTN and identify patients who may be at greatest risk of respiratory deterioration. Optimal management has not been established, and caring for patients with TTN, particularly at community hospitals, can be difficult. Increasing knowledge of the pathophysiology leads to improved therapeutic options.

Objectives

Define the molecular mechanisms involved in lung fluid clearance. Identify the clinical symptoms and signs, radiologic findings and risk factors associated with TTN. List the differential diagnosis of TTN. Explain the different treatment options for TTN.

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Alhassen, Z., Vali, P., Guglani, L. et al. Recent Advances in Pathophysiology and Management of Transient Tachypnea of Newborn. J Perinatol 41, 6–16 (2021). https://doi.org/10.1038/s41372-020-0757-3

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