Chapter 19: Transient Tachypnea of the Newborn

Question 1

Transient Tachypnea of the Newborn (TTN)

Answer 1

or respiratory distress syndrome type II

• common in newborns with diabetic mother
• delayed clearance of fetal lung fluid (which differs from amniotic fluid)
• there is fetal lung fluid in the alveoli, and air is trapped in the alveoli resulting in hypoxia because of poor lung ventilation

Question 2

Newborns at risk for TTN

Answer 2

• LGA newborns
• Newborns with a diabetic mother who delivered by cesarean birth or precipitous delivery
• late preterm infants- between 34 and 36 completed gestational weeks

Question 3

Signs and Symptoms of TTN

Answer 3

• high respiratory rate of 60 to 120 breaths/min
• grunting
• retractions
• cyanosis may be present
• nasal flaring

Question 4

Retractions

Answer 4

are a result of increased chest compliance and respiratory pressure
-the chest muscles of the newborn are immature, so increasing retraction depth means that the respiratory disease is worsening

Question 5

Diagnosis

Answer 5

blood gases usually show respiratory acidosis

Question 6

Prevention of Transient Tachypnea of the Newborn (TTN)

Answer 6

maintaining maternal glucose levels within normal limits and performing elective cesarean births after 39 weeks gestation
>vaginal delivery allows for extra fluid to be squeezed from the infants lungs, decreasing risk of TTN

Question 7

Nursing Care

Answer 7

• assessment of respiratory system immediately after birth and during the transitional period (within 1 to 2 hours)
• respiratory rate should be below 60 with no retractions, nasal flaring, or grunting (normal is 30-60 breaths/min)
• peripheral oximeter reading greater than 92%
• hold oral feedings for respirations over 60 to decrease risk of aspiration
• maintain a neural thermal environment to decrease the expenditure of energy and maintain peripheral oxygen levels within normal limits

Question 8

Medical Care

Answer 8

• continuous positive airway pressure at 40% oxygen for 24 to 48 hours
• complete resolution of TTN takes 2 to 3 days
• TTN is self-limiting with no reported long-term complications

Question 9

Continuous Positive Airway Pressure (CPAP)

Answer 9

delivered most often by nasal prongs to avoid intubation with an endotracheal tube

• CPAP maintains the patency of the upper airway and is usually set at pressures of 2 to 6 cm H20
• the nasal prongs fit snuggly into the newborns nose and are usually held in place by pinning the tubing to a stockinette cap
• if prongs not placed correctly or too much pressure is applied, nasal septal damage and necrosis can occur