Transient_Tachypnoea_of_the_Newborn_Flashcards
What is Transient Tachypnoea of the Newborn (TTN)?
TTN is the most common cause of respiratory distress in newborns, due to delayed fluid resorption in the lungs.
Why is TTN more common following caesarean sections?
TTN is more common post-caesarean because the lung fluid is not ‘squeezed out’ during birth canal passage.
What might a chest x-ray show in a case of TTN?
Chest x-ray in TTN may show lung hyperinflation and fluid in the horizontal fissure.
What is the management for Transient Tachypnoea of the Newborn?
Management includes observation, supportive care, and supplementary oxygen to maintain adequate oxygen saturations.
How long does it usually take for Transient Tachypnoea of the Newborn to resolve?
Transient Tachypnoea of the Newborn usually resolves within 1-2 days.
A 36-hour-old term newborn has rapid breathing shortly after birth. The mother reports an uneventful pregnancy and uncomplicated vaginal delivery. On examination, the baby appears well but is tachypnoeic with a respiratory rate of 70 breaths per minute. The newborn has mild subcostal recessions and grunts, but their oxygen saturation is measured 98% on room air. There is no evidence of cyanosis. A chest x-ray is obtained, which reveals hyperinflation and fluid in the horizontal fissure.
What is the most likely diagnosis?
Bronchopulmonary dysplasia
Congenital diaphragmatic hernia
Congestive heart failure
Meconium aspiration syndrome
Transient tachypnoea of the newborn
Chest x-ray in transient tachypnoea of the newborn may show hyperinflation and fluid in the horizontal fissure
Important for meLess important
Transient tachypnoea of the newborn is correct. This is a common respiratory disorder characterised by mild respiratory distress shortly after birth due to delayed clearance of foetal lung fluid. It typically presents with tachypnoea without significant respiratory distress and resolves spontaneously within the first few days of life. In this scenario, the newborn’s presentation of rapid breathing shortly after birth, without signs of severe respiratory distress or cyanosis, along with hyperinflation and fluid in the horizontal fissure on chest x-ray, is consistent with transient tachypnoea of the newborn.
Bronchopulmonary dysplasia is incorrect. This chronic lung disease primarily affects premature infants who require mechanical ventilation and oxygen therapy for acute respiratory distress syndrome or respiratory distress. It typically presents with signs of respiratory distress, such as tachypnoea, retractions, and oxygen desaturation. A chest x-ray may reveal hyperinflation of the lungs, diffuse reticulogranular opacities, and areas of atelectasis or fibrosis. In this scenario, the newborn is term, and there is no history of prematurity or prolonged mechanical ventilation, making bronchopulmonary dysplasia less likely. The chest x-ray in this newborn makes transient tachypnoea of the newborn the most likely diagnosis.
Congenital diaphragmatic hernia is incorrect. Congenital diaphragmatic hernia is a congenital anomaly characterised by the herniation of abdominal organs into the thoracic cavity through a defect in the diaphragm. It often presents with respiratory distress shortly after birth due to lung hypoplasia and compression of the lungs by abdominal organs. A chest x-ray typically shows bowel loops within the thoracic cavity, mediastinal shift, and lung hypoplasia on the affected side which is not described here. No signs of severe respiratory distress with the x-ray findings in this scenario make congenital diaphragmatic hernias less likely.
Congestive heart failure is incorrect. Congestive heart failure in newborns can occur due to various congenital heart defects or perinatal factors. It may present with tachypnoea, poor feeding, cyanosis, or signs of cardiac compromise. X-ray findings in newborns with congestive heart failure often include cardiomegaly, pulmonary vascular congestion, interstitial oedema, and pleural effusions. However, in this scenario, the newborn appears well with no signs of severe respiratory distress or cyanosis with an x-ray that doesn’t demonstrate these findings, making congestive heart failure less likely.
Meconium aspiration syndrome is incorrect. Meconium aspiration syndrome occurs when a newborn inhales meconium-stained amniotic fluid before or during delivery, leading to airway obstruction, inflammation, and chemical pneumonitis. It typically presents shortly after birth with tachypnoea, grunting, cyanosis, and signs of severe respiratory distress. A chest x-ray of a newborn with meconium aspiration syndrome may display patchy infiltrates, hyperinflation, and sometimes consolidation with areas of atelectasis. However, in this scenario, the newborn appears well with no signs of severe respiratory distress or cyanosis with an x-ray that doesn’t demonstrate these findings, making congestive heart failure less likely.
summarise
Transient tachypnoea of the newborn
Transient tachypnoea of the newborn (TTN) is the commonest cause of respiratory distress in the newborn period. It is caused by delayed resorption of fluid in the lungs
It is more common following caesarean sections, possibly due to the lung fluid not being ‘squeezed out’ during the passage through the birth canal
Chest x-ray may show hyperinflation of the lungs and fluid in the horizontal fissure.
Management
observation, supportive care
supplementary oxygen may be required to maintain oxygen saturations
Transient tachypnoea of the newborn usually settles within 1-2 days
A baby is born by elective Caesarean section at 38 weeks performed due to pregnancy-induced hypertension. At one hour the female baby is noted to be grunting with mild intercostal recession. Oxygen saturations are 95-96% on air. What is the most likely cause of her respiratory distress?
Surfactant deficient lung disease
Congenital pneumonia
Transient tachypnoea of the newborn
Persistent pulmonary hypertension of the newborn
Pulmonary hypoplasia
The most likely cause of the baby’s respiratory distress is transient tachypnoea of the newborn. This condition is characterized by rapid breathing, grunting, and mild intercostal recession. It occurs due to delayed clearance of fetal lung fluid after birth. The risk factors include elective Caesarean section without labour and maternal diabetes. Oxygen saturations of 95-96% on air are consistent with this diagnosis, as they are typically normal or mildly reduced. Transient tachypnoea of the newborn usually resolves within 24-48 hours with supportive care.
Surfactant deficient lung disease, also known as respiratory distress syndrome (RDS), is less likely in this case. RDS typically presents with more severe respiratory distress, including tachypnoea, nasal flaring, and audible expiratory grunting. Additionally, it is more common in preterm infants born before 37 weeks gestation due to insufficient surfactant production.
Congenital pneumonia could present similarly to transient tachypnoea of the newborn; however, it is less likely in this scenario because there are no risk factors for infection such as prolonged rupture of membranes or maternal fever during labour. Moreover, oxygen saturations would be expected to be lower if the baby had pneumonia.
Persistent pulmonary hypertension of the newborn (PPHN) occurs when there is a failure to transition from fetal circulation to postnatal circulation. PPHN presents with severe hypoxia and cyanosis that does not improve with supplemental oxygen administration. The oxygen saturations, in this case, do not support a diagnosis of PPHN.
Finally, pulmonary hypoplasia refers to the underdevelopment of the lungs and can occur due to various causes such as oligohydramnios or congenital diaphragmatic hernia. Pulmonary hypoplasia typically presents with severe respiratory distress and poor oxygenation, making it less likely in this case where the baby has only mild intercostal recession and near-normal oxygen saturations.
