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 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. 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 when examined. 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)
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.
If the baby's lips are bluish or the blood gas and pulse oximeter readings, 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. 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 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 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 usually recover completely within 12 to 24 hours after birth but can take up to 72 hours. They have no long-lasting side effects.
Written by Patricia Bromberger, MD, neonatologist, Kaiser Permanente, San Diego, CA.
Published by RelayHealth.
Last modified: 2011-02-10
Last reviewed: 2009-09-21
This content is reviewed periodically and is subject to change as new health information becomes
available. The information is intended to inform and educate and is not a replacement for medical
evaluation, advice, diagnosis or treatment by a health care professional.