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Transient tachypnea of newborn ttn
This document discusses transient tachypnea of the newborn (TTN). TTN is a common condition caused by a delay in clearing fetal lung fluid after birth. It presents with respiratory distress and affects up to 15% of preterm infants. Risk factors include cesarean delivery, prematurity, and gestational diabetes. Diagnosis is based on clinical presentation, physical exam, and chest x-ray findings showing diffuse haziness. Treatment involves respiratory support and monitoring as symptoms typically resolve within 3 days. Medications are not routinely used or recommended for TTN management.
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Introduction of Dr. Tarek s Kotb, overview of common conditions related to transient tachypnea of the newborn (TTN). Key topics include TTN diagnosis challenges.
Objectives include understanding TTN pathophysiology. Discusses fetal lung fluid importance and fluid clearance mechanisms, vital for proper respiratory function.
Discusses the incidence of TTN among infants based on gestational age and identifies key neonatal risk factors contributing to TTN development.
Signs of respiratory distress in TTN include tachypnea, nasal flaring, and retractions. Diagnosis is made through clinical presentation and radiographic findings.
Describes radiological and ultrasound findings consistent with TTN. Highlights key indicators observed during imaging studies for accurate diagnosis.
General management strategies for TTN emphasize respiratory support, nutrition, and the usage of specific medications. Discusses the ineffective diuretics and potential benefits of inhaled agents.
Addresses future research on TTN's association with asthma and stresses the need for bedside ultrasound in NICUs for enhanced diagnosis and treatment.
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Transient tachypnea of newborn ttn
- 1. DR TAREK SKOTB MBBCH MRCPCH.UK NRP INSTRUCTOR PALS INSTRUCTOR
- 2. WHY TTN RDS AIRLEAK PPHN Malformations CDH SEPSIS METABOLIS M MAS PNEUMONIACHD
- 3. TTN IS AVERY COMMON DISEASE, BUT OFTEN PRESENTS A DIAGNOSTIC AND THERAPEUTIC DILEMMA FOR THE CLINICIAN…. •Miller MJ, Fanaroff AA, Martin RJ: Respiratory disorders in preterm and term infants. In: Fanaroff AA, Martin RJ, eds. Neonatal- perinatal medicine: Diseases of the Fetus and Infant. 6th ed. St Louis: Mosby-Year Book; 1997: 1040-65.
- 4. OBJECTIVES 1.Understand the pathophysiologyof transient tachypnea of the newborn (TTN(. 2.Identify risk factors , clinical symptoms , and radiographic findings in infants with TTN. 3.Appreciate the differential diagnoses for TTN. 4.Describe the typical clinical course of an infant with TTN.
- 5. INTRODUCTION Fetal lungs arefilled with liquid that is crucial for normal lung growth. Vascular channels Pulmonary epithelial channels Lymphatic channels
- 6. A DELAY INflUID CLEARANCE LEADS TO INEFFECTIVE GAS EXCHANGE AND RESULTS IN RESPIRATORY DISTRESS. THIS IMPERMANENT CONDITION OF RETAINED FETAL LUNG flUID IS KNOWN AS TRANSIENT TACHYPNEA OF THE NEWBORN (TTN(.
- 7. CHOOSE THE CORRECTANSWER THE BULK OF FLUID CLEARANCE IS MEDIATED BY:- 1- UTERINE CONTRACTIONS 2- PASSAGE OF BABY THROUGH BIRTH CANAL 3- CORTISOL AND CATECHOLAMINE SURGE(MATERNAL HORMONES(
- 8. The bulk ofthis fluid clearance is mediated by transepithelial sodium reabsorption through amiloride-sensitive sodium channels in the alveolar epithelial cells with only a limited contribution from mechanical factors and Starling forces. Semin Perinatol.2006Feb;30(1):34-43.
- 9. Which of thefollowing statements concerning the occurrence of transient tachypnea of the newborn (TTN) is correct? a. Female infants are at higher risk of TTN than male infants b. Maternal gestational diabetes does not increase the risk of TTN. c. Both small-and large-for-gestational age infants are at increased risk of developing TTN . d. TTN occurs in 10% to 15% of infants born at term.
- 10. INCIDENCE TTN is oneof the most common causes of neonatal respiratory distress. TTN occurs in 10% of infants born between 33 and 34 weeks of gestation, 5%of infants delivered at 35to 36weeks, And fewer than1% of all term infants
- 11. NEONATAL RISK FACTORSFOR THE DEVELOPMENT OF TRANSIENT TACHYPNEA OF THE NEWBORN (TTN( •Delivery before completing 39 weeks of gestation •Cesarean section without labor •Prematurity •Male sex •Large for gestational age •Small for gestational age •Perinatal asphyxia •Maternal asthma •Maternal gestational diabetes
- 12. CLINICAL PRESENTATION They havesigns of respiratory distress such as tachypnea (respiratory rate >60 breaths/min(, nasal flaring, grunting, and intercostal, subcostal, and/or suprasternal retractions. On auscultation, breath sounds may be diminished, crackles may be appreciated, or lung fields may be clear. Tachycardia may often be associated.
- 13. DIAGNOSIS IS IT TRUETHAT TTN A DIAGNOSIS OF EXCLUSION? The diagnosis is made based on an infant’s clinical Presentation ,physical examination findings , and chest radiography findings. If symptoms persist beyond 72 hours after birth ,alternative diagnosis to TTN must be examine.
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- 20. ULTRASOUND FINDINGS INTTN Regular pleural line Numerous B lines Coalescent B lines in the basies of the lungs
- 21. ULTRASOUND FINDINGS INTTN baseapex
- 22. MANAGEMENT General management Respiratory Nutrition andhydration medications
- 23. RESPIRATORY MANAGEMENT Neonates withTTN may require noninvasive respiratory support (eg, nasal cannula, nasal CPAP) and may need supplemental oxygen to maintain normal oxygen saturation levels. If a newborn is requiring FiO2 greater than 0.40 or endotracheal intubation, there is increased likelihood of another cause of the child’s distress and reevaluation is necessary.
- 24. NUTRITION •An infant’s respiratorycondition is the determining factor for receiving enteral or IV nutrition. Often the clinical status and degree of tachypnea make it unsafe for an infant to receive oral feeds and instead the infant can receive nutrition via gavage feeding, IV solution, or a combination of both.
- 26. MEDICATIONS •Medications studied includediuretic therapy , inhaled racemic epinephrine, and inhaled b2-agonists. A recent systematic review analyzed the usefulness of routine diuretic therapy for TTN and concluded that neither oral nor IV furosemide provided any benefit by improving symptoms or reducing duration of hospitalization •ReKassab M, Khriesat WM, Anabrees J. Diuretics for transient tachypnoea of the newborn. Cochrane Database Syst Rev. 2015(11): CD003064. doi:10.1002/14651858.CD003064.pub3
- 27. MEDICATIONS •The inhaled b2-agonistsalbutamol has been studied and may have promise as a possible treatment option to improve respiratory symptoms associated with TTN and decrease hospital length of stay. Nevertheless, recent systematic reviews have concluded that more evidence is needed to confirm the efficacy and safety of inhaled epinephrine and b2-agonists in the treatment of TTN. •Moresco L, Bruschettini M, Cohen A, Gaiero A, Calevo MG. Salbutamol for transient tachypnea of the newborn. Cochrane Database Syst Rev. 2016;(5):CD011878
- 28. WHICH OF THEFOLLOWING STATEMENTS IS CORRECT REGARDING MEDICATIONS FOR THE TREATMENT OF TTN? A. A COCHRANE SYSTEMATIC REVIEW HAS DETERMINED THAT INTRAVENOUS FUROSEMIDE CAN REDUCE THE DURATION OF TACHYPNEA IN TTN BY 50% COMPARED WITH PLACEBO. B. TTN IS AN APPROVED INDICATION FOR INHALED NITRIC OXIDE IN THE SETTING OF NICU ADMISSION AND NEED FOR RESPIRATORY SUPPORT. C. CAFFEINE HAS BEEN SHOWN IN SEVERAL RANDOMIZED CLINICAL TRIALS TO REDUCE LENGTH OF STAY D.MEDICATIONS SUCH AS DIURETICS AND INHALATION AGENTS ARE NOT CURRENTLY RECOMMENDED AS STANDARD THERAPY IN THE MANAGEMENT OF TTN
- 30. FUTURE Studies have demonstratedan association between TTN and subsequent development of asthma, suggesting an underlying genetic predisposition. Bager P, Wohlfahrt J, Westergaard T. Caesarean delivery and risk of atopy and allergic disease: meta-analyses. Clin Exp Allergy. 2008; 38(4):634–642
- 31. MESSAGE It can bechallenging to diagnose and provide optimal treatment for transient tachypnea of the newborn. IT IS THE TIME FOR NEONATOLOGISTS TO USE BEDSIDE US IN NICUS
Editor's Notes
- #9 When infants are delivered near-term, especially by cesarean section (repeat or primary) before the onset of spontaneous labor, the fetus is often deprived of these hormonal changes, making the neonatal transition more difficult.