Diagnostics, Therapeutics,

Management and Prevention

Diagnostics
• Chest X-ray. This safe and painless test uses a small amount of radiation to
take a picture of the chest. Doctors can see if the lungs have fluid in them.
• Pulse oximetry. Measures how much oxygen is in the blood. A small piece
of tape with an oxygen sensor is placed around a baby's foot or hand, then
connected to a monitor.
• Complete blood count (CBC). This blood test checks for signs of infection.
• Arterial Blood Gas. To ascertain the degree of gas exchange and acid-base
balance. Consider an intraarterial catheter, such as an umbilical artery
catheter, if the infant's inspired fraction of oxygen exceeds 40%.
Therapeutics & Management
• Given TTN is a self-limited condition, supportive care is the mainstay
of treatment. (e.g., supplemental oxygen, neutral thermal environment,
adequate nutrition)

• Rule of 2 hours: Two hours after onset of respiratory distress, if an

infant’s condition has not improved or has worsened or if FiO2
required is more than 0.4 or chest x-ray is abnormal, consider
transferring infant to a center with a higher level of neonatal care
Therapeutics, Management
• Since TTN may be difficult to distinguish from early neonatal sepsis
and pneumonia, empiric antibiotic therapy with ampicillin and
gentamicin should always be considered.

• Oxygen support may be required if pulse oximetry or ABG suggest

hypoxemia. An oxygen hood is the preferred initial method; however,
nasal cannula, CPAP can also be used. Concentration should be
adjusted to maintain oxygen saturation in low 90s
Therapeutics & Management
• Neonates’ respiratory status is the usual determinant for the degree of
nutritional support required.
• Tachypnea of over 80 breaths per minute with associated increased
work of breathing often makes it unsafe for the infant to receive oral
feeds.
• Such infants should be kept nil per oral (NPO), and intravenous (IV)
fluids should be started at 60 to 80 ml per kg per day.
Therapeutics & Management
• Randomized control trials studying the efficacy of furosemide or
racemic epinephrine in TTN showed no significant difference in
duration of tachypnea or length of hospital stay compared with
controls
• Salbutamol (inhaled beta2-agonist) has been shown to decrease the
duration of symptoms and hospital stay; however, more evidence-
based studies are needed to confirm its efficacy and safety.
Prevention
• Eating a healthy diet during pregnancy
• Seeing your doctor regularly for prenatal checkups
• Quitting smoking
• Not consuming alcohol or drugs that aren’t prescribed by your doctor
• Schedule elective cesarean delivery until 39 weeks' gestation or later
or wait for the onset of spontaneous labor.
• Consider establishing fetal maturity as appropriate for elective
cesarean delivery prior to 39 weeks' gestation.
Reference
Jha K, Nassar GN, Makker K. Transient Tachypnea of the Newborn. [Updated
2020 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing;
2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537354/

Reuter S, Moser C, Baack M. Respiratory distress in the newborn. Pediatr

Rev. 2014; 35 (10): p.417-429. doi: 10.1542/pir.35-10-417 

Stanford Children’s Health. (2019b, May 24). Stanford Children’s Health.

https://www.stanfordchildrens.org/en/topic/default?id=transient-tachypnea-
of-the-newborn-90-P02420