From the Guidelines
Transient tachypnea of the newborn (TTN) should be managed with supportive care, focusing on maintaining adequate oxygenation and hydration, with the initial use of CPAP rather than intubation and IPPV for preterm infants with respiratory distress, as suggested by the 2015 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science 1. The primary goal of treatment is to alleviate respiratory distress and support the infant until the condition resolves spontaneously, typically within 24-72 hours. Key aspects of management include:
- Maintaining adequate oxygenation through supplemental oxygen as needed to maintain oxygen saturation above 90%
- Using continuous positive airway pressure (CPAP) at 5-6 cmH2O for infants with moderate respiratory distress or increased work of breathing
- Providing intravenous fluids to maintain hydration while oral feedings are temporarily withheld if respiratory distress is significant
- Close monitoring of vital signs, including respiratory rate, heart rate, and oxygen saturation
- Considering empirical antibiotic therapy if infection cannot be ruled out, but discontinuing it once infection is excluded, as the condition is typically benign and self-limiting. It is essential to note that TTN occurs due to delayed clearance of fetal lung fluid after birth, and most infants improve rapidly as this fluid is absorbed, making parental reassurance and explanation of the condition's nature crucial.
From the Research
Treatment of Transient Tachypnea of the Newborn (TTN)
Overview of Treatment Strategies
- The treatment of TTN typically involves supportive management, which may include supplemental oxygen therapy, withholding enteral feeds, and administration of intravenous fluids and antibiotics 2.
- Non-invasive respiratory support, such as continuous positive airway pressure (CPAP) and nasal intermittent positive pressure ventilation (NIPPV), may be used to reduce respiratory distress and improve lung fluid clearance 3, 4.
- Fluid restriction has been studied as a potential treatment strategy for TTN, but the evidence is limited and uncertain 5.
Pharmacological Interventions
- Exogenous glucocorticoids may be effective in accelerating the reabsorption of fetal lung fluid 2.
- Furosemide, racemic epinephrine, and inhaled β-agonists have been studied for possible benefit in TTN, but the routine administration of these drugs cannot be recommended without additional data 2.
- Salbutamol may reduce the duration of tachypnea, but the evidence is of low certainty 4.
Predicting the Need for Ventilation Support
- Bedside clinical clues, such as subcostal and xiphoid retractions, asynchrony in chest-abdomen movements, arterial pH < 7.30, and ratio of PaO2/% inspired O2 < 1.2, may help predict the need for respiratory support in patients with TTN 6.
- Simple scores can help physicians assess the likelihood of deterioration in infants with TTN 6.