Loma Linda University School of Allied Health Professions Department of Cardiopulmonary Sciences RSTH 421 PEDIATRIC PERINATAL RESPIRATORY CARE   Transient Tachypnea of the Newborn/Apnea of Prematurity

Objectives 1. Identify the definition of T.T.N.B.   2.                  Identify the cause of Respiratory Distress in T.T.N.B. 3.                  Describe the x-ray findings and blood gases seen in T.T.N.B. 4.                  Differentiate between the clinical findings of T.T.N.B. and R.D.S. 5.                  Describe the treatment of T.T.N.B. 6.                  Recognize the prognosis and time of recovery for T.T.N.B. 7.                  Define or recognize a the definition of apnea 8.                  Relate apnea to gestational age and sleep state. 9.                  Describe the treatment for apnea. 10.              Describe the prognosis for apnea. Arthur B. Marshak RSTH 421 TTNB - Apnea

Definitions Transient Tachypnea of the Newborn Delayed clearance of fetal lung liquid leading to transient and mild respiratory distress. Also called “Wet Lung Disease,” and type II RDS. Arthur B. Marshak RSTH 421 TTNB - Apnea

Etiology/Pathophysiology Transient Tachypnea of the Newborn Term or near term infants Recently seen in more premature infants Risk Factors C-Section/without labor Maternal Bleeding Prolapsed umbilical cord Maternal diabetes Large percentage found in normal deliveries Heavy maternal sedation Arthur B. Marshak RSTH 421 TTNB - Apnea

Etiology/Pathophysiology Transient Tachypnea of the Newborn Cause of distress Pulmonary capillary congestion with interstitial or pulmonary edema resulting Airway obstruction / hyperaeration / gas trapping FRC reduced or normal Thoracic gas volume (TGV) is increased: gas in lungs is not communicating with airways Arthur B. Marshak RSTH 421 TTNB - Apnea

Clinical Findings Tachypnea with respiratory rates as high as 150 BPM lasting 12-24 hours No cyanosis Clear breath sounds Normal or near normal ABGs *mild to moderate hypoxemia and mild respiratory acidosis lasting 8-24 hours. Grunting, chest wall retractions and nasal flaring Chest radiographs show “Wet” – looking with central perihilar streaking and often slightly enlarged heart. Over-expansion. Pleural effusions may be present. Chest radiographs clear as patient’s condition improves Arthur B. Marshak RSTH 421 TTNB - Apnea

CXR Progression Picture 1. Transient tachypnea of the newborn - Neonate at age 6 hours. Hyperaeration and streaky bilateral pulmonary interstitial opacities and prominent perihilar interstitial markings are seen along with mild cardiomegaly. Picture 2. Transient tachypnea of the newborn - Same patient as in Picture 1 at age 2 days. Cardiomegaly has disappeared. Pulmonary parenchymal abnormalities are diminishing but perihilar streaky markings persist. Picture 3. Transient tachypnea of the newborn - Same patient as in Pictures 1 and 2 at age 4 days. Normal heart size and clear lungs are seen. Arthur B. Marshak RSTH 421 TTNB - Apnea

Treatment Transient Tachypnea of the Newborn Supportive O2 therapy – FiO2 of 0.40 or lower Rarely intubated or needing CPAP Arthur B. Marshak RSTH 421 TTNB - Apnea

Prognosis Transient Tachypnea of the Newborn Very low mortality Arthur B. Marshak RSTH 421 TTNB - Apnea

Mount Rushmore US Side Arthur B. Marshak RSTH 421 TTNB - Apnea

Mt Rushmore Canadian Side Arthur B. Marshak RSTH 421 TTNB - Apnea

Arthur B. Marshak RSTH 421 TTNB - Apnea