1. 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

2. 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

3. 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

4. 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

5. 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

6. Clinical Findings
Tachypnea with respiratory rates as high as 150 BPM lasting 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

7. 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

8. 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

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

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

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

12. Arthur B. Marshak
RSTH 421
TTNB - Apnea