Some newborns' breathing during the first hours of life is
more rapid and labored than normal because of a lung condition
called transient tachypnea of the newborn (TTN).
About 1% of all newborns develop TTN, which usually eases after
a few days with treatment. Babies born with TTN need special
monitoring and treatment while in the hospital, but afterwards most
make a full recovery, with no lasting effect on growth and
development.
About TTN
Before birth, a fetus' lungs are filled with fluid. While
inside the mother, a fetus does not use the lungs to breathe -
all oxygen comes from the blood vessels of the placenta.
As the due date nears, the baby's lungs begin to clear
the fluid in response to hormonal changes. Some fluid may also be
squeezed out during the birth, as a baby passes through the birth
canal. After the birth, as a newborn takes those first breaths, the
lungs fill with air and more fluid is pushed out of the lungs. Any
remaining fluid is then coughed out or gradually absorbed into the
body through the bloodstream and lymphatic system.
In infants with TTN, however, extra fluid in the lungs remains
or the fluid is cleared too slowly. So it is more difficult for the
baby to inhale oxygen properly, and the baby breathes faster and
harder to get enough oxygen into the lungs.
Causes of TTN
TTN, also called "wet lungs" or type II respiratory
distress syndrome, usually can be diagnosed in the hours after
birth. It's not possible to detect before the birth whether a
child will have it.
TTN can occur in both
preemies
(because their lungs are not yet fully developed) and full-term
babies.
Newborns at higher risk for TTN include those who are:
- delivered by cesarean section (C-section)
- born to mothers with diabetes
- born to mothers with asthma
- small for gestational age (small at birth)
During vaginal births, especially with full-term babies, the
pressure of passing through the birth canal squeezes some of the
fluid out of the lungs. Hormonal changes during labor may also lead
to absorption of some of the fluid.
Babies who are small or premature or who are delivered via rapid
vaginal deliveries or C-section don't undergo the usual
squeezing and hormone changes of a vaginal birth. So they tend to
have more fluid than normal in their lungs when they take their
first breaths.
Signs and Symptoms of TTN
Symptoms of TTN include:
- rapid, labored breathing (tachypnea) of more than 60 breaths
a minute
- grunting or moaning sounds when the baby exhales
- flaring nostrils or head bobbing
- retractions (when the skin pulls in between the ribs or under
the ribcage during rapid or labored breathing)
- cyanosis (when the skin turns a bluish color) around the
mouth and nose
Other than the above symptoms, infants with TTN will look fairly
healthy.
Diagnosis
Because TTN has symptoms that are initially similar to more
severe newborn respiratory problems (such as pneumonia or
persistent pulmonary hypertension), doctors may use chest X-rays in
addition to physical examination to make a diagnosis.
Other indicators used to make a diagnosis of TTN:
- If an infant has TTN, the X-ray picture of the lungs will
appear streaked and fluid may be seen. The X-ray will otherwise
appear fairly normal.
- Pulse-oximetry monitoring, which is when a small piece of
tape containing an oxygen sensor is placed around a baby's
foot or hand and connected to a monitor. This tells doctors how
well the lungs are sending oxygen to the blood and is also useful
in monitoring TTN. Sometimes oxygen levels need to be checked
with a blood test.
- A complete blood count (CBC) may also be drawn from one of
the baby's veins or a heel to check for signs of
infection.
Treating TNN
As with any newborn who has a breathing problem, infants with
TTN are closely watched. Sometimes they'll be admitted to the
neonatal intensive care unit (NICU)
for extra care. Monitors will measure heart rate, breathing rate,
and oxygen levels.
Some are simply monitored to ensure that their breathing rates
slow down and their oxygen levels remain normal. Others might need
to receive extra oxygen through a mask, a small tube under the
nose, or under a plastic oxygen hood (sometimes called a
"headbox").
If a baby is still struggling to breathe, even when oxygen is
given, continuous positive airway pressure (CPAP) might
be used to keep air flowing through the lungs. With CPAP, a
baby wears a special oxygen cannula (a type of tubing placed
directly into the nose) and a machine continuously pushes a stream
of pressurized air into the baby's nose to help keep the lungs
open during breathing.
In the most severe cases of TTN, a baby would need ventilator
support, but this is rare.
Nutrition can be a problem if an infant is breathing so fast
that he or she can't suck, swallow, and breathe simultaneously.
In that case, intravenous (IV) fluids provide hydration and will
prevent the infant's blood sugar from dipping to dangerously
low levels.
If your baby has TTN and you want to breastfeed, talk to your
doctor or a nurse about maintaining your milk supply by using a
breast pump while your infant receives IV fluids.
Within 24 to 48 hours, the breathing of infants with TTN usually
improves and returns to normal, and within 72 hours, all symptoms
of TTN end.
If fluid stays in a baby's lungs beyond that, or if an
infant is not improving, doctors will look for other medical
problems.
Bringing Your Baby Home
After babies with TTN receive special monitoring and treatment
in the hospital, they usually recover fully. Even after TTN
resolves, watch for signs of respiratory distress and call your
doctor if you suspect a problem.
If your baby has trouble breathing, appears blue, or if the skin
pulls in between the ribs or under the ribcage during rapid or
labored breathing, call your doctor or emergency services (911)
right away.
Reviewed by:
Michael L. Spear, MD
Date reviewed: April 2009
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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