Transient Tachypnea of Newborn (TTN)- Symptoms and Treatment

A mild respiratory condition that affects newborn babies, Transient tachypnea affects 1 in 100 preterm babies and around 5 in 1000 term babies. It is characterised by a rapid breathing rate. This article tells you all about TTN – its causes, symptoms, and treatments.

What is Transient Tachypnea?

Transient tachypnea is a respiratory condition that affects newborn babies. The new-borns have fluid in their lungs (in the alveoli, or air sacs) which does not clear out properly, and this fluid makes it harder for the lungs to absorb oxygen. As a result, the newborn struggles for oxygen and breathes rapidly with rasping or grunting sounds. Tachypnea in a newborn is a temporary condition, and it usually lasts for 1 to 3 days.

The process of alveolar fluid clearing starts before birth and goes on during labour and even for a short while post-delivery. Hormones trigger this process just before birth. During labour, the contractions cause the birth canal to squeeze, in turn bringing about the expulsion of the remaining fluid from the lungs. The baby’s coughing and crying post-delivery help in intake of air and further expelling of the alveolar fluid. If any of these processes fail to clear out the fluid, the baby suffers from TTN.

Causes and Risk Factors

TTN is also known as wet lungs and is caused by slow removal or reabsorption of alveolar fluid in the lungs. Below we discuss the causes and risk factors for TTN:

Causes

Here are the causes of why TTN occurs in babies:

• Premature babies: As premature babies are born before the full term of 37 weeks, the chemicals that trigger the absorption and removal of the fluid in the lungs are not released. Hence the babies get TTN.
• Babies born via C-section: According to research, babies born via C-section (especially if the mother did not experience labour contractions before C-section) are more prone to getting TTN. This is because the babies do not go through the birth canal where the labour contractions squeeze out and expel the alveolar fluid from the lungs.

Risk Factors

Here are the risk factors for TTN in babies:

• Boy Babies: Male babies are at a much higher risk of having TTN than female babies, according to research data.
• Overweight babies: Scientific studies have found that babies with increased birth weight are at risk of developing TTN.
• Babies whose cord was clamped late: Newborns whose umbilical cord was not clamped immediately were also found to develop TTN.
• Maternal Conditions: If the mother has conditions like preeclampsia, asthma or diabetes, the baby is at a higher risk of developing TTN.

Signs and Symptoms

Here are the signs and symptoms of TTN:

• Cyanosis: Skin around the nose and mouth of the baby turns blue. This happens because the tissues are not getting enough oxygenated blood, thus turning them bluish.
• Rapid Laboured Breathing with More Than 60 Breaths a Minute: The baby looks like he is struggling to breathe and takes more than 60 breaths within a minute.
• Flared Nostrils and Bobbing of the Baby’s Head: The nostrils look flared and the baby’s head may bob up and down.
• Grunting, Rasping or Moaning Sounds with Every Exhalation: The breathing difficulty is apparent when the baby makes moaning or grunting sounds with every exhalation.
• Skin Retractions under the Ribcage or between the Ribs: The skin pulls inside between the two ribs or under the ribcage when the baby takes a breath.
• Hypoxia: Baby’s tissues do not get enough oxygen.

Diagnosis

TTN is usually diagnosed within a few hours after the baby’s birth. Here are some tests that are used to diagnose TTN:

1. Physical Exam: The doctor will first do a physical exam to check the baby for signs of bluish skin, rapid breathing and sounds during exhalation.
2. Chest X-Ray: If the baby has TTN, the chest X-ray will look streaky, and the fluid in the lungs might be visible.
3. Pulse Oximetry: An oxygen sensor is taped to the baby’s foot and connected to a monitor. This shows how much oxygen the lungs are sending into the blood.
4. Blood Gas Test: A blood gas test can determine accurately how much oxygen is there in the blood. If the level is low, the baby may be given oxygen.
5. Complete Blood Count (CBC): A complete blood exam is done, and the blood is checked for signs of infection.

Treatment

Here are the ways that TTN is treated:

1. Close Monitoring: Babies with TTN are monitored very closely. Their oxygen levels and heart and breathing rates are checked to ensure the baby is breathing normally.
2. NICU: Some babies may be admitted to the neonatal intensive care unit for extra care and 24-hour monitoring.
3. Breathing Assistance: Some babies may require extra oxygen, and it is given to them using a nasal cannula, a small tube that is placed under the nose.
4. Feeding: Breastfeeding a baby with TTN may not be possible as the baby cannot swallow and breathe at the same time. In this case, the baby is given fluid and nutrients intravenously.
5. Antibiotics: It can be difficult to differentiate between TTN and an infection. Hence, doctors usually recommend antibiotics for the baby. The antibiotics will be stopped if the blood test does not show any signs of infection.
6. Ventilator: In extreme cases where there are other complications present, the baby’s breathing issues may require the use of a ventilator. This equipment helps the baby breathe until the baby is able to breathe on his own.

Transient tachypnea of the newborn is true to its name as it is actually transient and resolves within 24 to 72 hours. In certain cases, it may take up to a week for the symptoms to disappear. Once the fluid in the lungs is completely expelled or reabsorbed, the baby’s breathing becomes normal again. This needs to be closely monitored. Transient tachypnea of the newborn cannot be prevented. New-borns who have had TTN do not need any special care and do not have any further health problems because of TTN. The new-borns also do not show any long-term ill-effects of TTN. Consult your doctor right away if the baby shows any of the signs and symptoms of TTN mentioned earlier.