TTNB

Question 1

What is Transient Tachypnea of the Newborn (TTN)?

Answer 1

A parenchymal lung disorder characterized by pulmonary edema resulting from delayed resorption and clearance of fetal alveolar fluid.

TTN typically presents in near-term and term infants.

Question 2

What occurs during gestation in relation to pulmonary fluid?

Answer 2

The pulmonary epithelium actively secretes fluid and chloride into the air spaces.

Question 3

What triggers the switch from fluid secretion to sodium resorption during labor?

Answer 3

A surge of fetal catecholamines.

Question 4

What happens when sodium channels are inactivated or ineffective during TTN?

Answer 4

A larger volume of lung fluid is present, inhibiting gas exchange and causing increased work of breathing and hypoxia.

Question 5

How is fluid removed from the lungs in newborns?

Answer 5

Via the lymphatic system.

Question 6

What are some risk factors for Transient Tachypnea of the Newborn?

Answer 6

• Elective C-Section with or without labor
• Excessive maternal sedation
• Prolonged labor or precipitous deliveries
• Maternal fluid overload
• Breech delivery
• Male sex
• Macrosomia (BW > 4500 g)
• Perinatal/birth asphyxia
• IDM

Question 7

What is a consequence of lack of uterine contractions during delivery?

Answer 7

The infant misses the lung liquid efflux via the trachea due to high transpulmonary pressures.

Question 8

What is the typical respiratory rate for an infant with TTN?

Answer 8

60 – 120 bpm.

Question 9

What are common clinical signs of TTN?

Answer 9

• Tachypnea
• Rales
• Grunting
• Flaring
• Retracting
• Varying degrees of cyanosis
• Barrel chest

Question 10

What findings might chest X-ray show in TTN?

Answer 10

• Hyperexpansion
• Prominent perihilar streaking
• Depression of the diaphragm
• Fluid in the minor fissure
• Fluid in the pleural space

Question 11

What is the differential diagnosis for TTN?

Answer 11

TTN is a diagnosis of exclusion; consider:
* Pneumonia
* Heart disease
* RDS
* Metabolic disorders
* Polycythemia

Question 12

What is a distinguishing factor of RDS compared to TTN?

Answer 12

RDS typically occurs in premature infants and requires higher respiratory support.

Question 13

What is the management approach for TTN?

Answer 13

• Adequate oxygenation
• Supportive care
• Possibly antibiotics until pneumonia is ruled out
• NPO if RR > 80
• Fluids/Glucose for metabolic homeostasis
• NTE to prevent hypothermia

Question 14

What is the typical resolution time for TTN?

Answer 14

Usually resolves in 48 – 72 hours.

Question 15

True or False: Infants with TTN may require intubation if they need 100% oxygen.

Answer 15

True.

Question 16

Fill in the blank: Infants delivered by breech or C-section miss fetal trunk flexion which increases abdominal pressure, forcing liquid out of the _______.

Answer 16

nose and mouth.