II. Epidemiology

  1. Most common cause of Newborn Respiratory Distress (40% of cases)
  2. Incidence: 5-6 per 1000 births

III. Pathophysiology

  1. Benign cause of Newborn Respiratory Distress
  2. Response to residual alveolar fluid following delivery (delayed reabsorption)
    1. Prostaglandin release typically increases with Vaginal Delivery
    2. Prostaglandins trigger lymphatic dilation and aid alveolar fluid clearance
  3. Surfactant deficiency may play a role
    1. However, surfactant replacement is not indicated

IV. Risk Factors

  1. Maternal factors
    1. Ceserean Section delivery
    2. Gestational Diabetes
    3. Maternal Asthma history
  2. Newborn factors
    1. Male gender
    2. Fetal Macrosomia

V. Signs

  1. Tachypnea
    1. Onset: Within 2 hours of delivery
    2. Duration: Hours to Days
      1. Initial higher Respiratory Rates predict a longer course

VI. Imaging: Chest XRay

  1. Diffuse parenchymal infiltrates especially perihilar
  2. Heart with surrounding "wet silhouette"
  3. Intralobar fluid
  4. Hyperexpansion

VII. Differential Diagnosis

VIII. Management

  1. See Respiratory Distress in the Newborn
  2. See Newborn Resuscitation
  3. Supportive care - generally improves spontaneously
  4. Nebulized Albuterol
    1. Reduces TTN duration and need for Supplemental Oxygen
  5. Consider fluid restriction
    1. Stroustrup (2012) J Pediatr 160(1): 38-43 [PubMed]
  6. Avoid potentially harmful or unhelpful measures
    1. Furosemide (Lasix) is not effective

IX. Complications

X. Prevention

  1. Avoid cesarean delivery before 39 weeks
  2. If cesarean delivery before 39 weeks cannot be avoided
    1. Corticosteroids (Betamethasone or Dexamethasone) at 48 hours before Cesarean Delivery (37-39 weeks)

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