II. Epidemiology
- Most common cause of Newborn Respiratory Distress (40% of cases)
- Incidence: 5-6 per 1000 births
III. Pathophysiology
- Benign cause of Newborn Respiratory Distress
- Response to residual alveolar fluid following delivery (delayed reabsorption)
- Prostaglandin release typically increases with Vaginal Delivery
- Prostaglandins trigger lymphatic dilation and aid alveolar fluid clearance
-
Surfactant deficiency may play a role
- However, surfactant replacement is not indicated
IV. Risk Factors
- Maternal factors
- Ceserean Section delivery
- Gestational Diabetes
- Maternal Asthma history
- Newborn factors
- Male gender
- Fetal Macrosomia
V. Signs
-
Tachypnea
- Onset: Within 2 hours of delivery
- Duration: Hours to Days
- Initial higher Respiratory Rates predict a longer course
VI. Imaging: Chest XRay
- Diffuse parenchymal infiltrates especially perihilar
- Heart with surrounding "wet silhouette"
- Intralobar fluid
- Hyperexpansion
VII. Differential Diagnosis
VIII. Management
- See Respiratory Distress in the Newborn
- See Newborn Resuscitation
- Supportive care - generally improves spontaneously
-
Nebulized Albuterol
- Reduces TTN duration and need for Supplemental Oxygen
- Consider fluid restriction
- Avoid potentially harmful or unhelpful measures
- Furosemide (Lasix) is not effective
IX. Complications
- Childhood Asthma higher risk
X. Prevention
- Avoid cesarean delivery before 39 weeks
- If cesarean delivery before 39 weeks cannot be avoided
- Corticosteroids (Betamethasone or Dexamethasone) at 48 hours before Cesarean Delivery (37-39 weeks)