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Alhassen Z, Vali P, Guglani L, Lakshminrusimha S, Ryan RM. Recent Advances in Pathophysiology and Management of Transient Tachypnea of Newborn. J Perinatol 2021; 41:6-16. [PMID: 32753712 DOI: 10.1038/s41372-020-0757-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 05/22/2020] [Accepted: 07/22/2020] [Indexed: 11/08/2022]
Abstract
Transient tachypnea of newborn (TTN) results from failure of the newborn to effectively clear the fetal lung fluid soon after birth. TTN represents the most common etiology of respiratory distress in term gestation newborns and sometimes requires admission to the neonatal intensive care unit. TTN can lead to maternal-infant separation, the need for respiratory support, extended unnecessary exposure to antibiotics and prolonged hospital stays. Recent evidence also suggests that TTN may be associated with wheezing syndromes later in childhood. New imaging modalities such as lung ultrasound can help in the diagnosis of TTN and early management with distending pressure using continuous positive airway pressure may prevent exacerbation of respiratory distress.
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Singh S, Lumbreras-Marquez MI, Farber MK, Xu X, Singh P, Gorman T, Palanisamy A. Transient Tachypnea of Newborns Is Associated With Maternal Spinal Hypotension During Elective Cesarean Delivery: A Retrospective Cohort Study. Anesth Analg 2020; 129:162-167. [PMID: 30768454 DOI: 10.1213/ane.0000000000004064] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The risk for transient tachypnea of newborns, a common cause of respiratory distress in the neonatal period, is 2- to 6-fold higher during elective cesarean delivery compared to vaginal delivery. Here, we evaluated the association between transient tachypnea of newborns and the degree and duration of predelivery maternal hypotension during spinal anesthesia for elective cesarean delivery. METHODS Demographic data, details of anesthetic management, blood pressure measurements, and vasopressor requirement preceding delivery were compared between transient tachypnea newborns (n = 30) and healthy neonates (n = 151) with normal respiratory function born via elective cesarean delivery between July 2015 and February 2016. The degree and duration of hypotension were assessed using area under the curve for systolic blood pressure (SBP) ≤90 mm Hg and area under the curve for mean arterial pressure ≤65 mm Hg. After adjusting for confounders, multivariable logistic regression was used to evaluate the association between area under the curve for SBP and transient tachypnea of newborns. RESULTS The median area under the curve for SBP was higher in cases of transient tachypnea of newborns (0.94; interquartile range, 0-28.7 mm Hg*min) compared to healthy controls (0; interquartile range, 0-3.30 mm Hg*min; P = .001). Similarly, median area under the curve for mean arterial pressure was also higher in cases of transient tachypnea of newborns (0; interquartile range, 0-18.6 mm Hg*min) compared to controls (0; interquartile range, 0-1.1 mm Hg*min; P = .01). Mothers of transient tachypnea newborns received significantly higher amounts of phenylephrine and ephedrine compared to controls (P = .001 and 0.01, respectively). Hence, the total vasopressor dose given to mothers in the transient tachypnea of newborn group was much higher than for the control group (P = .001). In the multivariable logistic regression, area under the curve for SBP was significantly associated with transient tachypnea of newborns (odds ratio, 1.02; 95% CI, 1.01-1.04, P = .005) after adjusting for gravidity and the type of anesthetic (spinal versus combined spinal epidural). CONCLUSIONS Our results suggest that the degree and duration of maternal SBP <90 mm Hg after neuraxial anesthesia during elective cesarean delivery are associated with transient tachypnea of newborns. Future prospective studies should further explore the effects of maternal hypotension, its prevention, and treatment for transient tachypnea of newborns.
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Affiliation(s)
- Shubhangi Singh
- From the Department of Anesthesiology and Critical Care, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Michaela K Farber
- From the Department of Anesthesiology and Critical Care, Brigham and Women's Hospital, Boston, Massachusetts
| | - Xinling Xu
- From the Department of Anesthesiology and Critical Care, Brigham and Women's Hospital, Boston, Massachusetts
| | - Prashant Singh
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Terri Gorman
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Arvind Palanisamy
- Department of Anesthesiology, Washington University, St Louis, Missouri
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Heinonen S, Süvari L, Gissler M, Pitkänen O, Andersson S, Helve O. Transient Tachypnea of the Newborn Is Associated With an Increased Risk of Hospitalization Due to Respiratory Syncytial Virus Bronchiolitis. Pediatr Infect Dis J 2019; 38:419-21. [PMID: 30882737 DOI: 10.1097/INF.0000000000002057] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Transient tachypnea of the newborn (TTN) is a self-limiting respiratory disorder, resulting from a failure to clear the lungs of perinatal fluid. As similar pathophysiologic features are present in children with respiratory syncytial virus (RSV) bronchiolitis, we hypothesized that these two conditions may be connected. METHODS This was a population-based cohort study that included all children born in term (≥37 weeks of gestation) without congenital malformations in Finland between 1996 and 2015. Children diagnosed with TTN (International Statistical Classification of Diseases and Related Health Problems, 10th Revision [ICD-10] code P22.1) after birth and children hospitalized because of RSV bronchiolitis (ICD-10 code J21.0) during first year of life were identified from the Medical Birth Register and National Hospital Discharge Register, respectively, and the data were linked. Logistic regression was used to analyze the association between these two conditions. RESULTS Of the 1,042,045 children included in the study cohort, 16,327 (1.57%) were diagnosed with TTN at birth and 12,345 (1.18%) were hospitalized because of RSV bronchiolitis during the first year of life. The rate of RSV hospitalization was higher in children with a history of TTN compared with children without TTN diagnosis [260/16,327 (1.59%) vs. 12,085/1,025,718 (1.18%), respectively; P value <0.0001]. After adjusting for gestational age at birth, mode of delivery, gender, birth weight, multiple births, older siblings and maternal smoking, TTN was associated with increased risk for RSV hospitalization (odds ratio: 1.31, 95% confidence interval: 1.16-1.48). CONCLUSIONS TTN diagnosis after birth was associated with increased risk for RSV hospitalization during the first year of life.
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Ben-Ari Y. Oxytocin and Vasopressin, and the GABA Developmental Shift During Labor and Birth: Friends or Foes? Front Cell Neurosci 2018; 12:254. [PMID: 30186114 PMCID: PMC6110879 DOI: 10.3389/fncel.2018.00254] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 07/24/2018] [Indexed: 12/15/2022] Open
Abstract
Oxytocin (OT) and vasopressin (AVP) are usually associated with sociability and reduced stress for the former and antidiuretic agent associated with severe stress and pathological conditions for the latter. Both OT and AVP play major roles during labor and birth. Recent contradictory studies suggest that they might exert different roles on the GABA excitatory/inhibitory developmental shift. We reported (Tyzio et al., 2006) that at birth, OT exerts a neuro-protective action mediated by an abrupt reduction of intracellular chloride levels ([Cl-]i) that are high in utero, reinforcing GABAergic inhibition and modulating the generation of the first synchronized patterns of cortical networks. This reduction of [Cl-]i levels is abolished in rodent models of Fragile X Syndrome and Autism Spectrum Disorders, and its restoration attenuates the severity of the pathological sequels, stressing the importance of the shift at birth (Tyzio et al., 2014). In contrast, Kaila and co-workers (Spoljaric et al., 2017) reported excitatory GABA actions before and after birth that are modulated by AVP but not by OT, challenging both the developmental shift and the roles of OT. Here, I analyze the differences between these studies and suggest that the ratio AVP/OT like that of excitatory/inhibitory GABA depend on stress and pathological conditions.
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Affiliation(s)
- Yehezkel Ben-Ari
- Neurochlore and Ben-Ari Institute of Neuroarcheology (IBEN), Marseille, France
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Keleş E, Gebeşçe A, Demirdöven M, Yazgan H, Baştürk B, Tonbul A. The Effects of Inhaled β-Adrenergic Agonists in Transient Tachypnea of the Newborn. Glob Pediatr Health 2016; 3:2333794X16645258. [PMID: 27336017 PMCID: PMC4905123 DOI: 10.1177/2333794x16645258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 01/06/2016] [Accepted: 01/12/2016] [Indexed: 11/25/2022] Open
Abstract
Aim. To investigate the efficacy of an inhaled β-adrenergic agonists in transient tachypnea of the newborn (TTN). Method. We retrospectively analyzed a cohort of 51 term infants (Group 1) and 37 term infants (Group 2) monitored in the newborn intensive care unit diagnosed with TTN. Infants in Group 1 received humidified oxygen alone, and infants in Group 2 were administered the inhaled β-2 agonist plus humidified oxygen. Results. TTN clinical respiratory assessment, respiratory rate, oxygen saturation values, need for supplemental oxygen therapy, blood gas PH, PO2, and duration of hospitalization were significantly improved in infants in Group 2 as compared with infants in Group 1 (P < .05). No statistically significant difference was observed with regard to blood glucose, potassium, heart rate, and PCO2 (P > .05). Conclusion. Inhaled β-adrenergic agonist added to humidified oxygen was found to improve clinical and laboratory parameters. We believe that further studies should be conducted with larger groups to demonstrate the efficacy of β-2 agonists in TTN patients.
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Affiliation(s)
- Esengul Keleş
- Department of Pediatrics, Fatih University, Istanbul Esengül Keleş, MD, Department of Pediatrics, Fatih University, Istanbul
| | - Arzu Gebeşçe
- Department of Pediatrics, Fatih University, Istanbul Esengül Keleş, MD, Department of Pediatrics, Fatih University, Istanbul
| | - Mehmet Demirdöven
- Department of Pediatrics, Fatih University, Istanbul Esengül Keleş, MD, Department of Pediatrics, Fatih University, Istanbul
| | - Hamza Yazgan
- Department of Pediatrics, Fatih University, Istanbul Esengül Keleş, MD, Department of Pediatrics, Fatih University, Istanbul
| | - Bülent Baştürk
- Department of Pediatrics, Fatih University, Istanbul Esengül Keleş, MD, Department of Pediatrics, Fatih University, Istanbul
| | - Alparslan Tonbul
- Department of Pediatrics, Fatih University, Istanbul Esengül Keleş, MD, Department of Pediatrics, Fatih University, Istanbul
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Tsuda H, Hirakawa A, Kotani T, Sumigama S, Mano Y, Nakano T, Imai K, Kawabata I, Takahashi Y, Iwagaki S, Kikkawa F. Risk assessment for neonatal RDS/TTN using gestational age and the amniotic lamellar body count in twin pregnancies. Clin Chim Acta 2015; 451:301-4. [PMID: 26477481 DOI: 10.1016/j.cca.2015.10.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 10/14/2015] [Accepted: 10/14/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND The amniotic lamellar body count (LBC) is useful for predicting respiratory distress syndrome (RDS) and transient tachypnea of the newborn (TTN) in twin pregnancies. However, the risk of neonatal respiratory complications varies with gestational age (GA). We herein created a model to predict the risk for RDS and TTN using GA and the LBC in twin pregnancies. METHODS Six hundred thirty-two amniotic fluid samples, comprising 169 dichorionic twin (DCT) and 147 monochorionic twin (MCT) gestations, were obtained at Cesarean section. The samples were analyzed immediately without centrifugation. A logistic regression model including the LBC and GA was used to develop the prediction model for RDS/TTN. RESULTS There were 101 neonates (16.0%) with RDS/TTN. The GA and LBC were significant independent factors affecting RDS/TTN. According to the logistic regression model, we determined the probability of RDS/TTN given the values of GA and the LBC. The overall diagnostic accuracy for predicting neonatal RDS/TTN using GA and the LBC was higher than the use of the LBC alone. CONCLUSIONS GA-specific LBC cutoffs for the risk assessment of neonatal RDS/TTN have been considered to be more accurate in twin pregnancies. Our findings provide valuable, new information for the management of twin pregnancies.
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Tsuda H, Kotani T, Sumigama S, Mano Y, Nakano T, Hua L, Kikkawa F. Relationship between the cortisol levels in umbilical cord blood and neonatal RDS/TTN in twin pregnancies. J Matern Fetal Neonatal Med 2015; 29:2151-6. [DOI: 10.3109/14767058.2015.1077510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Hiroyuki Tsuda
- Department of Obstetrics and Gynecology, Nagoya University School of Medicine, Nagoya, Japan and
| | - Tomomi Kotani
- Department of Obstetrics and Gynecology, Nagoya University School of Medicine, Nagoya, Japan and
| | - Seiji Sumigama
- Department of Obstetrics and Gynecology, Nagoya University School of Medicine, Nagoya, Japan and
| | - Yukio Mano
- Department of Obstetrics and Gynecology, Nagoya University School of Medicine, Nagoya, Japan and
| | - Tomoko Nakano
- Department of Obstetrics and Gynecology, Nagoya University School of Medicine, Nagoya, Japan and
| | - Li Hua
- Department of Obstetrics and Gynecology, Nagoya University School of Medicine, Nagoya, Japan and
- Bell Research Center for Reproductive Health and Center, Nagoya, Japan
| | - Fumitaka Kikkawa
- Department of Obstetrics and Gynecology, Nagoya University School of Medicine, Nagoya, Japan and
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Tsuda H, Kotani T, Sumigama S, Mano Y, Kawabata I, Takahashi Y, Iwagaki S, Hirakawa A, Kikkawa F. Amniotic lamellar body count: predicting and distinguishing neonatal respiratory complications in twin pregnancies. Clin Chim Acta 2015; 441:75-8. [DOI: 10.1016/j.cca.2014.12.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 11/17/2014] [Accepted: 12/15/2014] [Indexed: 11/29/2022]
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Yalaz M, Levent E, Olukman M, Calkavur S, Akisu M, Kultursay N. Role of digoxin-like immunoreactive substance in the pathogenesis of transient tachypnea of newborn. Biomed Res Int 2013; 2013:704763. [PMID: 23936837 DOI: 10.1155/2013/704763] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 06/07/2013] [Indexed: 12/02/2022]
Abstract
Background. Transient tachypnea of newborn (TTN) is usually observed in term or near-term infants. It constitutes an important part of the respiratory distress cases observed in the neonatal intensive care unit (NICU).
Aim. This paper examines the effects of digoxin-like immunoreactive substance (DLIS) on fluid and ion balance, hemodynamic and echocardiographic parameters of neonates with TTN. Methods. Plasma DLIS, Na+, K+, urea, creatinine, serum and urine osmolarity, urine FeNa+, 24-hour urine output, echocardiographic investigation and mean blood pressure, and clinical parameters of disease severity were recorded in TTN group and compared with control on the 1st and 7th days of their lives. Results. Plasma DLIS levels were statistically higher in TTN group (0.66 ± 0.37 ng/mL) compared to control group (0.24 ± 0.20 ng/mL) both on the 1st day (P < 0.01) and the 7th day (P < 0.05). For TTN group, significant correlation was found between plasma DLIS levels and maximum respiratory rate, duration of tachypnea, and length of hospitalization on the 1st day. Plasma DLIS levels were correlated negatively with serum osmolarity levels. Plasma DLIS levels were positively correlated with urine output, urinary FeNa+ levels, cardiac output, left ventricles end diastolic diameters, and right ventricles end diastolic diameters. Conclusions. Increased DLIS levels were correlated with disease severity in cases with TTN. This increase may be a primary or secondary event in the disease progress. It may help reduce the fluid overload due to already disturbed cardiac functions in patients by increasing urine output and natriuresis; however it may also contribute to disease pathogenesis, by inhibiting alveolar Na+-K+-ATPase which further decreases fetal alveolar fluid resorption.
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Ozkiraz S, Gokmen Z, Boke SB, Kilicdag H, Ozel D, Sert A. Lactate and lactate dehydrogenase in predicting the severity of transient tachypnea of the newborn. J Matern Fetal Neonatal Med 2013; 26:1245-8. [PMID: 23414515 DOI: 10.3109/14767058.2013.776532] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Low Apgar score is strongly associated with the incidence of transient tachypnea of the newborn (TTN) and other respiratory diseases of the newborn. We aimed to investigate the relationship between hypoxia determinants and the prolonged oxygen and respiratory support requirement even if the Apgar scores were normal. METHODS Retrospective case-controlled study. Infants born after 35 weeks of gestational age with clinical signs, chest X-ray findings and clinical course consistent with TTN were included. Receiver operating characteristic curves were used to assess the predictive values of determinants in predicting the risk for prolonged oxygen requirement and mechanical ventilatory support. RESULTS We showed a positive correlation between the duration of oxygen with lactate and lactate dehydrogenase (LDH) levels. LDH offered the best predictive value for prolonged oxygen requirement with a positive predictive value (PPV) of 88.9%. The predictive value of lactate exceeds the predictive value of LDH, aspartate aminotransferase, and percentage of normoblasts to predict the requirement of respiratory support with a PPV of 88.5%. CONCLUSIONS Lactate and LDH might be useful for clinicians at first level hospitals for decision making to refer the TTN patient to the secondary or tertiary level neonatal intensive care unit before the clinical situation is worsened.
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Affiliation(s)
- Servet Ozkiraz
- Department of Pediatrics, Division of Neonatology, Baskent University, Konya Research and Training Hospital, Konya, Turkey
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Oztekin O, Akyol M, Kalay S, Tezel G, Akcakus M, Oygur N. Investigation of the serum glucocorticoid kinase 1 gene in patients with transient tachypnea of the newborn. J Matern Fetal Neonatal Med 2013; 26:990-4. [PMID: 23339546 DOI: 10.3109/14767058.2013.766709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to investigate whether there is a role of the serum glucocorticoid kinase (SGK) 1 gene, which has an effect on the control of the epithelial sodium channels. MATERIALS AND METHOD This study included patients who were diagnosed with transient tachypnea of the newborn (TTN) with more than 37 weeks of gestation. As the control group, healthy newborns of the same gestational age were included. From each group, within the first 5 d of their lives, 2 cc of whole blood was taken in EDTA tubes, and stored at -80 °C. The DNA extraction was performed. RESULTS There were 32 patients in the TTN, and also 32 patients in the control group. The heterozygous allele rs1057293 (3/28) and rs1743966 (8/28) were located in the encoder region of the SGK 1 gene. In addition, in encoding region of the SGK 1 gene, the Arg97Ile (1/28), which causes the amino acid changes, had a genotype frequency of 0.0357, and a mutation was identified in Arg97Ile. DISCUSSION We have defined polymorphisms rs1057293 and rs1743966 in the SGK 1 gene, and the Arg97Ile mutation, for the first time in patients with TTN. This pilot study gave us some clues about a genetic basis of TTN phenotype, next to the lack of the pulmonary maturation.
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Affiliation(s)
- Osman Oztekin
- Department of Pediatrics, Division of Neonatology, Akdeniz University Medical School, Antalya, Turkey
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Armangil D, Yurdakök M, Korkmaz A, Yiğit S, Tekinalp G. Inhaled beta-2 agonist salbutamol for the treatment of transient tachypnea of the newborn. J Pediatr 2011; 159:398-403.e1. [PMID: 21481414 DOI: 10.1016/j.jpeds.2011.02.028] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Revised: 02/17/2011] [Accepted: 02/23/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the efficacy of inhaled salbutamol, a beta-2 adrenergic agonist, for the treatment of transient tachypnea of the newborn (TTN) and to determine whether inhaled salbutamol is safe in newborn infants. STUDY DESIGN Inhaled salbutamol or normal saline solution was administered to 54 infants with gestational ages ranging from 34 to 39 weeks and TTN. The response to salbutamol therapy was evaluated by determining respiratory rate, clinical score of TTN, level of respiratory support, and fraction of inspired oxygen before and at 30 minutes and 1 and 4 hours after salbutamol nebulization. RESULTS Among the 54 infants with TTN, 32 received salbutamol and 22 received normal saline solution. After one dose, the salbutamol group showed significant improvements in respiratory rate, clinical score of TTN, fraction of inspired oxygen, and level of respiratory support (P < .05). After treatment, the mean pH, partial pressure of arterial oxygen, and partial pressure of arterial carbon dioxide values were better in the salbutamol group when compared with the placebo group (P < .05). Duration of hospitalization in the neonatal intensive care unit was also shorter for the salbutamol group (P < .05). CONCLUSION Inhaled salbutamol treatment was effective with respect to both clinical and laboratory findings of TTN and without adverse events.
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Affiliation(s)
- Didem Armangil
- Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
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Abstract
At birth, lung fluid produced during fetal life must be cleared immediately and efficiently before the first breath takes place, in order for infants to achieve a normal and successful transition from prenatal to postnatal life. Postnatal lung fluid resorption is mediated through activation of airway epithelial sodium channels (ENaC). The observation that ENaC expression is a gestational age-dependent process contributes to our understanding of the development of respiratory distress in both term and preterm infants due to impaired clearing of fluid from their lungs. As fluid absorption, mediated by ENaC activity, in postnatal life has a significant biological role in preventing respiratory distress, any strategy that enhances ENaC activity can potentially help to decrease its incidence and associated morbidity.
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Affiliation(s)
- C Katz
- Pediatric Pulmonary Division, Meyer Children's Hospital of Haifa, Haifa, Israel
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Abstract
An infant born by cesarean delivery is at risk of having excessive pulmonary fluid which makes predisposition to transient tachypnea of the newborn (TTN), because fetal thorax compression during labor leads to the loss of large volumes liquid from the lungs. At birth, the pulmonary epithelium switches from predominantly facilitated Cl⁻ secretion to predominantly active Na+ reabsorption with the increase expression epithelial Na+ -channels (ENaC). Diminished activity or immaturity of this process may contribute to the development of TTN. Familial clustering of some TTN cases shows a genetic predisposition in the developing of this disorder. Antenatal glucocorticoids induce lung Na+ reabsorption by increasing the number and activity of channels even in hypoxia. Since a large release of fetal adrenaline occurs late in labor stimulating ENaC to start reabsorbing lung fluids, aerolized ß-agonists may be used in the treatment. Genetic predisposition for ß-adrenergic hyporesponsiveness may cause TTN in newborn period, and asthma/wheezing in older age groups. Although furosemide accelerates lung fluid resorption and cause pulmonary vasodilatation, oral or aerosolized furosemide cannot be recommended as treatment for TTN unless additional data become available.
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Affiliation(s)
- Murat Yurdakök
- Neonatal Intensive Care Unit, Hacettepe University Children's Hospital, Ankara, Turkey.
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Tutdibi E, Gries K, Bücheler M, Misselwitz B, Schlosser RL, Gortner L. Impact of labor on outcomes in transient tachypnea of the newborn: population-based study. Pediatrics 2010; 125:e577-83. [PMID: 20156904 DOI: 10.1542/peds.2009-0314] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Our aim was to assess the effect of labor on the risk and course of transient tachypnea of the newborn (TTN) in term neonates from a contemporary, population-based cohort. METHODS We analyzed perinatal characteristics of term singleton newborns (gestational age [GA] of > or =37 completed weeks) who were born between January 2001 and December 2005 in the federal states of Hesse and Saarland (Germany). TTN was diagnosed on the basis of International Classification of Diseases, 10th Revision codes. RESULTS Of a total of 275 459 births, 239 971 fulfilled the inclusion criteria of GA of > or =37 completed weeks and singleton live birth. Among those, 13 346 term infants were admitted for neonatal care and 1423 were diagnosed as having TTN. The overall incidence of TTN was 5.9 cases per 1000 singleton live births in our study cohort. Elective cesarean section, low GA, male gender, and low birth weight were associated with TTN. The duration of oxygen supplementation for newborns with TTN was associated inversely with the duration of labor (r = -0.151; P = .028). CONCLUSIONS Our study indicates that TTN is strongly related to elective cesarean section and low GA. Furthermore, the absence of exposure to labor contractions is associated with increased risk and severe course of TTN at term, with longer duration of oxygen supplementation.
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Affiliation(s)
- Erol Tutdibi
- Children's University Hospital of Saarland, Center of Pediatrics and Neonatology, Kirrberger Strasse, 66421 Homburg/Saar, Germany.
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Abstract
Transient tachypnea of the newborn (TTN) is the consequence of delayed clearance of fetal lung liquid in the newborn. With recognition of the increased risk in babies born by Cesarean sections, epidemiologic association with maternal asthma and increasing research on the possible role of genetic polymorphisms of ion-channel subunits, our understanding of the pathophysiology of this condition has vastly improved. We now know that the late-preterm infant, born at 34–36 weeks gestation, is at increased risk for both TTN and respiratory distress syndrome due to surfactant deficiency. As the incidence of Cesarean sections rises, there is likelihood of increased respiratory morbidity in newborns that will necessitate additional medical interventions and exposure to complications of intensive care. This review focuses on the risk factors that are associated with the development of TTN and the treatment strategies that are employed for the management of this condition.
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Affiliation(s)
- Lokesh Guglani
- Division of Pediatric Pulmonology, Children’s Hospital of Pittsburgh, Children’s Hospital Drive, 45th St and Penn Avenue, Pittsburgh, PA 15201 USA
| | - Rita M Ryan
- Chief, Division of Neonatology, Professor of Pediatrics, Pathology & Anatomical Sciences, Gynecology-Obstetrics Director, Neonatal-Perinatal Medicine Fellowship Program, Director, Center for Developmental Biology of the Lung University at Buffalo, Women & Children’s Hospital of Buffalo 219 Bryant Street Buffalo, NY 14222-2006, USA
| | - Satyan Lakshminrusimha
- Associate Professor of Pediatrics, Division of Neonatology, Associate Program Director, Neonatal-Perinatal Medicine Fellowship Program, University at Buffalo, Women & Children’s Hospital of Buffalo, 219 Bryant Street, Buffalo, NY 14222-2006, USA
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Heinzmann A, Brugger M, Engels C, Prömpeler H, Superti-Furga A, Strauch K, Krueger M. Risk factors of neonatal respiratory distress following vaginal delivery and caesarean section in the German population. Acta Paediatr 2009; 98:25-30. [PMID: 19086941 DOI: 10.1111/j.1651-2227.2008.01150.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The incidence of caesarean section (CS) is steadily rising world-wide. In particular, CS on maternal demand is performed more frequently. In parts, this might be due to insufficient information of pregnant women about neonatal risks of CS. We sought to specify neonatal outcomes following different modes of delivery, i.e. vaginal delivery, primary CS and secondary CS and to define risk factors for respiratory morbidity and hospitalization. METHODS We analysed 2073 births (gestational age > 35 weeks) during a two-year period at a tertiary obstetric and neonatal centre in Germany. Statistical analyses were performed for single parameters by SPSS as well as by logistic regression to account for possible confounders. Furthermore, extensive model calculation was done. RESULTS Respiratory morbidity was increased following primary and secondary CS (p = 0.001). By multiple logistic regression, the strongest effect on respiratory symptoms was seen with gestational age, each week more in utero reducing the risk by an odds ratio (OR) of 0.69 (95% CI: [0.61; 0.79]; p = 1.9 x 10(-8)). Furthermore, a significant interaction between mode of delivery and gestational age was found for the risk of respiratory symptoms (p = 0.0035). CONCLUSION For every eight newborns delivered by primary CS one more than expected with vaginal delivery is hospitalized. It is highly relevant to recognize that each week of gestational age reduces the risk of respiratory symptoms, especially if primary CS is performed. The higher rate of respiratory morbidity and neonatal admission following CS should be clearly recognized in counselling of pregnant women.
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Affiliation(s)
- Andrea Heinzmann
- Centre for Pediatrics and Adolescent Medicine, University of Freiburg, Mathildenstrasse 1, Freiburg, Germany.
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Affiliation(s)
- Richard Olver
- Tayside Institute of Child Health, University of Dundee, Dundee, UK.
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