Transient tachypnoea of the newborn — clinical case

Case

A 4-hour-old male infant born at 36 weeks by elective caesarean to a mother with gestational diabetes is grunting with a respiratory rate of 95 per minute and an oxygen saturation of 93% in room air. [3]

Findings

On examination he is centrally pink with mild subcostal recession and expiratory grunting; cardiovascular examination is normal with no murmur and no pre-post-ductal saturation difference. The working diagnosis is transient tachypnoea of the newborn, modified by two overlapping risks — late prematurity and maternal diabetes — both of which blur the line with early respiratory distress syndrome. [3]

Investigations

The chest radiograph shows perihilar streaking, hyperinflation and fluid in the horizontal fissure rather than the ground-glass granularity of surfactant deficiency. Blood culture, full blood count and CRP are taken to exclude sepsis, and a capillary gas shows mild hypoxaemia with normal carbon dioxide. [1]

Management

He is managed supportively with low-flow oxygen titrated to a SpO₂ target of 91–95%, oral feeds withheld while the respiratory rate exceeds 60 with nasogastric feeds substituted, and empirical antibiotics pending cultures. Blood glucose is monitored for hypoglycaemia given the diabetic pregnancy. [3]

Course

By 48 hours his respiratory rate has normalised, he tolerates full feeds, requires no oxygen, and antibiotics are stopped after negative cultures. Parents are counselled about the excellent prognosis but advised that TTN may modestly increase the risk of wheeze and bronchiolitis in early childhood. [8]