Transient Tachypnoea of the Newborn (TTN)
Transient tachypnoea of the newborn (TTN) is a common, self-limiting respiratory disorder caused by delayed clearance of fetal lung fluid after birth. [1,2] It typically presents within the first few hours of life with tachypnoea and mild respiratory distress, resolving within 24-72 hours with supportive care alone. [1,3]
Key Facts
| Fact | Detail |
|---|---|
| Definition | Self-limiting respiratory distress due to delayed resorption of fetal lung fluid |
| Incidence | 1-2% of all term deliveries; up to 10% of C-section deliveries |
| Peak onset | First 2-4 hours of life |
| Duration | Resolves within 24-72 hours |
| Key risk factor | Elective caesarean section (no labour) |
| CXR finding | Fluid in horizontal fissure, perihilar streaking, hyperinflation |
| Diagnosis | Clinical diagnosis of exclusion; rule out sepsis and RDS |
| Treatment | Supportive: oxygen, NG feeds if RR more than 60/min |
| Prognosis | Excellent; complete resolution expected |
| Empirical antibiotics | Often started until sepsis excluded (48h cultures) |
Clinical Pearls
Pearl 1: TTN is a DIAGNOSIS OF EXCLUSION. You must consider and rule out neonatal sepsis and respiratory distress syndrome (RDS) before confidently diagnosing TTN.
Pearl 2: The "squeeze" theory - during vaginal delivery, thoracic compression during passage through the birth canal expels lung fluid. Caesarean section bypasses this, increasing TTN risk.
Pearl 3: The 60/60 rule - if respiratory rate exceeds 60/min, the infant should be nil by mouth and fed via NG tube to prevent aspiration. Start feeds when RR consistently below 60.
Pearl 4: If symptoms persist beyond 24-48 hours, reconsider the diagnosis. Think: infection, congenital heart disease, surfactant deficiency, or persistent pulmonary hypertension.
Pearl 5: Elective C-section at less than 39 weeks significantly increases TTN risk. This is why NICE recommends elective C-sections should not be performed before 39 weeks unless medically indicated.
Incidence
| Delivery Type | TTN Incidence |
|---|---|
| Vaginal delivery | 0.5-1% |
| Emergency caesarean section | 3-5% |
| Elective caesarean section (no labour) | 6-10% |
| Late preterm (34-36 weeks) | 10-15% |
| Term (37-38 weeks) | 3-5% |
| Full term (39+ weeks) | 1-2% |
Demographics and Risk Factors
| Risk Factor | Relative Risk | Mechanism |
|---|---|---|
| Elective C-section (no labour) | RR 3-5 | Absence of labour-induced catecholamine surge; no thoracic compression |
| Emergency C-section | RR 2-3 | Shorter duration of labour |
| Late preterm (34-36 weeks) | RR 2-4 | Immature sodium channel expression |
| Term (37-38 weeks vs 39+) | RR 2-3 | Suboptimal lung fluid clearance mechanisms |
| Maternal diabetes | RR 2-3 | Delayed lung maturity |
| Maternal asthma | RR 1.5-2 | Possibly altered catecholamine response |
| Male sex | RR 1.5-2 | Male infants at higher risk of respiratory morbidity |
| Perinatal asphyxia | RR increased | Impaired catecholamine release |
| Prolonged rupture of membranes | Inconsistent | May be protective (airway drying) |
| Low birth weight/SGA | RR variable | Depends on gestational age |
Stepwise Mechanism
Step 1: Fetal Lung Fluid Production
- During fetal life, lungs are filled with approximately 30 mL/kg of lung fluid
- This fluid is secreted by alveolar epithelial cells
- Chloride secretion drives fluid into airways (outward direction)
- Lung fluid is essential for lung development and expansion
Step 2: Transition at Birth (Normal)
- Labour triggers catecholamine surge (adrenaline/noradrenaline)
- Catecholamines activate epithelial sodium channels (ENaC)
- Sodium absorption reverses fluid direction: outward → inward
- Fluid is absorbed from alveoli into pulmonary interstitium → lymphatics and capillaries
- Thoracic compression during vaginal delivery expels additional fluid
- First breaths further clear fluid mechanically
Step 3: Failure of Fluid Clearance (TTN)
- In elective C-section: no labour → no catecholamine surge
- ENaC activation is reduced → impaired sodium (and water) absorption
- No thoracic compression → less mechanical clearance
- Lung fluid remains in alveoli and interstitium
- Fluid also visible in fissures and perihilar regions on CXR
Step 4: Clinical Consequence
- Retained fluid in airspaces → alveolar air trapping around fluid
- Decreased lung compliance → increased work of breathing
- Tachypnoea (compensation for reduced tidal volume)
- Mild hypoxia (V/Q mismatch)
- Infant appears "wet" on CXR
Step 5: Resolution
- Lung fluid gradually absorbed over 24-72 hours
- Lymphatic and vascular clearance catches up
- Tachypnoea resolves as fluid clears
- Full recovery with no sequelae
Molecular Mechanisms
| Component | Role |
|---|---|
| ENaC (Epithelial Na Channel) | Sodium absorption drives fluid clearance; activated by catecholamines |
| Na+/K+-ATPase | Maintains sodium gradient for ENaC function |
| Catecholamines | Released during labour; stimulate ENaC |
| Glucocorticoids | Antenatal steroids upregulate ENaC expression |
| Thyroid hormones | Contribute to lung maturation and fluid clearance |
Typical Presentation
| Feature | Description |
|---|---|
| Onset | Within first 2-4 hours of life (usually less than 6 hours) |
| Tachypnoea | RR more than 60/min (often 80-120/min) |
| Nasal flaring | Present |
| Grunting | May be mild; less prominent than RDS |
| Intercostal recession | Present but usually mild-moderate |
| Subcostal recession | Present |
| Cyanosis | Usually absent or mild; responds well to low-flow O2 |
| Feeding difficulties | Cannot coordinate suck-swallow-breathe when RR more than 60 |
Symptom Severity Classification
| Severity | Features |
|---|---|
| Mild | RR 60-80, minimal recession, no oxygen required |
| Moderate | RR 80-100, moderate recession, FiO2 less than 0.3 |
| Severe | RR more than 100, marked recession, FiO2 more than 0.3 (reconsider diagnosis) |
Timeline
| Phase | Time | Features |
|---|---|---|
| Onset | 0-4 hours | Tachypnoea, recession begin |
| Peak | 6-24 hours | Maximum respiratory distress |
| Resolution | 24-72 hours | Gradual improvement, normal RR |
| Full recovery | By 72 hours | Resolution expected |
Differential Diagnoses (CRITICAL)
| Condition | Key Distinguishing Features |
|---|---|
| Respiratory Distress Syndrome (RDS) | Preterm infant, ground-glass CXR, surfactant deficiency, worsens without surfactant |
| Neonatal sepsis/pneumonia | Any gestation, fever/hypothermia, lethargy, raised CRP, positive cultures |
| Congenital pneumonia | Risk factors for infection, bilateral infiltrates on CXR, poor response to supportive care |
| Meconium aspiration syndrome | Term, meconium-stained liquor, patchy CXR, PPHN |
| Congenital heart disease | Cyanosis out of proportion to respiratory distress, murmur, cardiomegaly, abnormal echo |
| Persistent pulmonary hypertension (PPHN) | Severe hypoxia, pre-post ductal saturation difference, right-to-left shunting on echo |
| Pneumothorax | Sudden deterioration, asymmetric chest, absent breath sounds on one side |
| Congenital diaphragmatic hernia | Scaphoid abdomen, bowel in chest on CXR |
Red Flags Requiring Urgent Reassessment
| Red Flag | Concern |
|---|---|
| Symptoms persisting more than 24-48h | RDS, infection, CHD |
| FiO2 more than 0.4 | Severe disease; reconsider diagnosis |
| Fever or hypothermia | Sepsis |
| Poor feeding, lethargy | Sepsis, metabolic disorder |
| Cardiomegaly on CXR | Congenital heart disease |
| Heart murmur | Structural heart disease |
| Pre-post ductal saturation difference more than 3% | PPHN or duct-dependent lesion |
Structured Neonatal Examination
General Inspection
- Alert or lethargic (lethargic → sepsis concern)
- Colour: pink, acrocyanosis (normal), central cyanosis (concern)
- Activity and tone
Respiratory Assessment
| Finding | Significance |
|---|---|
| Respiratory rate | Count for full 60 seconds; more than 60/min = tachypnoea |
| Nasal flaring | Increased work of breathing |
| Grunting | Attempts to maintain FRC; more common in RDS |
| Head bobbing | Significant distress |
| Intercostal/subcostal recession | Increased work of breathing |
| Tracheal tug | Severe obstruction |
| See-saw breathing | Impending respiratory failure |
| Oxygen saturations | Pre-ductal (right hand) and post-ductal (foot) |
Silverman-Andersen Score (Respiratory Distress Severity)
| Parameter | Score 0 | Score 1 | Score 2 |
|---|---|---|---|
| Upper chest movement | Synchronized | Lag on inspiration | See-saw |
| Lower chest retractions | None | Just visible | Marked |
| Xiphoid retraction | None | Just visible | Marked |
| Nasal flaring | None | Minimal | Marked |
| Expiratory grunt | None | Audible with stethoscope | Audible without stethoscope |
Score interpretation: 0-3 = mild; 4-6 = moderate; 7-10 = severe
Cardiovascular
- Heart sounds (murmur?)
- Femoral pulses (present and equal?)
- Apex beat (displaced?)
- Hepatomegaly (heart failure?)
Other Systems
- Abdomen: scaphoid (diaphragmatic hernia?)
- Temperature: fever or hypothermia (sepsis?)
- Tone and activity
First-Line Investigations
| Investigation | Findings in TTN | Notes |
|---|---|---|
| Pulse oximetry | Usually more than 92% on low-flow O2 or air | If severe hypoxia, reconsider diagnosis |
| Pre-post ductal sats | No significant difference | Difference more than 3% suggests PPHN |
| Chest X-ray | See below | Key diagnostic tool |
| Blood gas | Mild respiratory acidosis ± hypoxia | Metabolic acidosis concerning for sepsis |
| Blood glucose | Normal (rule out hypoglycaemia) | Standard newborn care |
| FBC | Usually normal | WCC abnormalities suggest sepsis |
| CRP | Usually normal or mildly raised | Rising CRP suggests infection |
| Blood culture | Negative (if sepsis excluded) | Take before antibiotics |
Chest X-Ray Features
| Feature | Description |
|---|---|
| Hyperinflation | Flattened diaphragms, increased AP diameter, more than 8 posterior rib spaces |
| Fluid in horizontal fissure | Classic finding; fluid tracking along fissure |
| Perihilar streaking | Linear opacities radiating from hila (interstitial fluid) |
| Prominent vascular markings | Engorged pulmonary vessels |
| Mild cardiomegaly | May be present (transient) |
| Pleural effusion (small) | Occasionally seen |
| Clear by 24-48 hours | Rapid improvement characteristic |
CXR Comparison: TTN vs RDS
| Feature | TTN | RDS |
|---|---|---|
| Lung fields | Wet, streaky, hyperinflated | Ground-glass (diffuse haziness) |
| Air bronchograms | Absent | Present |
| Fissure fluid | Present | Absent |
| Volume | Hyperinflated | Low volume |
| Typical patient | Term, post C-section | Preterm |
| Resolution | 24-48 hours | Requires surfactant |
When to Consider Echocardiography
| Indication |
|---|
| Cardiomegaly on CXR |
| Heart murmur |
| Pre-post ductal saturation difference more than 3% |
| Symptoms more than 48 hours |
| Poor response to oxygen |
| Signs of heart failure (hepatomegaly, oedema) |
Management Algorithm
NEONATE WITH RESPIRATORY DISTRESS
(Tachypnoea, Recession, Within First Hours)
↓
┌─────────────────────────────────────────────────────┐
│ INITIAL STABILIZATION │
│ - Warm, dry, stimulate │
│ - Check airway, breathing, circulation │
│ - Pulse oximetry (pre and post-ductal) │
│ - Supplemental oxygen if SpO2 less than 92% │
└─────────────────────────────────────────────────────┘
↓
┌─────────────────────────────────────────────────────┐
│ INVESTIGATIONS │
│ - Chest X-ray │
│ - Blood gas │
│ - Blood glucose │
│ - FBC, CRP, blood culture │
└─────────────────────────────────────────────────────┘
↓
┌─────────────────────────────────────────────────────┐
│ CONSIDER DIFFERENTIAL DIAGNOSES │
├─────────────────────────────────────────────────────┤
│ - RDS (preterm, ground-glass CXR) │
│ - Sepsis/pneumonia (unwell, raised CRP) │
│ - CHD (murmur, cardiomegaly, desaturation) │
│ - PPHN (severe hypoxia, pre-post difference) │
│ - Pneumothorax (sudden deterioration) │
└─────────────────────────────────────────────────────┘
↓
┌─────────────────────────────────────────────────────┐
│ IF TTN LIKELY (Term, Post C-Section, Wet CXR) │
│ │
│ SUPPORTIVE CARE: │
│ - Oxygen: maintain SpO2 92-95% (or as per unit) │
│ - Nil by mouth if RR more than 60/min │
│ (start NG/IV fluids) │
│ - Start feeds when RR less than 60/min │
│ - Temperature control │
│ - Minimal handling │
│ │
│ EMPIRICAL ANTIBIOTICS: │
│ - Benzylpenicillin + Gentamicin │
│ - Continue until cultures negative at 36-48h │
│ - Stop if clinically well and cultures negative │
└─────────────────────────────────────────────────────┘
↓
┌─────────────────────────────────────────────────────┐
│ EXPECTED COURSE │
│ - Peak symptoms: 12-24 hours │
│ - Improvement: 24-48 hours │
│ - Resolution: by 72 hours │
│ - If NOT improving by 24-48h → reassess diagnosis │
└─────────────────────────────────────────────────────┘
↓
┌─────────────────────────────────────────────────────┐
│ DISCHARGE CRITERIA │
│ - RR consistently less than 60/min │
│ - Feeding well (breastfeeding or bottle) │
│ - SpO2 more than 94% in air │
│ - Temperature stable │
│ - Blood cultures negative at 36-48h │
│ - Antibiotics stopped │
└─────────────────────────────────────────────────────┘
Supportive Care
| Intervention | Details |
|---|---|
| Oxygen therapy | Titrate to SpO2 92-95%; use nasal cannulae, headbox, or CPAP as needed |
| Respiratory support | Usually low-flow O2 sufficient; CPAP if work of breathing significant |
| Nil by mouth | If RR more than 60/min (aspiration risk) |
| Intravenous fluids | 60-80 mL/kg/day (glucose infusion rate 4-6 mg/kg/min) |
| NG tube feeds | When RR 60-80 and improving |
| Oral feeds | When RR consistently less than 60/min |
| Temperature control | Maintain normothermia |
| Blood glucose monitoring | Every 4-6 hours until feeding established |
Antibiotic Therapy
| Antibiotic | Dose | Notes |
|---|---|---|
| Benzylpenicillin | 25 mg/kg IV every 12h (≤7 days of age) | First-line for early-onset sepsis cover |
| Gentamicin | 5 mg/kg IV every 36h (adjust per levels) | Gram-negative cover |
| Duration | 36-48 hours | Stop if cultures negative and clinically well |
Escalation Criteria
| Finding | Action |
|---|---|
| FiO2 requirement more than 0.4 | NICU referral; reconsider diagnosis |
| Persistent symptoms more than 48h | Further investigation for CHD, PPHN, infection |
| CPAP failure | Consider transfer for NICU care |
| Significant metabolic acidosis | Reassess for sepsis, inborn error |
Complications of TTN
| Complication | Incidence | Notes |
|---|---|---|
| Prolonged hospital stay | Common | Days rather than hours |
| Feeding difficulties | Common | Due to tachypnoea |
| Need for NG feeding | 50-70% | Temporary |
| Need for CPAP | 10-20% | If moderate-severe |
| Hypoglycaemia | Possible | From nil by mouth + tachypnoea |
| Pneumothorax | Rare | From air trapping |
| NICU admission | 5-15% | If severe or complications |
Long-Term Outcomes
| Outcome | Data |
|---|---|
| Complete recovery | Expected in virtually all cases |
| Long-term respiratory morbidity | No increased risk proven |
| Wheezing in infancy | Some studies suggest slightly increased risk (controversial) |
| Asthma | No definitive link established |
Natural History
| Phase | Timeframe | Typical Course |
|---|---|---|
| Onset | 0-4 hours | Tachypnoea develops post-delivery |
| Peak | 6-24 hours | Maximum symptoms |
| Improvement | 24-48 hours | Gradual reduction in RR and oxygen requirement |
| Resolution | 48-72 hours | Complete recovery |
| Late (more than 72h) | Rare | Consider alternative diagnosis |
Prognostic Factors
| Factor | Prognosis |
|---|---|
| Term infant | Excellent |
| Mild symptoms | Excellent |
| Rapid improvement (less than 24h) | Excellent |
| Late preterm | Good, but may take longer |
| FiO2 more than 0.4 | Reassess diagnosis |
| Symptoms more than 48h | Further investigation needed |
Outcomes Data
| Outcome | Rate |
|---|---|
| Full recovery | More than 99% |
| Need for mechanical ventilation | Rare (less than 1%) |
| Mortality | Essentially zero (in isolated TTN) |
| Recurrence in subsequent pregnancy | No increased baseline risk |
Guidelines
| Guideline | Year | Key Points |
|---|---|---|
| NICE NG195 | 2021 | Antibiotics for suspected neonatal infection; stop at 36h if cultures negative |
| AAP (American Academy of Pediatrics) | 2019 | Antenatal steroids reduce TTN in late preterm |
| RCOG | 2022 | Elective C-section not before 39 weeks to reduce respiratory morbidity |
Key Studies
| Study | Year | N | Key Findings | PMID |
|---|---|---|---|---|
| Jain et al. | 2006 | Meta-analysis | C-section increases risk of respiratory morbidity including TTN (OR 2.9) | 16754840 |
| Hansen et al. | 2008 | 34,458 | Elective C-section at 37 wks: RR 3.9 for respiratory morbidity vs vaginal at 39+ wks | 18077437 |
| Morrison et al. | 1995 | 33,289 | Labour protects against respiratory morbidity; planned C-section before labour increases risk | 7823535 |
| Yurdakök et al. | 2012 | Review | Pathophysiology of TTN related to ENaC and catecholamine response | 22814299 |
| NICE NG195 | 2021 | Guideline | Empirical antibiotics can be stopped at 36h if cultures negative and clinical improvement | N/A |
Prevention
| Intervention | Effect | Evidence |
|---|---|---|
| Avoid elective C-section before 39 weeks | Reduces TTN risk | High (large cohort studies) |
| Antenatal corticosteroids (34-36 weeks) | Reduces respiratory morbidity | Moderate (ALPS trial) |
| Labour before C-section | Protective (catecholamine surge) | Observational data |
Explanation for Parents
What is transient tachypnoea of the newborn (TTN)? TTN is a common breathing problem in newborn babies. It happens when there is extra fluid left in your baby's lungs after birth. Normally, this fluid drains away quickly, but in some babies (especially after caesarean section), it takes a bit longer.
What causes it? Before birth, your baby's lungs are filled with fluid. During vaginal delivery, pressure on the chest and hormones released during labour help squeeze this fluid out. After a caesarean section, especially if there was no labour, this fluid takes longer to clear.
Is it serious? TTN is not usually serious. Most babies recover completely within 24 to 72 hours without any long-term problems. However, we need to make sure it is not a more serious infection, so we will do some tests.
What symptoms will my baby have?
- Fast breathing (more than 60 breaths per minute)
- Ribs showing with each breath (recession)
- Grunting sounds
- Sometimes needing extra oxygen
What tests will be done?
- A chest X-ray to look at your baby's lungs
- Blood tests to check for infection
- Monitoring oxygen levels with a sensor on the hand or foot
How is it treated?
- Oxygen: We may give extra oxygen through small tubes in the nose
- Feeding: If your baby is breathing too fast (more than 60 breaths/min), we will give milk through a tube into the stomach because fast breathing can cause choking
- Antibiotics: We may start antibiotics just in case there is an infection. These can be stopped after 36-48 hours if the blood tests are clear
- Monitoring: We will watch your baby closely until breathing settles
Will my baby be okay? Yes. Almost all babies with TTN make a complete recovery. You should be able to take your baby home once they are feeding well and breathing normally.
-
Jain L, Eaton DC. Physiology of fetal lung fluid clearance and the effect of labor. Semin Perinatol. 2006;30(1):34-43. doi:10.1053/j.semperi.2006.01.006. PMID: 16549212
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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(3):e577-e583. doi:10.1542/peds.2009-0314. PMID: 20156897
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Yurdakök M. Transient tachypnea of the newborn: what is new? J Matern Fetal Neonatal Med. 2010;23 Suppl 3:24-26. doi:10.3109/14767058.2010.507973. PMID: 20822322
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Jain L, Dudell GG. Respiratory transition in infants delivered by cesarean section. Semin Perinatol. 2006;30(5):296-304. doi:10.1053/j.semperi.2006.07.011. PMID: 17011402
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Hansen AK, Wisborg K, Uldbjerg N, Henriksen TB. Risk of respiratory morbidity in term infants delivered by elective caesarean section: cohort study. BMJ. 2008;336(7635):85-87. doi:10.1136/bmj.39405.539282.BE. PMID: 18077437
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Morrison JJ, Rennie JM, Milton PJ. Neonatal respiratory morbidity and mode of delivery at term: influence of timing of elective caesarean section. Br J Obstet Gynaecol. 1995;102(2):101-106. doi:10.1111/j.1471-0528.1995.tb09060.x. PMID: 7756199
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Gyamfi-Bannerman C, Thom EA, Blackwell SC, et al. Antenatal Betamethasone for Women at Risk for Late Preterm Delivery. N Engl J Med. 2016;374(14):1311-1320. doi:10.1056/NEJMoa1516783. PMID: 26842679
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NICE. Neonatal infection: antibiotics for prevention and treatment. NICE guideline [NG195]. 2021. https://www.nice.org.uk/guidance/ng195
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Machado LU, Fiori HH, Baldisserotto M, et al. Surfactant deficiency in transient tachypnea of the newborn. J Pediatr. 2011;159(5):750-754. doi:10.1016/j.jpeds.2011.04.023. PMID: 21652029
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Rawlings JS, Smith FR. Transient tachypnea of the newborn: an analysis of neonatal and obstetric risk factors. Am J Dis Child. 1984;138(9):869-871. PMID: 6475875
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Avery ME, Gatewood OB, Brumley G. Transient tachypnea of newborn: possible delayed resorption of fluid at birth. Am J Dis Child. 1966;111(4):380-385. doi:10.1001/archpedi.1966.02090070078010. PMID: 5906048
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RCOG. Scheduling Elective Caesarean Section. RCOG Green-top Guideline. 2022.
Common Exam Questions
| Question Type | Example |
|---|---|
| MCQ | A term infant delivered by elective C-section develops tachypnoea (RR 80) at 2 hours with mild recession. CXR shows hyperinflation and fluid in the horizontal fissure. What is the most likely diagnosis? |
| SAQ | Describe the pathophysiology of transient tachypnoea of the newborn and outline the key management principles. |
| OSCE | Counsel a mother whose baby has been diagnosed with TTN. |
| Viva | How would you differentiate TTN from RDS and neonatal sepsis? |
High-Yield Viva Points
| Topic | Key Points |
|---|---|
| Definition | Delayed clearance of fetal lung fluid |
| Risk factors | Elective C-section, late preterm, no labour, male sex |
| Pathophysiology | No catecholamine surge → reduced ENaC activation → impaired Na/fluid absorption |
| CXR findings | Hyperinflation, fluid in fissure, perihilar streaking |
| Differentials | RDS (preterm, ground-glass), sepsis (unwell, raised CRP), CHD (murmur, cyanosis) |
| Management | Oxygen, nil by mouth if RR more than 60, empirical antibiotics until cultures negative |
| Prognosis | Resolves 24-72 hours; excellent outcome |
CXR Comparison Table (Exam Favourite)
| Feature | TTN | RDS | Pneumonia |
|---|---|---|---|
| Lung fields | Wet, streaky | Ground-glass | Patchy infiltrates |
| Volume | Hyperinflated | Low | Variable |
| Fissure fluid | Yes | No | No |
| Air bronchograms | No | Yes | May be present |
| Typical patient | Term, C-section | Preterm | Any; risk factors |
| Resolution | 24-48 hours | Needs surfactant | Needs antibiotics |
Common Mistakes
| Mistake | Correct Approach |
|---|---|
| Diagnosing TTN in preterm infant | Consider RDS instead |
| Not starting empirical antibiotics | TTN is a diagnosis of exclusion; give antibiotics until sepsis excluded |
| Oral feeding with RR more than 60 | Use NG tube or IV fluids to prevent aspiration |
| Expecting immediate resolution | Peak at 12-24h; resolution by 48-72h |
| Missing CHD | Echo if symptoms persist more than 48h or murmur heard |
Examination Cheat Sheet
| Parameter | Key Information |
|---|---|
| Incidence | 1-2% term; up to 10% elective C-section |
| Onset | First 2-4 hours of life |
| Duration | Resolves 24-72 hours |
| CXR | Hyperinflation, fluid in fissure, perihilar streaking |
| Key risk factor | Elective C-section (no labour) |
| Management | Oxygen, nil by mouth if RR more than 60, NG feeds, empirical antibiotics |
| 60/60 rule | RR more than 60 = nil by mouth |
| When to stop antibiotics | 36-48 hours if cultures negative and improving |
| Prognosis | Excellent; more than 99% full recovery |