Diagnosis Of Transient Tachypnea Of The Newborn Research Articles

Safety and Efficacy of 2.5 mg and 1.25 mg Nebulized Salbutamol Compared with Placebo on Transient Tachypnea of the Newborns: A Triple-Blind Phase II/III Parallel Randomized Controlled Trial.

Background: To evaluate the safety and efficacy of 2.5 and 1.25 mg nebulized salbutamol on Transient Tachypnea of the Newborn (TTN) compared with placebo. Methods: We conducted a triple-blind, phase II/III parallel randomized controlled trial in two university-affiliated hospitals with neonatal intensive care units. Newborns with a confirmed diagnosis of TTN, with gestational age >35 weeks and gestational weight >2 kg were included. Cases of asphyxia, meconium aspiration syndrome, and persistent pulmonary hypertension were excluded. Ninety eligible patients were randomly allocated in three intervention groups (2.5 mg salbutamol, 1.25 mg salbutamol, and placebo), and a single-dose nebulized product was prescribed 6 hours after the birth. Safety outcomes included postintervention tachycardia, hyperglycemia, hypokalemia, and changes in blood pressure. To evaluate the efficacy, the duration of postintervention tachypnea, TTN clinical score, and clinical and paraclinical respiratory indices were assessed. Parents, Outcome assessors, and data analyzer were blind to the intervention. Results: There was no adverse reaction, including tachycardia, hypokalemia, and jitteriness. Both groups of salbutamol recipients showed significant improvement regarding respiratory rate, TTN clinical score, and oxygenation indices compared with the placebo (p-values <0.001). Nonstatistically significant higher hospital stay was observed in the placebo group. Single 2.5 mg salbutamol nebulization showed a little better outcome than the dose of 1.25 mg, although we could not find statistical superiority. Conclusion: The newly applied single high dose of 2.5 mg nebulized salbutamol is safe in treating TTN and leads to notable faster improvement of respiratory status without any considerable adverse reaction. Registry code: IRCT20190328043133N1.

Lung Ultrasound Findings in the Diagnosis of Transient Tachypnea of Newborn in Late Preterm and Term Neonates

Background: Transient tachypnea of the newborn (TTN) is a prevalent etiology of respiratory distress (RD) in neonates. The condition is a result of the accumulation of fetal lung fluid owing to defective processes responsible for its removal. However, differentiating TTN from various etiologies of RD may provide challenges. Lung ultrasound (LUS) has effectively been used to diagnose and differentiate infant RD. The objective of this research was to evaluate the ultrasonographic findings in the diagnosis of TTN in late preterm and full-term neonates.&#x0D; Methods: All neonates had been exposed to full taking of history, full clinical assessment, chest X-ray, routine laboratory tests, and LUS assessment was performed on 80 late preterm and full-term neonates diagnosed with TTN by clinical and radiological findings and performed on control group.&#x0D; Results: Among 80 neonates who were diagnosed to have TTN, double lung point sign (DLP) was present in 62 (77. 5 %), pleural line abnormalities had been observed in 80 (100%), alveolar interstitial syndrome (AIS) was observed in 68 (85.0%), while white lung was present only in 12 TTN cases (15%), and no pleural effusion was found in any of the patients. While these findings weren’t detected in the control group.&#x0D; Conclusion: LUS could be accurately and reliably used in the diagnosis and screening of TTN. Most common findings in TTN were pleural line abnormalities followed by AIS and DLP.

The diagnostic value of pulmonary near-infrared spectroscopy in the early distinction of neonatal pneumonia from transient tachypnea of the newborn.

Pulmonary near-infrared spectroscopy (NIRS) is a new and promising tool for diagnosis of neonatal respiratory diseases (RD). The study aimed to determine the role of pulmonary regional oxygen saturation (pRSO2 ) values obtained by NIRS in the early distinction of neonatal pneumonia (NP) from transient tachypnea of the newborn (TTN). This prospective, observational, double-blind study was conducted in neonatal intensive care unit (NICU) between 2020 and 2021. Late preterm and term newborns hospitalized in the NICU due to the diagnosis of TTN and NP were included. Cerebral RSO2 and pRSO2 values were measured during the 1st, 24th, 48th, and 72nd hours of hospitalization, using NIRS. Of the eligible 40 infants, 65% (n: 26) were diagnosed as TTN and 35% (n: 16) as NP. The pRSO2 values were significantly higher in the TTN group than the NP group for both apexes (75.3 ± 8.7 vs. 69 ± 5.4, p: .018, respectively) and lateral lung (77.8 ± 6 vs. 72.7 ± 6.2, p: .016, respectively) in the 1st hour of hospitalization. There were significant differences in pRSO2 apex and pRSO2 lateral values between the 1st and 24th hours of hospitalization and the 24th and 48th hours in the NP group (p2 : .001 for both). The optimal pRSO2 apex cut-off value was >72% to predict the diagnosis of NP with a sensitivity of 78.6% and a specificity of 69.2%. Pulmonary NIRS may be considered as a feasible and promising diagnostic tool in late preterm and term infants with RD. It may also be helpful for the early differentiation of NP from TTN and the courses of these diseases.

Elective cesarean section versus induced vaginal delivery: Do any differences in terms of neonatal respiratory morbidities exist?

Background/Aim: Transient tachypnea of the newborn (TTN) is mostly a benign and self-limiting common physiological disorder. Certain factors, such as elective cesarean section (CS) not preceded by spontaneous labor, delivery before 39 gestational weeks, and perinatal asphyxia, interfere with the fetal–neonatal transition. In our study, we aimed to review the results of hospitalized newborns who receive a diagnosis of TTN and investigate the possible relationship between the implementation of labor induction and the occurrence of this disorder. Methods: This study used a case-control study design. We scanned the hospital records of 156 term newborns hospitalized between January 2017 and January 2018 who received a diagnosis of TTN and who did not have any additional fetal and/or maternal risk factors. Demographic features, mode of delivery, and implementation of labor induction in vaginal deliveries were recorded and compared to the data from 150 healthy term infants. Infants were then split into two groups according to their type of labor induction, and a separate subgroup analysis was performed in terms of the risk of TTN development. Results: The incidence of TTN was 2.9% in vaginal deliveries and 8.5% in CSs. Differences between groups regarding gestational age, birth weights, gender, elective induction in vaginal deliveries, interventions in the delivery room, and types of intervention were found (P&lt;0.05). The risk of developing TTN was 2.5 times higher in the induction group compared to those who did not receive induction but still developed TTN (P&lt;0.001). Also, the risk was significantly higher in the induction group compared to those who did not receive induction and did not develop TTN (P&lt;0.001). After applying a logistic regression analysis, labor induction (odds ratio: 1.005; 95% confidence interval: 1.003–1.008, P&lt;0.001) was found to be an independent significant risk factor for developing TTN. Conclusions: This study indicates that infants born via electively induced vaginal delivery had significantly higher rates of TTN. Therefore, elective labor induction can be added as a new risk factor for TTN development. In our opinion, labor induction without valid medical and obstetric indications should be avoided due to maternal and fetal complications.

The diagnostic value of n-terminal probrain natriuretic peptides to differentiate neonatal pneumoniae and transient tachypnea of the newborn.

The primary objective of the study was to determine the diagnostic value of serum N-terminal probrain natriuretic peptide (NT-proBNP) levels to differentiate neonatal pneumonia (NP) and transient tachypnea of the newborn (TTN). The secondary objective was to investigate the prognostic role of NT-proBNP levels in neonates with severe respiratory distress (RD). A prospective, observational, single-blinded study involving 58 late preterm and term newborns who were diagnosed with TTN or NP was conducted between June 2020 and June 2021 at a level-3 neonatal intensive care unit in Kırıkkale University Faculty of Medicine. TTN and NP groups were compared for serum NT-proBNP levels measured at the 1st and 24th hours of life. Optimal cut-off NT-proBNP value was determined by Youden index to predict the diagnosis of NP. Lung ultrasound was used to support the diagnosis of TTN and NP. In addition, lung ultrasound score (LUS) was used to determine severe RD. The median of NT-proBNP level was significantly higher at the 24th hour of life in the NP group than in the TTN group, respectively 7263.5 pg/mL (1643-35,000) and 3308 pg/mL (69-19,746), p = 0.004. At a cut-off value of 5515.5 pg/mL, NT-proBNP had a sensitivity of 75% and specificity of 73.8% to predict NP [AUC= 0.749 (95% CI: 0.602-0.895; p = 0.004)]. The study population was divided into two groups as high score group (n: 23, LUS ≥ 7) and low score group (n: 35, LUS < 7) according to the LUS at the 6th hour of life. NT-proBNP values at 24th hour of life were 6320 pg/mL (69-35,000) in high score group and 3500 pg/mL (570-15,948) in low score group, p = 0.044. Duration of oxygen support (p = 0.006), noninvasive ventilation (p = 0.008) and NICU stay (p = 0.004) were higher in high-score group. NT-proBNP values at 24th hour of life can be used as a relatively early predictor in the differentiation between NP and TTN in late preterm and term neonates. In addition, elevated NT-proBNP values are related to the higher LUS which reflects the severity of RD regardless of diagnosis.

Risk factors of transient tachypnea of the newborn developing into pulmonary hypertension of the newborn: a case-control study.

Transient tachypnea of the newborn (TTN) is the consequence of delayed resorption of lung fluid. When TTN develops, the infant may develop severe hypoxemia and progress to persistent pulmonary hypertension of the newborn (PPHN). To examine factors associated with the development of PPHN in TTN infants. This retrospective study comprised 23 infants in whom a diagnosis of TTN with PPHN (TTN-PPHN) was confirmed and 59 infants with severe TTN without PPHN who required mechanical ventilation between 2009 and 2018 at Songklanagarind Hospital, Thailand. Logistic regression was used to assess factors associated with TTN and PPHN. The factors identified by univariate analysis that were associated with development of PPHN were oxygen saturation (SpO2) <90% and respiratory rate (RR) ≥70 breaths/min at the time of admission, mean airway pressure (MAP) ≥8 cmH2O, oxygen index (OI) ≥10, partial pressure of oxygen (PaO2) ≤60, partial pressure of carbon dioxide (PCO2) ≥45 mmHg, and infants who did not receive positive pressure ventilation (PPV). In multivariate analyses, RR ≥70 breaths/min (adjusted odds ratio [aOR] 9.96, 95% confidence interval [CI] 2.1-47.29, P < 0.001) and OI ≥10 (aOR 29.22, 95% CI 4.46-191.23, P < 0.001) remained statistically significantly associated with PPHN. High RR and high OI were factors associated with PPHN in TTN infants.

Maternal Obesity-Associated Neonatal Morbidities in Early Newborn Period.

Maternal obesity has been associated with pregnancy-related complications and neonatal morbidities. The primary aim of this study was to evaluate early neonatal morbidities associated with maternal obesity from the infant-mother dyad data set at a single, large Regional Perinatal Center (RPC) in NY. A retrospective chart review of all mother-infant dyads born from January 2009 to December 2019 was done. Maternal obesity was defined using the NIH definition of pre-pregnancy body mass index (BMI) ≥ 30 Kg/m2. Maternal data included pre-pregnancy BMI, gestational diabetes, hypertension, and mode of delivery. Neonatal data recorded the birth weight, gestational age, respiratory support after delivery, diagnosis of transient tachypnea of the newborn (TTN), respiratory distress syndrome (RDS), neonatal hypoglycemia (NH), and hypoxic-ischemic encephalopathy (HIE). Diagnosis of TTN, RDS, NH, and HIE was defined by the service neonatologist and cross-checked by the data system review neonatologist. Medical records of 22,198 infant-mother dyads included in the study had 7,200 infants (32.4%) born to obese mothers and 14,998 infants (67.6%) born to non-obese women. There was a statistically significant increase in the diagnosis of gestational diabetes, gestational hypertension, and cesarean deliveries in obese mothers. Diagnosis of TTN, RDS, and NH was significantly higher in infants born to obese mothers, while HIE incidence was similar in both the groups. Infants born to obese mothers are more likely to be delivered by cesarean section and are at a higher risk of diagnosis of transient tachypnea of newborn, respiratory distress syndrome, and hypoglycemia in the early neonatal period.

Efficacy of Budesonide, Epinephrine and Salbutamol Inhalation for Treatment of Transient Tachypnea of Newborn: Prospective Controlled Study

Background: Transient tachypnea of the newborn (TTN) is a neonatal lung disease which has a picture of lung edema due to delayed resorption of lung fluids. It is commonly seen in full-term or late-preterm in­fants with an occurrence rate of 5.7 in 1,000 infants. The aim of this work was to compare the efficacy of inhaled budesonide, epinephrine and salbutamol for treatment of TTN.&#x0D; Methods: This prospective controlled study was conducted on a100 full term neonates with presumed diagnosis of TTN. They were randomly assigned into four groups equally. Group I received nebulized budesonide, Group I received nebulized epinephrine, Group III received nebulized salbutamol and Group IV received nebulized normal saline.&#x0D; Results: Salbutamol significantly decreased respiratory rate and TTN clinical score, duration of respiratory support along with hospitalization time and helped with reaching full feeding earlier compared to other groups.&#x0D; Conclusions: Inhaled salbutamol significantly decreased TTN clinical score, shorter duration of respiratory support, hospitalization and earlier initiation of enteral feeding compared to placebo. Inhaled budesonide and epinephrine did not significantly reduce the duration of oxygen treatment, with no other significant effect on TTN.

The use of immature granulocyte and other complete blood count parameters in the diagnosis of transient tachypnea of the newborn

BackgroundAlthough Transient tachypnea of the newborn (TTN) is one of the most common causes of respiratory distress in the newborn period, there is no laboratory parameter used to diagnose it. Immatur granulocyte (IG) measurement is accepted as a useful indicator that can be used in early detection of many infectious conditions, especially neonatal sepsis. In this study, it was aimed to determine if IG and other complete blood count (CBC) parameters could be used as laboratory findings supporting TTN diagnosis. Materials and methodsThis study, which was retrospectively planned, was conducted in the neonatal intensive care unit (NICU) a public hospital between January 1, 2019 and January 31, 2021. Randomly selected 50 infants, hospitalized with the diagnosis of TTN, constituted the patient group of the study. 50 infants hospitalized with the diagnosis of hyperbilirubinemia and did not have any additional problems accepted as the control group. IG and other CBC parameters of infants in the patient and control groups were compared in the study. ResultsThere was no significant difference between the patient and control groups in terms of demographic data and types of delivery (p > 0.05). The rate of delivery by elective cesarean section (C/S) was significantly higher than the rate of normal spontaneous vaginal (NSV) delivery in the patient group (p < 0.001). The IG number and percentage, WBC (white blood cell) count, RDW (red cell distribution width), number and percentage of NRBC (nucleated red blood cell), neutrophil and lymphocyte ratio, count and percentage of basophil and PLR (platelet/lymphocyte ratio) of the patient group was significantly higher than the control group (p < 0.05). ConclusionAccording to the findings obtained in the study, it was concluded that IG and other CBC parameters may be used to support clinical and imaging findings to diagnose transient tachypnea of the newborn.

Prediction of the Course of Transient Tachypnea of the Newborn by Blood Laboratory Parameters at the Time of Admission

Background: Transient tachypnea of the newborn (TTN) is a common but mild respiratory problem seen in late preterm and term newborns. However, it may sometimes cause severe morbidity. Objectives: Therefore, biomarkers that can predict TTN severity may aid the clinician in determining the need for intensive care. Our aim was to identify whether blood gases and complete blood count parameters could be utilized to predict the severity of TTN.s Methods: We retrospectively examined the medical records of newborns (&gt; 37 weeks gestation, &gt; 2000 grams) diagnosed with TTN who were hospitalized in the Neonatal Intensive Care Unit (NICU) of Karabuk University Faculty of Medicine, Training and Research Hospital, Karabük/Turkey between June 2019 and June 2020. Patients were grouped according to the length of stay in the NICU. Group 1 included patients that did not require NICU monitoring after 48 hours, and group 2 included patients who continued to require NICU monitoring after 48 hours. Blood gases and complete blood count parameters were compared between the two groups. Results: During the study period, 91 newborns were hospitalized in the NICU due to respiratory distress. Thirty-nine patients who did not meet the inclusion criteria were excluded. Gestational age and birth weight were significantly lower in group 2 (P &lt; 0.05). There were no significant differences between the groups in terms of leukocyte count, hemoglobin level, mean platelet volume (MPV), and platelet count. Partial carbon dioxide pressure (PCO2) was significantly elevated, and base excess (BE) was significantly greater in group 2. Conclusions: We determined a relationship between a prolonged stay in NICU and the levels of PCO2 and BE among patients hospitalized with a diagnosis of TTN. Therefore, PCO2 and BE values may be valuable to determine the prognosis of TTN in the early period. Despite being one of the most common causes of intensive care admission in the newborn population, there is limited data on the diagnosis, treatment, and prognosis of TTN; thus, we believe that our results will shed light on this problem.

Fluid restriction in the management of transient tachypnea of the newborn.

Transient tachypnea of the newborn (TTN) is caused by delayed clearance of lung fluid at birth. TTN typically appears within the first two hours of life in term and late preterm neonates and is characterized by tachypnea and signs of respiratory distress. Although it is usually a self-limited condition, admission to a neonatal unit is frequently required for monitoring and providing respiratory support. Restricting intake of fluids administered to these infants in the first days of life might improve clearance of lung liquid, thus reducing the effort required to breathe, improving respiratory distress, and potentially reducing the duration of tachypnea. To evaluate the efficacy and safety of restricted fluid therapy as compared to standard fluid therapy in decreasing the duration of oxygen administration and the need for noninvasive or invasive ventilation among neonates with TTN. We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 12), in the Cochrane Library; Ovid MEDLINE and electronic ahead of print publications, in-process & other non-indexed citations, Daily and Versions(R); and the Cumulative Index to Nursing and Allied Health Literature (CINAHL), on December 6, 2019. We also searched clinical trial databases and the reference lists of retrieved articles for randomized controlled trials and quasi-randomized trials. We included randomized controlled trials (RCTs), quasi-RCTs, and cluster trials on fluid restriction in term and preterm neonates with the diagnosis of TTN or delayed adaptation during the first week after birth. For each of the included trials, two review authors independently extracted data (e.g. number of participants, birth weight, gestational age, duration of oxygen therapy, need for continuous positive airway pressure [CPAP], need for mechanical ventilation, duration of mechanical ventilation) and assessed the risk of bias (e.g. adequacy of randomization, blinding, completeness of follow-up). The primary outcome considered in this review was the duration of supplemental oxygen therapy in hours or days. We used the GRADE approach to assess the certainty of evidence. Four trials enrolling 317 infants met the inclusion criteria. Three trials enrolled late preterm and term infants with TTN, and the fourth trial enrolled only term infants with TTN. Infants were on various methods of respiratory support at the time of enrollment including room air, oxygen, or nasal CPAP. Infants in the fluid-restricted group received 15 to 20 mL/kg/d less fluid than those in the control group for varying durations after enrollment. Two studies had high risk of selection bias, and three out of four had high risk of performance bias. Only one study had low risk of detection bias, with two at high risk and one at unclear risk. The certainty of evidence for all outcomes was very low due to imprecision of estimates and unclear risk of bias.Twotrialsreported the primary duration of supplemental oxygen therapy. We are uncertain whether fluid restriction decreases or increases the duration of supplemental oxygen therapy (mean difference [MD] -12.95hours, 95% confidence interval [CI]-32.82to 6.92;I² = 98%; 172 infants).Similarly, there is uncertainty for various secondary outcomes including incidenceof hypernatremia (serum sodium > 145 mEq/L, risk ratio [RR] 4.0, 95% CI 0.46 to 34.54; test of heterogeneitynot applicable;1 trial, 100 infants), hypoglycemia(blood glucose < 40 mg/dL, RR 1.0, 95% CI 0.15 to 6.82; test of heterogeneity not applicable;2 trials, 164 infants), endotracheal ventilation (RR0.73, 95% CI 0.24 to 2.23; I² = 0%; 3 trials, 242infants), need for noninvasiveventilation (RR 0.40, 95% CI 0.14 to 1.17; test of heterogeneity not applicable; 2 trials, 150 infants), length of hospital stay (MD -0.92 days, 95% CI -1.53 to -0.31; test of heterogeneity not applicable; 1 trial, 80 infants), and cumulative weight loss at 72 hours of age (%) (MD 0.24, 95% CI -1.60to 2.08; I² = 89%; 2 trials, 156 infants).We did not identify any ongoing trials; however, one trial is awaiting classification. We found limited evidence to establish the benefits and harms of fluid restriction in the management of TTN. Given the very low certainty of available evidence, it is impossible to determine whether fluid restriction is safe or effective for management of TTN. However, given the simplicity of the intervention, a well-designed trial is justified.

865 Are newborn outcomes different for term babies who were exposed to antenatal corticosteroids?

Antenatal corticosteroids improve newborn outcomes for preterm infants. However, predicting which women presenting for threatened preterm labor will have preterm infants is inaccurate, and manywomen receive antenatal corticosteroids but then go on to deliver at term. This study aimed to compare the short-term outcomes of infants born at term to women who received betamethasone for threatened preterm labor with infants who were not exposed to betamethasone in utero. We performed a retrospective cohort study of infants born at or after 37 weeks' gestational age to mothers diagnosed as having threatened preterm labor during pregnancy. The primary neonatal outcomes of interest included transient tachypnea of the newborn, neonatal intensive care unit admission, and small for gestational age and were evaluated for their association with betamethasone exposure while adjusting for covariates using multiple logistic regression. Of 5330 women, 1459 women (27.5%) received betamethasone at a mean gestational age of 32.2±3.3 weeks. The mean age of women was 27±5.9 years and the mean gestational age at delivery was 38.9±1.1 weeks. Women receiving betamethasone had higher rates of maternal comorbidities (P<.001 for diabetes mellitus, asthma, and hypertensive disorder) and were more likely to self-identify as White (P=.022). Betamethasone-exposed neonates had increased rates of transient tachypnea of the newborn, neonatal intensive care unit admission, small for gestational age, hyperbilirubinemia, and hypoglycemia (all, P<.05). Controlling for maternal characteristics and gestational age at delivery, betamethasone exposure was not associated with a diagnosis of transient tachypnea of the newborn (adjusted odds ratio, 1.10; 95% confidence interval, 0.80-1.51), although it was associated with more neonatal intensive care unit admissions (adjusted odds ratio, 1.49; 95% confidence interval, 1.19-1.86) and higher odds of the baby being small for gestational age (adjusted odds ratio, 1.78; 95% confidence interval, 1.48-2.14). Compared with women evaluated for preterm labor who did not receive betamethasone, women receiving betamethasone had infants with higher rates of neonatal intensive care unit admission and small for gestational age. Although the benefits of betamethasone to infants born preterm are clear, there may be negative impacts for infants delivered at term.

Steroids for All

Background: Due to difficulties estimating the risk of preterm labor, many women diagnosed with threatened preterm delivery and given antenatal corticosteroids to improve neonatal outcomes do not deliver until term. Our objective was to compare the short-term outcomes of infants born at term to women who received betamethasone (BMZ) for threatened preterm labor to infants who were not exposed to BMZ in utero. &#x0D; &#x0D; Methods: We performed a retrospective cohort study of infants born at or after 37 weeks’ gestational age (GA) to mothers diagnosed with threatened preterm labor during pregnancy. Controlling for covariates, the primary neonatal outcomes of interest, including transient tachypnea of the newborn (TTN), neonatal intensive care unit (NICU) admission, and birthweight, were evaluated for their association with BMZ exposure. &#x0D; &#x0D; Results: Of 5330 women, 1459 (27.5%) women received BMZ at a mean GA of 32.2±3.3 weeks. The mean age of women was 27±5.9 years-old and the mean GA at delivery was 38.9±1.1 weeks. Women receiving BMZ had higher rates of maternal comorbidities (P&lt;0.001 for diabetes, asthma, and hypertensive disorder) and were more likely to self-identify as white (P=0.022). BMZ-exposed neonates had lower birth weights and increased rates of oxygen usage, TTN, hyperbilirubinemia, hypoglycemia, and NICU admission rates (all P-values &lt;0.05). &#x0D; Controlling for maternal characteristics and GA at delivery, BMZ exposure was not significantly associated with diagnosis of TTN [OR 1.09 (95% CI 0.80-1.50)], though it was associated with more NICU admissions [1.49 (1.19-1.86)] and lower birthweight by 91.5 (-122.3 to -60.6) grams. &#x0D; &#x0D; Conclusions: Compared to women evaluated for preterm labor that did not receive BMZ, women receiving BMZ had infants with higher rates of NICU admission and lower birthweights, though the rate of TTN diagnosis was similar between the two groups. While the benefits of BMZ to infants born preterm are clear, there may be negative impacts for infants delivered at term.

Procalcitonin Level at 24 Hours of Age May be Predictive for Transient Tachypnea of the Newborn

Abstract Objective It is an important problem to differentiate transient tachypnea of the newborn (TTN) from bacterial pneumonia or other conditions in patients admitted to Neonatal Intensive Care Unit. The aim of this study was to evaluate the predictive value of procalcitonin (PCT) for TTN. Methods A total of 52 infants were contained in the study. The patients were divided into three groups. Group 1 consisted of patients with pronounced grunting at more than 2 hours postnatal age (n = 16). Group 2 consisted of patients whose grunt was reduced or gone at 2 hours postnatal age but in whom tachypnea persisted until 24 hours postnatal age (n = 18). Group 3 consisted of patients with minimal or no respiratory distress at 24 hours postnatal age (n = 18). In all groups, PCT concentrations were determined at birth and 24 hours postnatal age. Results PCT concentrations at birth were significantly higher in Group 1 than other groups, but there was no difference between Groups 2 and 3. PCT concentrations at 24 hours postnatal age were significantly higher in Groups 1 and 2 than Group 3. No difference was found between Group 1 and Group 2 at 24 hours postnatal age. All PCT concentrations in Group 3 were significantly lower than other groups. PCT thresholds for the diagnosis of TTN were 0.44 ng/mL at birth (sensitivity 58%, specificity 50%) and 5.11 ng/mL at 24 hours postnatal age (sensitivity 79.4%, specificity 89.1%). Conclusion Serial PCT measurements at birth and postnatal 24 hours may be helpful in differentiating between pneumonia and TTN. Further researches are needed to confirm this initial study.

Double Lung Point Vs X-Ray in Transient Tachypnea of Newborn

Background: Transient tachypnea of the newborn (TTNB) is one of the most common causes of perinatal dyspnea and is traditionally diagnosed by chest x-ray. Lung ultrasound is an upcoming tool which is being proved in recent studies to have a better diagnostic capability with the main characteristic feature being the Double Lung Point. Aims &amp; objectives: To define ultrasonographic appearance of TTNB, evaluate its clinical relevance for early diagnosis and compare the outcome with xray and to assess the diagnostic ability of Double lung point.Subjects and Methods:All newborns presenting with tachypnea within 4 hours of life in 1 ½ years of study period. (November 2017-May 2019) were enrolled for study. Methods of collection of data: All newborns fulfilling the inclusion criteria were included as study subjects, At same time CHEST XRAY and LUS were done. Statistical analysis: Fisher’s exact test was used as test of significance for qualitative data. Continuous data was represented as mean and standard deviation. Mann Whitney U test and Kruskul-wallis test was used for subgroup analysis. P value of &lt;0.05 was considered as statistically significant.Result:In study period of 1 ½ years 99 cases which were admitted in NICU with respiratory distress meeting the criteria were included. 60 cases were diagnosed to have TTNB, 34 RDS &amp; 5 Pneumonia. Chest xray and Lung ultrasound (LUS) of these 60 TTNB cases were compared . LUS of TTNB and other cases was also compared for presence of double lung point (DLP). The sensitivity &amp; specificity of DLP in diagnosis of TTNB was noted to be 68 % &amp; 100 % respectively with 100 % Positive predictive value. Thus confirming LUS to be a more reliable diagnostic tool than x-ray.Conclusion:Therefore LUS could be used widely in NICU as 1st line of diagnostic medium in diagnosis of various respiratory conditions and early initiation of treatment accordingly.

Human Epididymis Protein 4 Levels in Neonates with Respiratory Disorder.

Results There were no differences found in the HE4 levels determined for the mothers' blood samples and umbilical cord blood samples in all investigated groups. In comparison with healthy children, the elevated HE4 levels were observed in neonates with TTN. Significant positive correlation between HE4 and CRP as well as PCT levels was observed in all investigated neonates. The receiver operating characteristic (ROC) curve analysis demonstrated the cut-off value for the serum HE4 in the researched neonates at the level of 318.5 pmol/L, yielding the sensitivity of 73.9% and specificity of 66.7% for the early diagnosis of TTN. Conclusions Serum HE4 could be considered as a candidate biomarker for the early diagnosis of pulmonary dysfunction in the newborns.

New Risk Factors for Transient Tachypnea of the Newborn and Childhood Asthma: A Study of Clinical Data and a Survey of Parents.

Objectives: It is established that transient tachypnea of the newborn (TTN) is associated with an increased risk of early childhood asthma. However, the question remains whether both asthma and TTN have common risk factors as well as the same underlying etiology. This study aims to determine possible risk factors for TTN as well as early childhood asthma.Methods: This study was carried out in two phases. While the first phase included medical records of 1318 newborns, the second phase consisted of a phone survey.Results: Elective cesarean section (ECS), maternal asthma, gestational age (GA), babies with large and small birth weight, number of pregnancies, and number of children were found to be significantly associated with TTN. ECS, maternal asthma, length of the hospital stay due to TTN, and O2 treatment were statistically significant for asthma. TTN was found to be associated with a subsequent diagnosis of childhood asthma after adjusting for ECS and maternal asthma.Conclusions: Both ECS and maternal asthma are the common risk factors for the development of both TTN and childhood asthma as previously reported. In order to uncover this association, when ECS is taken out, it is seen that the association between TTN and asthma is stronger. Furthermore, O2 treatment and duration of hospital stay due to TTN were also found to be associated with childhood asthma. Association of maternal allergic rhinitis and eczema with TTN was investigated and there was no relationship between maternal allergic rhinitis or maternal eczema and the subsequent diagnosis of TTN.

Lung ultrasound in early diagnosis of neonatal transient tachypnea and its differentiation from other causes of neonatal respiratory distress.

Transient tachypnea of the newborn (TTN) is one of the most common causes of neonatal respiratory distress (RD). However, distinguishing TTN from other causes of RD may be difficult during the first 12:24 h after birth. Lung ultrasonography (LUS) has been successfully utilized in the diagnosis and differential diagnosis of neonatal RD. This study aimed to investigate the diagnostic value of LUS for early diagnosis of TTN as well as differentiate it from other causes of neonatal RD in near and full term Egyptian neonates. LUS was performed in 65 near and full term neonates presented with RD within the first 12:24 hours of admission in NICU of Suez Canal University, Ismailia, Egypt. Among the 65 neonates included in the study, 73.8% were diagnosed to have TTN, 18.5% were diagnosed to have pneumonia, 4.6% had meconium aspiration syndrome (MAS) and 3.1% had respiratory distress syndrome (RDS). The Double lung point has 69.6% sensitivity, 100% specificity, 100% PPV and 39.1% NPV for detecting TTN. We have novel data showing a positive correlation between the degree of alveolar-interstitial syndrome (AIS) and the type of oxygen support offered to neonates diagnosed with TTN. We found LUS to be a reliable and non-invasive tool for the early diagnosis of TTN and its differentiation from other causes of neonatal RD in near and full term Egyptian neonates.

Comparison of Restricted Fluid Volume with Standard Fluid Volume in Management of Transient Tachypnea of the Newborns: A Randomized Controlled Trial

Background Transient tachypnea of the newborn (TTN) is one of the most common neonatal respiratory disease and its symptoms usually begins in the first few hours after birth. The volume of fluid intake according to the neonate's conditions varies. We aimed to compare the restricted fluids volume with standard fluids volume in treatment of neonates with TTN. Materials and Methods: This clinical trial was performed on 80 neonates with a diagnosis of TTN admitted in the Neonatal intensive care unit (NICU) of Fatemiyeh Hospital and Beasat Hospital of Hamadan Medical University in Iran. Patients were randomly divided to standard fluids volume (control = 40), and restricted fluids volume treatment groups (case = 40). The hospitalization duration, oxygen therapy duration as well as the number of days need for oxygen with hood; Nasal continuous positive airway pressure (NCPAP), and mechanical ventilation therapy was recorded. After data collection, the data were statistically analyzed via SPSS software (version 21.0). Results: The subjects were 30 (37.5%) females and 50 (62.5%) males (62.5%) with an average gestational age of 38.12(±1.07) weeks.The main aim from this interventional study was effect of restricted fluidtherapy on management of TTN in NICU section. The hospitalization duration, oxygen therapy duration and need for oxygen therapy with hood in the intervention group were significantly lower than the control group (P 0.05). Conclusion TTN treatment with restricted fluids volume, compared with standard volume of fluids, significantly reduces the need for respiratory supports as well as the duration of hospitalization in the NICU section.

Risk Factors Affecting Transient Tachypnea of the Newborn in Fatemieh Hospital of Hamadan, Iran, 2015 - 2016

Background: Transient tachypnea of the newborn (TTN) is one of the important causes of neonatal respiratory distress and hospitalization in the neonatal intensive care unit (NICU). Objectives: The current study aimed at identifying the risk factors of TTN in a single tertiary care center. Methods: The current prospective, case-control study was conducted on 180 newborns allocated in the 2 groups of with TTN (n = 90) as the case group, and without TTN (n = 90) as the control group for 1 year from April to March 2015 in a public hospital of Hamadan, Iran. Newborn and mother’s information was extracted from their medical records. Diagnosis of TTN was based on clinical and radiological findings, after ruling out other respiratory distress causes. Data were analyzed using logistic regression and P < 0.05 was considered the level of significance. Results: The raw data analysis of regression factors associated with TTN showed that the risk of TTN was higher in late preterm infants (odds ratio (OR): 6.15; 95 confidence interval (CI): 3.17-11.92, P = 0.001) as well as male newborns (OR: 0.33, 95 CI: 0.17-0.62, P = 0.001), and those born by cesarean (OR: 11.22, 95 CI: 5.33-23.62, P = 0.001). Moreover, the risk of TTN increased with Apgar score in the first minute (OR: 0.02.95 CI: 0.00-0.05, P = 0.001) and decreased with the fifth minute (OR: 0.02; 95 CI: 0.00-0.06, P = 0.001). The results of multiple regression analysis showed that the odds of TTN of late preterm newborns was 2.96 times higher than that of term newborns (OR: 2.96, 95 CI: 1.09-8.04, P = 0.033). Furthermore, with increase in Apgar score in the first minute, the risk of TTN reduced (OR: 0.02; 95 CI: 0.01-0.07, P = 0.001). Conclusions: Prematurity and Apgar score in the first minute were the risk factors for TTN. Consequently, the risk of TTN can be reduced by the prevention of preterm birth and improvement of perinatal care. © 2018, Iranian Red Crescent Medical Journal.