Transient Tachypnea Of The Newborn Research Articles

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.

Uzroci i ishodi lečenja respiratornog distresa kod novorođenčadi kasne preterminske gestacije - iskustvo tercijarnog neonatalnog centra

Introduction/Aim: Respiratory distress (RD) is the most common cause of morbidity in preterm infants. The current study was under-taken to determine causes of RD in late preterm infants, analyze characteristics of RD regarding gestational age, compare different clinical forms of RD and determine the factors influencing the unfavorable outcome of late preterm infants with RD. Methods: The study included infants born between 34 0/7 and 36 6/7 weeks of gestation with RD hospitalized at the Institute for Mother and Child Health Care of Serbia "Dr Vukan Cupic". Demographic and clinical characteristics, clinical signs and course of the disease, the occurrence of complications, as well as quantification of disease severity were analyzed. The outcome was assessed through mortality , duration of mechanical ventilation, and length of hospital stay. Patients were ranked and compared according to gestation and type of RD. Descriptive and analytic statistical methods were used for analyzing the results. Results: The study comprised a total of 65 late preterm newborns with RD, the majority of whom were male (n=44, 67.7%). Respiratory distress syndrome (RDS) (46.2%) and transient tachypnea of the newborn (TTN) (40%) were the most common causes of RD. TTN was most prevalent in neonates in the 36 th gestational week, whether RDS was most present before 35 th gestational week. The average length of hospital stay was 15 days and mortality in the group was 1.5%. Conclusion: The most prevalent causes of RD in late preterm infants are RDS and TTN. Late preterm infants represent a vulnerable group of newborns, with a heightened risk of associated morbidity and mortality.

Evaluation of Perinatal and Developmental Outcomes in Neonates with Abstinence Syndrome Admitted to NICU

Drug abuse by pregnant women is one of the significant problems for mothers and their neonates. This study aimed to investigate the effects of maternal substance use disorder during pregnancy on neonatal developmental criteria. In a case-control study, clinical records of 90 neonates diagnosed with neonatal abstinence syndrome who were admitted to NICU in one of four hospitals affiliated with Shahid-Beheshti University of Medical Sciences in Tehran, Iran between 2017 and 2020 were compared to 90 neonates without neonatal abstinence syndrome (control group). Demographic information and data for neonatal developmental characteristics and complications were extracted from the clinical records of this convenience sample. Data for the type and method of maternal substance use during pregnancy were collected through a telephone call with mothers. Our data showed that the prevalence of drug addiction was 1.8% among pregnant women, and the most common drugs used by mothers were opium (n = 45%, 50%), amphetamine (n = 30%, 33%), and methadone (n = 14%, 16%). Neonates with abstinence syndrome had a higher prevalence of transient tachypnea of the newborn (TTN) (<i>P</i> = 0.004), and a prevalence of being admitted to NICU (<i>P</i> = 0.05) and for a longer duration (<i>P</i> < 0.001). Their mothers had a higher prevalence of having pre-eclampsia (<i>P</i> = 0.010). Using morphine vs. amphetamine showed no difference based on their effects on mothers and neonates. Substance use during pregnancy increased the prevalence of pregnancy complications (pre-eclampsia) and neonatal complications (TTN and prevalence and duration of hospitalization). Therefore, planning for the development of health policies to raise awareness among women and more broadly, all members of the community, is important to prevent the tendency to engage in this potentially high-risk behavior.

Noninvasive Fetal Lung Maturity Prediction Based on Amniotic Fluid Turbidity Using Ultrasonic Histogram Measurement Function

Background: Amniotic fluid turbidity increases with fetal lung maturation due to vernix and lung surfactant micelles suspended in the amniotic fluid. This study focused on this phenomenon and evaluated the presence or absence of respiratory distress syndrome (RDS)/transient tachypnea of the newborn (TTN) by quantitatively assessing the brightness of the amniotic fluid turbidity using a noninvasive ultrasound histogram measurement function. Methods: We included cases of singleton pregnancies managed at the Niigata University Medical and Dental Hospital between November 2020 and March 2022. Histograms of amniotic fluid turbidity were measured at the center of the amniotic fluid depth, avoiding the fetus, placenta, and umbilical cord, with the gain setting set to 0, and the average value was obtained after three measurements. Histograms of fetal urine in the bladder were measured similarly. The value obtained by subtracting the fetal bladder brightness value from the amniotic brightness value based on histogram measurements was used as the final amniotic fluid brightness value. Results: We included 118 cases (16 of RDS/TTN and 102 of control). The gestational age of delivery weeks was correlated with amniotic fluid brightness (Spearman’s rank correlation coefficient was 0.344; p = 0.00014). Amniotic fluid brightness values were significantly lower in the RDS/TTN group than in the control group (RDS/TTN: 16.2 ± 13.5, control: 26.3 ± 16.3; p = 0.020). The optimal cutoff value of amniotic fluid brightness to predict RDS/TTN was 20.3. For predicting RDS/TTN, the sensitivity, specificity, positive predictive value, and negative predictive value were 91.7%, 69.6%, 26.2%, and 94.1%, respectively. Conclusions: The quantitative value of the amniotic fluid brightness by histogram measurements may provide an easy and objective index for evaluating the presence or absence of RDS/TTN.

Late preterm polyhydramnios and the risk of transient tachypnea of the newborn

Clearance of fetal lung fluid at birth is instrumental in neonatal respiratory outcomes, with decreased fluid clearance related to development of transient tachypnea of the newborn (TTN). The effects of excess fetal lung fluid on neonatal respiratory outcomes in the late preterm (LP) period have yet to be elucidated. We aimed to determine if polyhydramnios (POLY) in LP gestation increases the risk of TTN.

Comparison of Effects of Salbutamol Inhalation with Continuous Positive Airway Pressure and Bubble Continuous Positive Airway Pressure Alone in the Management of Severe Transient Tachypnea of the Newborn

Objective: To find the frequency of known risk factors in cases of severe transient tachypnea of the newborn (TTN) and to measure the effect of inhaled Salbutamol to bubble CPAP on required treatment duration.&#x0D; Study Design: Quasi-experimental study.&#x0D; Place and Duration of Study: Neonatal Intensive Care Unit, Combined Military Hospital, Malir Cantt, Karachi Pakistan, from Nov 2019 to Jun 2020.&#x0D; Methodology: A total of 60 cases of severe TTN, labelled on a predefined criterion were included in the study. The sample was randomized into two groups using an alternate sampling technique. Group-A was treated with bubble CPAP alone, while in Group-B, inhaled Salbutamol was added. The response was measured regarding the time taken to settle respiratory distress.&#x0D; Results: Out of 60 cases, 54(90.0%) were delivered through Caesarean section. A total of 9(15.0%) cases were born prematurely. Polycythemia was found in 10(16.6%) cases. Maternal asthma and gestational diabetes frequency were 8(13.33%) and 12(20.0%), respectively. A significant reduction was seen in the duration of respiratory distress in the study population receiving bubble CPAP with inhaled Salbutamol in the first 24 hours of illness (p-value&lt;0.001).&#x0D; Conclusion: Caesarean section is the most significant risk factor for developing TTN. Adding Salbutamol nebulization to bubble CPAP resulted in an earlier settlement of respiratory distress.

Diagnostic Utility of Bedside Lung Ultrasonography in Neonates with Respiratory Distress

Background: Lung Ultrasound (LUS) has recently become an important method for diagnostic examination and monitoring of lung disease. Many lung diseases, such as respiratory distress syndrome (RDS), transient tachypnea of the newborn (TTNB), pneumonia were diagnosed by chest X-ray, but can now easily be diagnosed with LUS. LUS has many advantages over X-ray including accuracy, reliability, low cost, radiation free, simple investigation, do multiple times, results are obtained immediately.&#x0D; Objective: The aim of this study was to evaluate role of LUS in neonates with respiratory distress (RD) within 4 hours of life and to calculate the sensitivity, specificity, and negative and positive predictive value of LUS for RDS and TTNB, using an external reader blinded to the clinical condition.&#x0D; Design and Methods: Neonates born at a gestation from 28 weeks to 40 weeks born in the hospital and developing RD on first 4 hours of life were enrolled. The diagnosis based on clinico-radiological features as ascertained by the treating neonatologist was considered gold standard. Just before LUS, the RD was objectively scored using Modified Silverman Andersen score. X-ray and LUS were performed bed side within 4 hours of life. Images were captured and stored and interpreted by the Radiologist who was blinded to the neonate’s clinical condition. LUS were interpreted according to observational index included pleural A lines, B lines, Air bronchogram and Lung consolidation. Based on LUS findings, differentiation between RDS, TTNB, MAS and Pneumonia were made.&#x0D; Results: 100 neonates were studied. 22 infants had a final diagnosis of RDS and 64 of TTNB. LUS showed a Sn of 100% and Sp of 89.7%, with a PPV of 73.3% and a NPV of 100 % for RDS, and a Sn of 82.8% and Sp of 100% with a PPV of 100% and a NPV of 76.6% for TTNB.&#x0D; Conclusion: LUS is a reliable method to diagnose RDS and TTNB in newborns with RD with high sn and sp.

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.

Efficacy and Safety of Standardized Protocol of CPAP Therapy for Full-Term Newborns in Delivery Room at Transient Tachypnea: Clinical Trial with Historical Control

Background. Nowadays there is no consensus on the tactics and optimal protocol for Continuous Positive Airway Pressure (СРАР) at transient tachypnea of newborns (TTN) in delivery room.Objective. The aim of the study is to examine the efficacy and safety of standardized protocol of CPAP therapy for newborns with TTN in delivery room.Methods. The clinical study (implementation of standardized CPAP protocol) included full-term infants (gestational age — 37–41 weeks) with diagnosed TTN and CPAP therapy during first 60 minutes of life. Similar inclusion criteria were applied for the historical control group (born within previous year for whom CPAP was implemented according to “usual” protocol). Initiation of mononasal CPAP in main group was carried out when respiratory disorders were assessed according to Downes scale ≥ 3 points with control points at 20–40–60 minutes via the same scale, in control group at ≥ 4 points — for all cases, and according to the doctor's decision at 1–3 points. Mean airway pressure was maintained at 8 and 5–10 cm H2O, CPAP duration was 20–60 and 5–30 min, respectively. The major endpoints: the frequency of patient transfer from delivery room to intensive care unit or hospitalization to the neonatal pathology department, as well as total period of hospitalization. Moreover, frequency of invasive manipulations (intravenous catheterization, parenteral feeding), antibacterial therapy, cerebral injuries (cerebral ischemia, intracerebral hemorrhage), nasal passages injuries, pneumothorax (in the first 24 hours of life) were recorded during the entire hospitalization period.Results. 140 newborns with TTN were included in the clinical study, 30 were excluded from the study, specifically 13 due to violation of the CPAP protocol. The historical control group included 165 newborns. This groups were comparable for most baseline (before the start of CPAP) indicators except for maternal COVID-19 frequency during pregnancy and twin newborns frequency. This groups were comparable for most baseline (before the start of CPAP) indicators except for the frequency of maternal COVID-19 cases during pregnancy and the frequency of twin newborns. Hospitalization rate in intensive care units (18.2 versus 70.3%; p &lt; 0.001) and neonatal pathology departments (31.8 versus 80.0%; p &lt; 0.001), as well as total period of hospitalization (3 versus 10 days; p &lt; 0.001) were lower in the standardized CPAP therapy group. Lower frequency of invasive manipulations, antibacterial therapy, and cerebral ischemia was recorded in this group. The safety of СРАР administration in delivery room was confirmed by the absence of nasal passages injuries in both groups, as well as comparable frequency of pneumothorax.Conclusion. The use of standardized CPAP protocol in delivery room for full-term newborns with TTN had higher rate of favorable hospitalization outcomes. Study limitations require validation of all the findings in independent studies.

Morbidity and mortality among infants of diabetic mothers admitted to a neonatal care unit in Karbala pediatric teaching hospital.

This study aimed to determine the morbidity and mortality patterns among infants of diabetic mothers admitted to the neonatal care unit in Karbala pediatric teaching hospital. The study enrolled fifty diabetic infants (pregestational and gestational) admitted to the ward from the 1st of October 2013 to the 30th of January 2014. Data on delivery mode, gestational age, birth weight, other associated morbidities, investigation results, therapy, length of hospital stay, and outcome were collected and compared to infants of non-diabetic mothers admitted during the same period. A retrospective analysis of maternal data was performed. 62% of infants were born to mothers with gestational diabetes, and 38% were born to mothers with pre-gestational diabetes. 86% were born by caesarian section, of which 35% were by emergency cesarean section. The mean gestational age of infants of diabetic mothers was 37w1d±1.88, and 29 (64%) had macrosomia. The most typical morbidities were hypoglycemia (significantly higher in infants of diabetic mothers (IDMs) than infants of non-diabetic mothers) and hyperbilirubinemia in 36 (72%) and 24 (48%), respectively. There was no difference in morbidity patterns between infants of pregestational and gestational diabetic mothers except for macrosomia, and transient tachypnea of newborns was higher in gestational diabetes. The mortality rate was not significantly higher in IDMs. Diabetes during pregnancy has a serious effect on neonates and their mothers. The commenced morbidities in IDMs were hypoglycemia, macrosomia, and hyperbilirubinemia, so strict control of blood glucose level during pregnancy and education of diabetic women is essential before and during gestation.

Relationship between risk factors of hearing loss and the results of otoacoustic emission in newborns

Objective Congenital hearing loss is a disabling and multi-factorial disease that affects on newborn and children. This study aims to demonstrate the relationship between risk factors for hearing loss and the results of Otoacoustic emission in Iranian newborns. Methods We have retrospectively considered 536 newborns admitted to the Audiology Department of a Children’s Hospital in the north of Iran. Transient Evoked Otoacoustic Emissions (TEOAEs) was recorded during the first week of birth, and the risk factors of hearing loss were collected. Results We found that parent relatives and family history were significantly correlated with OAEs refer results. Moreover, hyper-bilirubinemia indicated a significant correlation only with first right OAEs. There was a significant correlation between gender and first left and right OAEs. Other risk factors such as seizure, transient tachypnoea of the newborn (TTN) and respiratory distress syndrome (RDS), and lip cleft had a significant correlation with first left and right OAEs results; however, these correlations were not relatively highlighted. Conclusions Generally, our data confirm that hearing screening is an absolute necessity in the greater number of newborns. People who got consanguineous marriages should be aware of high incidence of the congenital hearing loss due to parent relatives and family history.

Multi-Level Classification of Lung Pathologies in Neonates using Recurrence Features.

The use of Lung Ultrasound (LUS) as a tool to diagnose and monitor lung diseases in neonates has increased in urban hospitals. LUS's main advantages compared to chest CT or X-rays is that it is less expensive, more accessible, and does not expose the patient to radiation. Performing LUS on neonates and diagnosing the LUS images require highly trained medical professional and clinicians. While availability of such specialists in general is not an issue in urban areas, there is lack of such personnel in rural and remote communities. Hence, an automated computer-aided screening approach as a first level diagnosis assistance in such scenarios might be of significant value. Many of the image morphologies used by clinicians in diagnosing the LUS have strong recurrence characteristics. Building upon this knowledge, in this paper, we propose a feature extraction method designed to quantify such recurrent features for classification of LUS images into 6 common neonatal lung conditions. These conditions were normal lung, chronic lung disease (CLD), transient tachypnea of the newborn (TTN), pneumothorax (PTX), respiratory distress syndrome (RDS), and consolidation (CON) that could be pneumonia or atelectasis. The proposed method extracts virtual scanlines from the LUS images and converts them into signals. Then using recurrence quantification analysis (RQA), features were extracted and fed to pattern classifiers. Using a simple linear classifier the proposed features can achieve a classification accuracy of 69.3% without clinical features and 77.6% with clinical features. Clinical Relevance- Development of an automated computer-aided screening tool for first level diagnosis assistance in neonatal LUS pathologies. Such a tool will be of significant value in rural and remote medical communities.

Thoracic Fluid Content in Neonates Presented with Respiratory Distress as a Predictive Tool for Transient Tachypnea of Newborn.

Respiratory conditions are the most common reason for admission of newborns to a neonatal care unit. The index of contractility (ICON) can be used to measure the thoracic fluid content (TFC) in neonates which is a significant parameter in cases presented with transient tachypnea of newborn (TTN). The objective was to compare TFC between newborn infants with TTN compared with other causes of respiratory distress (RD). We tested the hypothesis that TFC would be higher in infants with TTN. In total, 105 newborns were enrolled at the delivery room and were categorized into three groups: TTN, other causes of RD, and control, according to physical examination and Chest X-Ray. TFC was measured within the first 6 hours for all infants and at 24 and 48 hours for the first two groups. Demographic data showed higher male participants and use of antenatal steroid therapy in RD groups. TFC within the first 6 hours was higher in RD groups. However, TFC at 24 hours of ≤24 mL/kg, and TFC drop rate at 24 hours of >12% are statistically significant discriminators of TTN from non-TTN, with sensitivity and specificity of 97.1 and 47.1%, and 60 and 82.4%, respectively (Fig 1 and 2). ICON can be used in conjunction with clinical parameters and CXR as a tool for differentiation between TTN and other causes of RD within the first 24 hours of life by using the cutoff value of TFC at 24 hours and TFC drop rate. This will allow earlier and optimum management of different causes of RD. · Thoracic fluid content. · Neonatal respiratory distress. · Newborn.

The Evaluation of Hematological Parameters in Newborn Diagnosed with Congenital Pneumonia

The aim of this study is to compare the hematological parameters of transient tachypnea of the newborn (TTN) and congenital pneumonia. The hematological parameters of 84 newborns who had a gestational age over 35 weeks, who were diagnosed with transient tachypnea, and congenital pneumonia, who were hospitalized in the Newborn Unit of the Uşak University, Faculty of Medicine, Training and Research Hospital between 2015 and 2021, were analyzed retrospectively from the electronic records of the patients. The mean gestational age was determined as 38.0±1.4 weeks in patients with TTN and 38.8±1.5 weeks in patients with congenital pneumonia. A statistically significant difference was detected between the patients gestational age (p=0,016), birth weight (p=0,017), lymphocyte (p=0,037), thrombocyte (p=0,001) and delivery types (p=0,027). Statistically cesarean delivery was higher in the TTN group; the patients in the group with congenital pneumonia had a higher gestational age; the median lymphocyte and thrombocyte values were also found to be lower than in the TTN group. No statistically significant differences were detected between the two groups in terms of other hematological parameters. The present study presented that TTN was seen at lower gestational weeks and in newborns with lower birth weights. It was suggested that cesarean delivery can be considered to be a risk factor for TTN. When hematological parameters are examined, it is noted that patients with congenital pneumonia have a predisposition to lymphopenia and thrombocytopenia.

Challenges of Management and Outcome of Neonatal Medical Emergencies in a Peripheral Hospital, Bangladesh

Background: Respiratory distress and desaturation remains a significant cause of neonatal intensive care admission ,althoughmanagement has evolved gradually over the years resulting in improving survival for the these neonates . Still 10% of neonatesrequire respiratory support immediately after delivery due to respiratory disorder, and up to 1% of neonates are in need ofresuscitation. Objectives: The aim of the study is to present some fundamental steps of emergency neonatal management which includerapid identification and admission , followed by assessment for respiratory distress, hypoxemia and hypoglycemia ,initialstabilization when required and early administration of medications. Methods: This hospital based retrospective study was conducted at Combined Military Hospital ,sylhet ,Bangladesh fromApril 2021 to September 2022 .A total 224 sick neonates shortly after delivery included for this study. Results: From April ,2021 to september 2022, 917 newborn were born, of which 224 neonates were identified and admitted as a emergency cases immediate after delivery at combined military hospital,sylhet .Immediately after admission around allcases were assessed for hypoxemia ,hypoglycaemia and hypothermia.Around 66% were hypoxemic (preterm 71.4% ,22.3%in full term and 6.2% in post term ).There was male predominance 55% .Respiratory distress syndrome (RDS ) was found to bethe commonest 35.7% causes followed by persistent pulmonary hypertension with large patent ductus arteriosus(PPHN withPDA) 17.8% ,septicemia 16.9% ,meconium aspiration syndrome (MAS) 8.9%, transient tachypnea of newborn (TTN) 8%,congenital pneumonia 4.9% ,perinatal asphyxia (PNA) 3.5% , large atrial septal defect (ASD) with ventricular setal defect(VSD) 2.6% and 1.75% was hypoglycemic .All babies received immediately oxygenation . Bubble CPAP was required in 90(40.1%) cases. Vascular access was established in all cases and 2.6% neonates received medications bycentral (femoral) line.Mortality was 2( 0.8%) in neonates with respiratory distress due to respiratory distress syndrome with multiple congenitalanomalies . 2(0.8%) cases referred to tertiary hospital (Combined Military Hospital,Dhaka ) requiring mechanical ventilation. Conclusion: Early and appropriate treatment seeking is one of the most important aspects for interrupting the pathways to neonatal deaths due to severe illness. In developing countries, the role of Paediatrician is multidimensional . paediatrician by early detection of risk factors and timely intervention can reduce significantly neonatal mortality rate.

Diffusion coefficient of carbon dioxide in relation to partial pressure of carbon dioxide as a marker for weaning from high-frequency oscillatory ventilation

Background Respiratory distress syndrome and transient tachypnea of newborn are common causes for admission to neonatal ICU. Measurement of diffusion coefficient of carbon dioxide (DCO2) and partial pressure of carbon dioxide in arterial blood (PaCO2) are useful to detect changes in alveolar ventilation, pulmonary perfusion, and CO2 production and help adjust ventilation settings. Aim Our study evaluated DCO2 in relation to PaCO2 as a maker for weaning from high-frequency oscillatory ventilation (HFOV). Patients and methods A total of 40 neonates were included in the study and were divided into two equal groups based on their gestational age (preterm vs. full term), and we measured DCO2 and PaCO2 in both groups at the time of shifting to HFOV and every 4 h till weaning from HFOV. Results The mean value of DCO2 was significantly higher in the full-term group, and there was no statistically significant difference between both studied groups regarding the mean value of PaCO2, except on the third day and at the time of weaning to conventional mechanical ventilation, where it was significantly higher in the preterm group. There was a significant negative correlation between mean value of DCO2 and mean value of PaCO2 on the first, second, and third day of HFOV and at the time of weaning to conventional mechanical ventilation. Conclusion DCO2 can be used roughly as a reflection for CO2 status but cannot be used alone as an indicator for weaning from HFOV but could be used in combination with other markers.

Evaluating Clinical Outcomes and Physiological Perspectives in Studies Investigating Respiratory Support for Babies Born at Term With or at Risk of Transient Tachypnea: A Narrative Review.

Respiratory distress in the first few hours of life is a growing disease burden in otherwise healthy babies born at term (>37 weeks gestation). Babies born by cesarean section without labor (i.e., elective cesarean section) are at greater risk of developing respiratory distress due to elevated airway liquid volumes at birth. These babies are commonly diagnosed with transient tachypnea of the newborn (TTN) and historically treatments have mostly focused on enhancing airway liquid clearance pharmacologically or restricting fluid intake with limited success. Alternatively, a number of clinical studies have investigated the potential benefits of respiratory support in newborns with or at risk of TTN, but there is considerable heterogeneity in study designs and outcome measures. A literature search identified eight clinical studies investigating use of respiratory support on outcomes related to TTN in babies born at term. Study demographics including gestational age, mode of birth, antenatal corticosteroid exposure, TTN diagnosis, timing of intervention (prophylactic/interventional), respiratory support (type/interface/device/pressure), and study outcomes were compared. This narrative review provides an overview of factors within and between studies assessing respiratory support for preventing and/or treating TTN. In addition, we discuss the physiological understanding of how respiratory support aids lung function in newborns with elevated airway liquid volumes at birth. However, many questions remain regarding the timing of onset, pressure delivered, device/interface used and duration, and weaning of support. Future studies are required to address these gaps in knowledge to provide evidenced based recommendations for management of newborns with or at risk of TTN.

Role of Misoprostol (PGE1) before Elective Caesarean Section in Decreasing Transient Tachypnea of the Newborn (TTN)

Role of Misoprostol (PGE1) before Elective Caesarean Section in Decreasing Transient Tachypnea of the Newborn (TTN)

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.

Comparison of inhaled salbutamol and intravenous furosemide in the treatment of transient tachypnea of the newborn regarding their safety and efficacy

Background Postnatal respiratory complications among term infants are common. The most commonly reported cause of neonatal respiratory distress is transient tachypnea of the newborn (TTN), with an estimated incidence of 0.5–2.8% of all newborns. Aim To evaluate and compare the efficacy and safety of inhaled salbutamol and intravenous (i.v.) furosemide in the treatment of TTN and to monitor of their possible adverse effects in neonates. Patients and methods This was a randomized controlled clinical trial on 100 neonates who were admitted immediately or shortly after birth owing to persistence of tachypnea to neonatal intensive care unit of pediatric hospitals, Cairo University, over a 1-year period. Our study included 100 neonates (25 in the salbutamol group, 25 in the furosemide group, and 50 in the control group) with TTN born between 35 and 39 weeks of gestational age. They were randomized in a blinded manner to receive one nebulized dose of salbutamol 0.15 mg/kg in 0.9% saline solution or i.v. furosemide 1 mg/kg once in addition to oxygen and i.v. fluids or received oxygen and i.v. fluids alone. Results The efficacy of inhaled salbutamol and furosemide was assessed by determining the respiratory rate, heart rate, TTN clinical score, and the level of respiratory support before receiving medication and 30 min, 1, and 4 h after drug therapy. The duration and level of respiratory support and the period of hospitalization were shorter in the salbutamol group. There was a significant decrease in the respiratory rate and TTN score in the salbutamol group 4 h after nebulized salbutamol. Conclusion Comparing the three groups after respiratory support, TTN score was significantly improved in the salbutamol group. The total duration of oxygen treatment in hours and total neonatal intensive care unit stay in days were significantly shorter in the salbutamol group than in furosemide and control groups. Regarding the safety of salbutamol, our study did not show a significant difference in adverse effects. Inhaled salbutamol treatment was effective in TTN without adverse events. Further studies at larger or repeated doses of furosemide may be needed.