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.

Maternal and fetal outcome in COVID 19 positive pregnant women with thyroid dysfunction

Background: Normally functioning thyroid glands are able to meet the increasing need for hormones during pregnancy and keep thyroid hormone levels within normal limits. However thyroid dysfunction in pregnancy can cause adverse maternal and fetal outcomes like pre-eclampsia and gestational hypertension, antepartum hemorrhage, anemia, preterm delivery, low birth weight and addition of SARS-CoV-19 infection can worsen the perinatal outcome. In present ambispective study, obstetric outcomes of 32 cases of COVID 19 positive pregnant women with thyroid dysfunction (Group A) were compared with 32 cases of COVID 19 negative pregnant women with thyroid dysfunction (Group B). Results: Pregnancy induced hypertension (PIH) was the most common antepartum complication noted in both the groups (28.1% vs 12.5%). Group-A had 40.6% LSCS rate whereas it was 37.5% in group-B. Average period of gestation at delivery was 38 weeks in both the groups. The most common neonatal complication was low birth weight (9.4%) in both the groups. Group A was also associated with meconium aspiration syndrome (MAS) (9.4%), neonatal sepsis (6.2%) and transient tachypnoea of newborn (TTN) (3.1%). NICU admissions were 37.5% in group A while only 6.25% in group B. (p value &lt;0.01). Most common indication for NICU admission was MAS (9.4%) in group A. It was observed that incidence of pregnancy induced hypertension (PIH) and neonatal complications including NICU admissions were increased in presence of both COVID 19 and thyroid disorder as compared to only thyroid disorder in pregnancy. Multi-disciplinary approach with more vigilant monitoring can help reduce perinatal morbidity and mortality.

Burden and Outcomes of Respiratory Diseases in Hospitalized Neonates at a Tertiary Care Hospital in Lahore: A Cross-Sectional Study

Abstract Background: Respiratory diseases constitute a significant contributor to health issues in neonates, leading to admissions to neonatal intensive care units (NICU), and many of these neonates never recover, resulting in high neonatal mortality rates with respiratory diseases. Objective: To assess the burden of respiratory diseases in hospitalized neonates and determine their outcomes, including discharges and deaths, among those admitted to neonatal intensive care units in a tertiary care hospital in Lahore. Methods: An observational analytical cross-sectional study was conducted on 187 neonates admitted to a neonatology department of the tertiary care hospital in Lahore. Demographical data was collected by using a structured questionnaire. The analyses were conducted using R software. The chi-square test was employed to ascertain the associations between significant factors of respiratory diseases in neonates. Results: Among the respiratory conditions requiring admission, pneumonia (n=92, 49.1%) stood out as the most frequently diagnosed respiratory disease in neonates, followed by respiratory distress syndrome (RDS) (n=53, 28.3%), transient tachypnea of the newborn (TTN) (n=18, 9.62%), and meconium aspiration syndrome (MAS) (n=24, 12.8%). In terms of mortality among these respiratory conditions, pneumonia had the highest frequency (40.5%), followed by RDS (39.2%), MAS (20.2%), in neonates. Conclusion: Respiratory disorders proved to be a prevalent reason for neonatal admissions to the NICU, showcasing a significant association with neonatal mortality, especially in pneumonia, respiratory distress syndrome, and meconium aspiration syndrome.

Thoracic fluid content (TFC) using electrical cardiometry versus lung ultrasound in the diagnosis of transient tachypnea of newborn

This study aimed to evaluate TFC by EC versus lung ultrasound (LUS) findings for diagnosing and follow-up of TTN in late preterm and term neonates. This prospective observational study was conducted on 80 neonates with gestational age ≥ 34 weeks. TTN group included 40 neonates diagnosed with TTN, and no lung disease (NLD) group included 40 neonates without respiratory distress. LUS and EC were performed within the first 24 h of life and repeated after 72 h. There was a statistically significant increase in TFC in TTN group on D1 [48.48 ± 4.86 (1 KOhm−1)] compared to NLD group [32.95 ± 4.59 (1 KOhm−1)], and then significant decrease in TFC in D3 [34.90 ± 4.42 (1 KOhm−1)] compared to D1 in the TTN group. There was a significant positive correlation between both TFC and LUS with Downes’ score, TTN score, and duration of oxygen therapy in the TTN group. Conclusion: Both LUS and TFC by EC provide good bedside tools that could help to diagnose and monitor TTN. TFC showed a good correlation with LUS score and degree of respiratory distress.What is Known:• Transient tachypnea of the newborn (TTN) is the most common cause of respiratory distress in newborns.• TTN is a diagnosis of exclusion, there are no specific clinical parameters or biomarker has been identified for TTN.What is New:• Thoracic fluid content (TFC) by electrical cardiometry is a new parameter to evaluate lung fluid volume and could help to diagnose and monitor TTN and correlates with lung ultrasound score.

Content Analysis of Nursing Education on Transient Tachypnea of New Born (TTNB) after Simulation-based Nursing Education

Content Analysis of Nursing Education on Transient Tachypnea of New Born (TTNB) after Simulation-based Nursing Education

Is Parity a Risk Factor for Late Preterm Birth? Results from a Large Cohort Study.

Most preterm births occur in the late preterm period. While prematurity-related adverse outcomes are significantly diminished when birth occurs during this period, these infants are still at increased risk of complications. Parity affects the incidence of obstetric complications. The purpose of this study was to determine whether parity impacts the risk of spontaneous late preterm birth (SLPTB) and associated complications. A retrospective observational cohort study was conducted. Patients were divided into three study groups according to parity. The primary outcome was the rate of SLPTB in each group. Secondary outcomes were unplanned cesarean delivery (UCD), prolonged third stage of labor respiratory distress syndrome (RDS), transient tachypnea of the newborn (TTN), intraventricular hemorrhage (IVH), neonatal hypoglycemia, duration of NICU admission, neonatal death, and composite adverse neonatal outcome (CANO). Primiparas were more likely to have SLPTB, UCD, and CANO compared to multiparas (2.6% vs. 1.9% OR 1.5 [1.3-1.7] p < 0.01) (4.1% vs. 1.3% OR 2.7 [1.2, 5.9] p < 0.01) (8.5% vs. 4.2 OR 2.1 [1.3-3.5] p = 0.002) and grandmultiparas (2.6% vs. 1.7% OR 1.4 [1.2-1.5] p < 0.001) 8.5% vs. 4.4% OR 2.0 [1.1, 3.8], p = 0.01) but no difference in UCD compared to grandmultiparas (4.1% vs. 3.3% OR 1.2 [0.6-2.7] p = 0.28). Primiparas are at increased risk of SLPTB and UCD, and this is accompanied by an increased risk of adverse neonatal outcomes.

Ultrasound Imaging in the Early Detection of Transient Tachypnoea of the Newborn: A Cross-sectional Study

Introduction: The most common cause of perinatal dyspnoea, frequently diagnosed on chest radiographs, is Transient Tachypnoea of Newborn (TTN). Lung Ultrasound (LUS) is recognised as a promising tool that has been proven in recent studies and tends to have better diagnostic capability. Aim: To describe the sonographic features of TTN and assess their clinical importance in early diagnosis. Materials and Methods: This cross-sectional hospital-based study was conducted at Department of Radiology, AJ Institute of Medical Sciences and Research Centre, Mangaluru, Karnataka, India, from November 2020 to May 2022. Newborns with tachypnoea admitted to the Neonatal Intensive Care Unit (NICU) were enrolled in this study. In a stable state, the infants were placed in supine, lateral, and prone positions for the ultrasound scan. LUS was performed on a total of 94 infants. Along with ultrasound, a chest radiograph was also taken. Follow-up LUS was performed on days 2, 3, and on the day of discharge from the NICU. The sonographic findings of TTN were evaluated using Pearson’s Chi-squared test. A p-value of &lt;0.05 was considered statistically significant. Results: Based on clinical manifestations, chest radiograph, and LUS, 60 newborns were diagnosed with TTN, and 34 had Respiratory Distress Syndrome (RDS). Out of the 60 newborns, the gestational age ranged from 32 weeks to 40 weeks, with a mean of 38 weeks + four days. Double Lung Point (DLP) was noted in 41 newborns with TTN, which showed a sensitivity and specificity of 68% and 100%, respectively, with a positive predictive value of 100%. Conclusion: The LUS could be widely used in the NICU as the first line of screening for the primary diagnosis of TTN and for early initiation of treatment accordingly.

The demographic profile, clinical spectrum, and outcome of term neonates requiring continuous positive airway pressure in a tertiary care teaching hospital

Background: Respiratory distress is the major cause of neonatal intensive care unit (NICU) admission of full-term neonates for which they require different levels of mode of ventilation. Aims and Objectives: The objective of this study was to determine the demographic profile, clinical spectrum, and outcome of term neonates, requiring continuous positive airway pressure (CPAP) in tertiary care teaching hospitals. Materials and Methods: The study was a prospective observational study conducted from December 2020 to November 2022 in the neonatal section of the department of pediatrics. Results: A total of 261 neonates were included in the study. The male-to-female ratio was 1.7:1, the range of birth weight was between 2.1 kg and 3 kg (60.91%), the gestation age was 38 weeks (59.2%), and 73.6% were lower-segment cesarean section born. The age of starting CPAP in most of the newborns was at admission to NICU (in 69.73% of cases). The success rate of CPAP therapy was high (60.9%) and the rest 39.08% of patients did not settle with CPAP and required higher modes of respiratory support such as nasalintermittent positive pressure ventilation (IPPV) (5.89%) and IPPV (94.11%). Conclusion: In the resource-limiting settings, due to the non-availability of higher levels of ventilatory gadgets, the early use of CPAP as a mode of ventilation in full-term babies with transient tachypnea of newborns is well-documented and it can be safely used in other common neonatal conditions which can cause respiratory distress in full-term neonates. The low-middle-income countries are facing challenges to improve comprehensive neonatal care; there is a dire need for simple and cost-effective methods of respiratory support. Bubble CPAP is one such promising ventilatory support intervention, which may reduce the need for costly mechanical ventilators.

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.

A quality improvement initiative to reduce antibiotic use in transient tachypnea of the newborn.

Evidence suggests that antibiotics are unnecessary in infants with transient tachypnea of the newborn (TTN) that are low-risk for early-onset sepsis. The aim was to reduce ampicillin and gentamicin days of therapy (DOT) in infants with suspected TTN by 10% within 12 months. We used the Model for Improvement to test interventions from August 2019 to September 2021 to decrease antibiotic utilization in low-risk infants with TTN. Interventions included the creation of an evidence-based clinical pathway, admission huddles, and prescriber audit and feedback. We reduced ampicillin and gentamicin use by 26% and 23%, respectively. In 123 infants with suspected TTN, we sequentially decreased starting antibiotics in this group from 71% to 41%, 13% and 0%. There were no cases of missed bacteremia. Creation of a multidisciplinary antimicrobial stewardship QI team and subsequent interventions were successful in safely reducing antibiotic use in infants with TTN.

Causes and outcome of infants admitted with respiratory distress in a tertiary care neonatal unit: A five year review

Background: Respiratory distress is a common cause for admission of infants to a neonatal unit. The aim of this study was to analyze the causes of respiratory distress leading to admission in a neonatal unit.&#x0D; Method: This is a 5 year retrospective review of neonates admitted initially with diagnosis of respiratory distress in the neonatal unit of a tertiary care hospital from November 2017 to October 2022. Cases were identified and analyzed using electronic database maintained in the neonatal unit and were cross checked with electronic discharge summaries where necessary.&#x0D; Results: Respiratory distress was found to be the most common cause for admission to the neonatal unit almost comprising of 46% of total admissions. The commonest cause for respiratory distress on admission was found to be transient tachypnoea of newborn (TTN) in term infants and surfactant deficiency respiratory distress syndrome (RDS) in preterm infants. As compared to babies with TTN, who were all discharged home, 18.4% of those with RDS did not survive. The overall mortality of infants presenting initially as respiratory distress was 9.1%. Other common causes for respiratory distress on admission were sepsis, birth asphyxia, shock, congenital heart disease, seizure and polycythemia.&#x0D; Conclusion: Respiratory distress is a common cause for admission to a neonatal unit in both term and preterm infants. Although TTN in term and RDS in preterm are common causes for respiratory distress in newborns, the underlying cause for respiratory distress is diverse and not just limited to the lungs and heart.

Frequency and Causal Relationship of Pneumothorax in Premature Neonates in a Tertiary Care Hospital

Objectives: To determine the frequency and causal relationship of Pneumothorax in prematurely born neonates in a tertiary care hospital. Study Design: Prospective longitudinal study Place and Duration of Study: Department of Paediatrics, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Aug 2017 to Jul 2019. Methodology: A total of 510 premature neonates fulfilling the inclusion criteria were enrolled in the study. In suspected cases,Pneumothorax was confirmed on a chest radiograph. Hemodynamically stable neonates were closely observed for spontaneous resolution, whereas unstable neonates were managed by needle thoracocentesis or thoracostomy with or without ventilator support. The outcome of the study was either death of the neonate or discharge from the NICU (Neonatal Intensive Care Unit). Results: Of 510 included premature neonates, 43(8.4%) developed Pneumothorax. Pneumothorax was more common in late pre-term (51.2%) and moderate pre-term (46.5%) infants. Underlying diseases causing Pneumothorax were respiratory distress syndrome (RDS) 21(48.8%), meconium aspiration syndrome (MAS) 8(18.6%), transient tachypnoea of the newborn (TTN) 5(11.6%), birth asphyxia syndrome (BAS) 6(14%) and Pneumonia 3(7%). 34(79.1%) patients required thoracostomy, whereas 7(16.3%) required only needle thoracocentesis. Spontaneous resolution occurred in only 2(4.7%) patients. Of 43 patients, 35(81.39%) were discharged, and 8 (18.60%) died. Conclusion: Pneumothorax is not an uncommon complication, especially in premature neonates. A high index of suspicion is required for early recognition and timely management of Pneumothorax, as delay is associated with significant mortality.

FACTORS LEADING TO TRANSIENT TACHYPNEA OF NEWBORN (TTN) IN BABIES, DELIVERED BY SPONTANEOUS VAGINAL DELIVERY AT TERTIARY CARE HOSPITAL KARACHI

Neonatal respiratory distress is a common issue, and one of its types is Transient Tachypnea of the Newborn (TTN), which happens when leftover lung fluid is not removed from the body on time. TTN usually occurs within the first 24 to 72 hours after delivery. This study aims to determine the frequency of TTN in newborns delivered vaginally and spontaneously at a tertiary care hospital in Karachi and identify the factors that may contribute to the condition. The study adopted a cross-sectional design and was conducted in the Neonatal Intensive Care Unit of the Department of Pediatric Medicine, Ziauddin Hospital, Karachi. After obtaining the necessary approvals, the study lasted for 9 months, from December 2021 to September 2022. Both quantitative and qualitative data were collected, assembled, and analyzed. Stratification was employed to adjust for effect modifiers, and a chi-square test was used to test for statistical significance with a p-value of 0.05. The study included 153 patients who met the inclusion and exclusion criteria. The average gestational age, height, weight, OFC, length of hospital stay, and mother's age were 30.7 ± 4.3 weeks, 49 ± 1.79 cm, 3.01 ± 0.38 kg, 36.65 ± 1.08 cm, 3.92 ± 4.65 days, and 39.8 ± 2.78 weeks, respectively. Of the 153 patients, 71 (46.4%) were male and 82 (53.6%) were female. 44.4%, 31.4%, 45.1%, and 31.4% of the patients had maternal diabetes, PROM, obesity, and low APGAR scores, respectively. The study found maternal diabetes and obesity were the primary risk factors for TTN in newborns. The study emphasizes the importance of good antenatal and obstetric care to detect any early problems during pregnancy that may contribute to the incidence of TTN.

Association between maternal coronavirus disease 2019 and transient tachypnea of the newborn: a single-center study.

Limited clinical reports have investigated the effects of maternal coronavirus disease 2019 (COVID-19) on fetuses and neonates. This retrospective study aimed to assess the impact of maternal COVID-19 on neonates during the perinatal period, including neonatal clinical outcomes, versus the outcomes of neonates of mothers without COVID-19. Neonates born to COVID-19-infected mothers at the National Health Insurance Service Ilsan Hospital between February 2021 and March 2022 were included. Those with gestational age (GA) ≥35+0 weeks who were born within 2 weeks of the maternal infection were matched 1:2 with a control group based on GA. The main outcomes were respiratory diseases, including transient tachypnea of the newborn (TTN), respiratory distress syndrome, meconium aspiration syndrome, the need for respiratory support, and length of hospital stay. Uni- and multivariate logistic regression analyses were performed and adjusted for relevant covariates, including maternal age, obstetric complications (hypertension and gestational diabetes), delivery mode, birth weight, sex, and small-for-gestational-age status. The case group comprised 103 neonates (mean GA, 38.5±1.3 weeks; mean birth weight, 3,121±397 g), while the control group included 206 neonates (mean GA, 38.4±1.2 weeks; mean birth weight, 3088±428 g). In the case and control groups, the proportion of cesarean sections was 91% and 40%, respectively, while the proportion of male infants was 56% and 47%, respectively. After adjusting for covariates, the case group had a higher risk of TTN (adjusted odd ratio [AOR], 3.69; 95% confidence interval [CI], 1.69-8.07), noninvasive respiratory ventilator use (AOR, 2.28; 95% CI, 1.05-4.97), and oxygen support (AOR, 4.83; 95% CI, 1.46-15.95). Newborns born to COVID-19-infected mothers are at increased risk of TTN and may require respiratory support. Close monitoring of respiratory symptoms is crucial in neonates.

Standardized approach to CPAP therapy in the delivery room in full-term infants with congenital infection: observational research

Background. At the present day, there are no protocols and guidelines on the therapeutic approaches of respiratory disorders in full-term infants in the delivery room. This concerns indications for the choice of respiratory therapy, parameters and its duration for deciding on effectiveness.The aim of the study is — to evaluate the effectiveness and safety of the standardized CPAP (continuous positive airway pressure) protocol therapy of transient tachypnea of newborns (TTN) in the delivery room in full-term infants with congenital infection.Methods. An observational clinical study of the efficacy and safety of the standardized CPAP therapy protocol developed by us for children with TTN in the delivery room in children with congenital infection, used during 6 months of 2021 in comparison with the historical control group recruited according to the same criteria for 12 months of 2020. The assessment of cerebral damage, the nature and duration of respiratory therapy and the duration of hospitalization of patients in comparison with those in the historical control group was carried out.Results. In 2020, out of 3901 full-term infants, CPAP was performed in the delivery room for 223 children, 31 of them with infection (control group). In 2021, out of 2057 full-term CPAP was performed on 140 children, 15 of them with infection (study group). A comparative analysis of the groups revealed no statistical differences in anthropometric data, gestational age, gender, APGAR score, as well as differences in the history of pregnancy and childbirth. The analysis of clinical characteristics also showed no differences between the groups (control group versus study group) in the frequency of cerebral ischemia (25 (80.6%) of the control group versus 9 (60.0%) of the study group; p = 0.135) and subependymal hemorrhage (6 (19.3%) of the control group versus 3 (20.0%) of the study group; p = 0.959), the frequency of ventilation (10 (32.2%) of the control group versus 5 (33.3%) of the study group; p = 0.942) and its duration (1 (1; 1.75) of the control group versus 2 (1.25; 2) days of the study group; p = 0.211), the frequency of BinCPAP (9 (29.3%) of the control group versus 5 (33.3%) of the study group; p = 0.434) and its duration (1 (1; 2) of the control group versus 1 (1; 1) day of the study group; p = 0.434) and the total duration of hospitalization (14 (10; 16) control groups versus 12 (12; 14) days of the study group; p = 0.429).Conclusion. The conducted study does not exclude that the standardized protocol of CPAP therapy in the delivery room for congenital infection is ineffective and does not affect the severity and duration of the disease, however, in combination with the data of the same protocol for TTN described in our previous studies, the high frequency of TTN and the low frequency of infection, the impossibility of their early differentiation allows assume, that the presented method can be considered as a universal respiratory strategy for full-term newborns with respiratory insufficiency in the delivery room.

The Association Between Hypoxic-Ischemic Encephalopathy and Thyroid Hormones.

We aimed to compare serum thyroid-stimulating hormone (TSH) and free thyroxine (fT4) levels in neonates with different hypoxic-ischemic encephalopathy (HIE) stages undergoing therapeutic hypothermia (TH), and to evaluate the TSH and fT4 levels in neonates with HIE/TH in comparison with a control group. This was a retrospective study conducted between January 2020 and December 2022. The neonates with HIE/TH constituted the study group and the neonates with transient tachypnea of the newborn (TTN) constituted the control group. The study group consisted of neonates with stage 2 and stage 3 HIE. Serum TSH and fT4 levels measured at postnatal fifth day were compared between the groups. Of the 202 (47.1%) neonates included in the study group, 144 (71.3%) had stage 2 HIE and 58 (28.7%) had stage 3 HIE. In the control group, there were 227 (52.9%) newborns. Serum TSH and fT4 levels were found to be lower in the newborns with stage 3 HIE compared with those with stage 2 HIE (p = 0.015, 0.002, respectively). Although the serum TSH level was higher in the newborns with HIE compared with the newborns with TTN, serum fT4 levels did not change between the groups (p = < 0.001, 0.14, respectively). When we made the analysis according to the reference intervals, HIE/TH was associated with higher rates of TSH elevation compared with TTN, and the difference was more pronounced in stage 2 HIE/TH (p < 0.001). Although stage 3 HIE/TH was significantly associated with higher rates of low fT4 compared with TTN (p = 0.006), this relationship was not significant between stage 2 HIE/TH and TTN. It would be reasonable to interpret thyroid function tests performed on the fifth day with caution in newborns with HIE/TH, because higher TSH and lower fT4 levels on the fifth day in this patient group may result in unnecessary repetition of tests.

Comparative Study on the Clinical Characteristics of Transient Tachypnea of Newborns according to the Need for Invasive Mechanical Ventilation

Purpose: Transient tachypnea of the newborn (TTN) is the most prevalent respiratory disease worldwide. Many neonates with TTN generally demonstrate spontaneous improvement. However, only few patients present with severe complications. This study aimed to investigate the differences in clinical features to identify neonates at risk for further complications.Methods: Between January 2015 and December 2020, 267 neonates who developed dyspnea within 6 h of birth were delivered at a gestational age of at least 37 weeks. The experimental group (group E) included 44 neonates who required invasive mechanical ventilation, whereas the control group (group C) included 223 neonates who required only observation or non-invasive respiratory support. We analyzed the differences in clinical and perinatal factors between the two groups.Results: Gestational age and pH on arterial blood gas analysis at admission were significantly lower in group E (&lt;i&gt;p&lt;/i&gt;&lt;0.05). Clinical findings, such as moaning, tachypnea (&gt;90 breaths/min), and pneumothorax, were more frequently observed in group E (&lt;i&gt;p&lt;/i&gt;&lt;0.05).Conclusion: Moaning, tachypnea (&gt;90 breaths/min), and need for respiratory assistance (fraction of inspired oxygen concentration ≥0.25) are predictive factors for increased risk of progression to a more severe disease course in neonates with TTN. Additional studies are needed to identify definitive factors that can differentiate TTN that improves spontaneously from TTN that requires intensive care.

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.

Characteristics and outcomes of respiratory distress among term infants born in a regional setting.

Respiratory distress is the leading cause of admission to neonatal units and is a common indication for medical retrieval. Whilst approximately 25% of births in NSW occur in regional centres, there is a paucity of neonatal research in these settings. To describe the characteristics and outcomes of term neonates admitted with respiratory distress to two regional special care nurseries (SCNs) and identify variables associated with the need for medical retrieval. We describe a cohort of 629 term infants admitted to the SCN in two regional hospitals, 2015-2019. We describe the admission characteristics, level of respiratory support, biochemical investigations, diagnosis and outcomes. During the study period, 629 eligible term infants were admitted, retrieval occurred in 29 (4.6%). Those admitted were more often male (66.5%), with a mean gestational age of 39 + 1 weeks (±9 days) and birth weight of 3470 g (±500 g). Infants requiring medical retrieval had higher PaCO2 on blood gas analysis (59.8 mmHg vs. 53.3 mmHg, OR 1.03, p = 0.02). There was no association between maternal GBS status, meconium-stained liquor, gestational age, or raised inflammatory markers and medical retrieval. Transient tachypnoea of the newborn was the most common diagnosis of neonates admitted to SCN with respiratory distress. Among term infants admitted to a SCN for respiratory distress most were male, of a normal birthweight and born in good condition. Within our cohort there was no association between retrieval and maternal GBS colonisation, meconium-stained liquor or raised infectious biomarkers. Medical retrieval was infrequent and was associated with higher PaCO2 on initial blood gas analysis. We present a large cohort of term newborn infants managed for respiratory distress in a regional setting over a five-year period. Retrieval was infrequent, and outcomes for the cohort were excellent with no deaths during the study period.

The effect of non-invasive high-frequency oscillatory ventilation on the duration of non-invasive respiratory support in late preterm and term infants with transient tachypnea of the newborn: a randomized controlled trial.

Nasal continuous positive airway pressure (nCPAP) is one of the most commonly used non-invasive respiratory support modes in neonates with transient tachypnea of the newborn (TTN). Non-invasive high-frequency oscillatory ventilation (nHFOV) is a non-invasive respiratory support mode that has been increasingly used in neonatal respiratory disorders. This prospective randomized controlled study compared the efficacy of nHFOV and nCPAP in reducing the duration of non-invasive respiratory support. Late preterm and term infants > 34weeks' gestation were included in the study. The infants were randomly assigned to receive either nHFOV or nCPAP. Treatment was started with standard settings in both groups. Infants who met treatment failure criteria were switched to nasal intermittent mandatory ventilation for further positive-pressure support. A total of 60 infants were included in the study. Thirty of these infants were included in the nHFOV group and 30 were included in the nCPAP group. The median duration of non-invasive respiratory support was not significantly different between the two groups (21h [IQR: 16-68] for nHFOV vs 15h [IQR: 11-33] for nCPAP; p = 0.09). However, after adjusting for potential confounders, nHFOV was associated with a shorter duration of non-invasive respiratory support than nCPAP (adjusted mean difference: 16.3h; 95% CI: 0.7 to 31.9; p = 0.04). nHFOV was well tolerated and did not increase the risk of complications. Conclusion: Our findings suggest that nHFOV is an effective and safe ventilation mode for late preterm and term neonates with TTN. Trial registry: Clinicaltrials.gov (NCT03006354). Date of registration: December 30, 2016. What is Known: • nHFOV is a ventilation model that has been increasingly used for the management of RDS. • TTN is one of the most common causes of neonatal respiratory distress. What is New: • nHFOV is associated with shorter duration of non-invasive respiratory support and duration of oxygen support. • nHFOV may be a safe and effective alternative to nCPAP for neonates with TTN.