Transient Tachypnea Of The Newborn Research Articles

The Care of Preterm and Term Newborns with Respiratory Conditions: A Systematic Synthesis of Evidence from Low- and Middle-Income Countries.

Neonatal respiratory conditions are leading causes of mortality and morbidity during the neonatal period. This review evaluated 11 management interventions for respiratory distress syndrome (RDS), apnoea of prematurity (AOP), meconium aspiration syndrome (MAS), transient tachypnea of the newborn (TTN), as well as bronchopulmonary dysplasia (BPD) as a potential complication from respiratory care in low- and middle-income countries (LMICs). Two different methodological approaches were completed: (1) updating outdated reviews and pooling all LMIC studies and (2) re-analysis of LMIC studies from up-to-date reviews. Review updates were conducted between October 2022 and February 2023 and followed systematic methodology. A total of 50 studies were included across four review updates and seven review re-analyses. Findings indicate that bubble CPAP (RR 0.74, 95% CI 0.58 to 0.96) and prophylactic CPAP (RR 0.39, 95% CI 0.26 to 0.57) for RDS reduced the risk of treatment failure compared to other ventilation types or supportive care, respectively. Postnatal corticosteroids reduced BPD assessed as oxygen requirement at 36 weeks' postmenstrual age (RR 0.56, 95% CI 0.41 to 0.77). All other outcomes were found to be non-significant across remaining interventions. Our findings indicate that prophylactic and bubble CPAP may provide some benefit by reducing treatment failure compared to other pressure sources. The safety and efficacy of other management interventions for RDS, AOP, BPD, MAS, and TTN remains uncertain given limited evaluations in LMICs. Future research should conduct adequately powered trials in underrepresented LMIC regions, investigate long-term outcomes, and evaluate cost-effectiveness.

Clinical Profile and Outcomes of Late Preterm Neonates in Relation to Gestational Age and Maternal Psychosocial Factors in a Tertiary Care Centre

The relationship between maternal psychosocial factors and outcomes among LPN remains unexplored. Objectives: To determine the morbidity profile of LPN with respect to gestational age and study its association with maternal psychosocial, lifestyle and demographic factors. Methodology: Cross-sectional study on LPNs in a tertiary care centre over one year. Results: Total sample: 263. LPN incidence: 94/1000 live births; Maternal age 20-30 years (p=0.03), high screen time (p=0.02), Caesarean section (p=0.02), moderate Maternal Stress (MS) (p=0.014) was associated with (a/w) births at 35 0/6 to 6/7 weeks of gestation (WOG).Low Birth Weight (LBW) LPN: 66.5% incidence, highest at 35 0/6 to 6/7 WOG; a/w maternal age 20-30 (p=0.002), nulliparity (p=0.02), moderate to severe MS (p=0.012), and Pregnancy Induced Hypertension (PIH) (p=0.04).Small for Gestational Age (SGA): 35%, peaking at 35 0/6 to 6/7 WOG; a/w nulliparity and severe MS. Sepsis 12.2%, highest at 34-35 0/6 to 6/7 WOG (p=0.001); a/w lower-middle socioeconomic status (p=0.05) and multiparity (p=0.02). Respiratory Distress Syndrome (RDS) 5.3%, peaked at 34 0/6 to 6/7 WOG (p=0.044); a/w poor socioeconomic status (p= 0.00). Transient tachypnoea of Newborn (TTN) 49.4%, a/w nulliparity (p=0.02). Neonatal hyperbilirubinemia (NNH) 57.8%, peaking at 34-35 0/6 to 6/7 WOG (p=0.01); a/w nulliparity (p=0.03). Perinatal asphyxia (PA) 6.5%, highest at 35 WOG. Conclusion: NNH and TTN were common in LPN. 35 WOG related to various risk factors and morbidities. LPN born to mothers with moderate MS, PIH, nulliparity, and age 20-30 were LBW. Mother’s screen time > 4 hours/day a/w LPNs born at 35 WOG.

Factors Affecting Lung Function in Preschool Children with a History of Transient Tachypnea of the Newborn

Background: Transient tachypnea of the newborn (TTN) is a common cause of self-limiting respiratory distress in neonates. Increasing data suggest that TTN may be a risk factor for developing childhood wheezing attacks or asthma. Objectives: The aim was to evaluate lung functions in preschool children diagnosed with TTN in the neonatal period using an Impulse Oscillometry System (IOS) to assess the presence of respiratory morbidity and its contributing factors. Methods: In this prospective study, preschool children diagnosed with TTN in the neonatal period and healthy age-matched children were defined as the TTN group and control group, respectively. Impulse Oscillometry System values for resistance (R5-R20), reactance (X5-X20), resonant frequency (Z5), and reactance area (AX) were compared between both groups and within the TTN subgroups. Asthma diagnosis was determined following IOS testing using the Modified Asthma Predictive Index/ International Study of Asthma and Allergies in Childhood (ISAAC). Results: A total of 52 preschool children and 101 healthy controls participated in the study. R5 minus R20 was significantly higher, and X10 and X15 values were significantly lower in the TTN group compared to the controls. Additionally, higher R values and AX values were observed in TTN subgroups with a history of late preterm birth, noninvasive respiratory support, and maternal asthma. The rates of variable respiratory symptoms and ≥ 4 wheezing attacks in one year were 20.5% and 18%, respectively. By the end of the study, the rate of newly diagnosed asthma in the TTN group was 30.8%. Moreover, R values and Z5 were significantly higher, and X values were significantly lower in the TTN subgroup exposed to passive smoking (PS) compared to the TTN subgroup not exposed. Conclusions: Our study showed that preschool children diagnosed with TTN in the neonatal period may have peripheral airway obstruction, a known characteristic of asthma. In addition to TTN-related factors, exposure to cigarette smoke appears to negatively impact their lung function. These findings suggest that long-term medical care should be provided for these children.

Left atrial strain assessment unveils left ventricular diastolic dysfunction in neonates with transient tachypnea of the newborn: A prospective observational study.

An inadequate clearance of lung fluid plays a key role in the pathogenesis of transient tachypnea of the newborn (TTN). To evaluate if left ventricular diastolic dysfunction contributes to reduced clearance of lung fluid in TTN. This was a prospective, observational study. Echocardiography and lung ultrasound were performed at 2, 24 and 48 h of life (HoL) to assess biventricular function and calculate lung ultrasound score (LUS). Left atrial strain reservoir (LASr) provided surrogate measurement of left ventricular diastolic function. Twenty-seven neonates with TTN were compared with 27 controls with no difference in gestation (36.1 ± 2 vs. 36.9 ± 2 weeks) or birthweight (2508 ± 667 vs. 2718 ± 590 g). Biventricular systolic function was normal in both groups. LASr was significantly lower in cases at 2 (21.0 ± 2.7 vs. 38.1 ± 4.4; p < 0.01), 24 (25.2 ± 4.5 vs. 40.6 ± 4.0; p < 0.01) and 48 HoL (36.5 ± 5.8 and 41.6 ± 5.2; p < 0.01), resulting in a significant group by time interaction (p < 0.001), after adjusting for LUS and gestational diabetes. A logistic regression model including LUS, birth weight and gestational diabetes as covariates, showed that LASr at 2 HoL was a predictor of respiratory support at 24 HoL, with an adjusted odds ratio of 0.60 (CI 0.36-0.99). LASr was reduced in neonates with TTN, suggesting diastolic dysfunction, that may contribute to the delay in lung fluid clearance.

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.

Risk of Transient Tachypnea of the Newborn following Elective Cesarean Section Increases at a Gestational Age of 37 Weeks Compared to That at ≥ 38 Weeks Despite the Exclusion of Pre-Existing Risk Factors for Neonatal Respiratory Disorders.

Elective cesarean sections (ECSs) for early-term pregnancies at 37 weeks of gestational age (GA) aim to reduce the risk of emergency cesarean sections due to the onset of labor or rupture of membranes. However, resultant increases in neonatal respiratory disorders, including transient tachypnea of the newborn (TTN) have been observed. However, few studies have elucidated the associated risk factors. Consequently, we aimed to determine whether differences existed in the clinical outcomes between neonates delivered via ECS at 37 weeks and those delivered at ≥ 38 weeks of GA. A retrospective analysis was conducted on 259 neonates born via ECS at Tottori University Hospital, between January 2013 and December 2019, with birthweights ≥ 2500 g and GAs > 37 weeks. The neonates were categorized into two cohorts: births at 37 and at ≥ 38 weeks of GA (37-week and 38-week cohorts). The principal clinical outcomes included the appearance, pulse, grimace, activity, and respiration (Apgar) scores, need for positive-pressure ventilation, incidence of TTN, and length of hospital stay. No statistically significant differences were observed in the indications for ECS, sex, or birthweight between the two cohorts. The 37-week cohort exhibited a lower 1-min Apgar score than did the 38-week cohort, with no statistically significant differences between the two cohorts, at 5 min. Statistically significant differences were not observed in the need for positive-pressure ventilation during initial resuscitation or length of hospital stay for patients with TTN between the two cohorts. Notably, the 37-week cohort exhibited a significantly higher incidence of TTN than did the 38-week cohort. ECSs at 37 weeks of GA exhibited an increased risk of TTN than ECSs at ≥ 38 weeks of GA. Strategic neonatal care and adequate preparation can mitigate this risk without affecting the length of hospital stay.

Maternal and Perinatal Outcomes of Low-risk Pregnancies with Amniotic Fluid Index &lt;5 cm: A Prospective Cohort Study

Introduction: The optimal management of Isolated Oligohydramnios (IO) is controversial. The general consensus is to deliver after 36 weeks. This has led to higher rates of obstetric interventions and adverse neonatal outcomes. Aim: To compare the pregnancy and perinatal outcomes of low-risk pregnancies with IO (Amniotic Fluid Index [AFI] &lt;5 cm) with that of low-risk pregnancies with normal levels of amniotic fluid. Materials and Methods: A prospective cohort study was conducted at the Department of Obstetrics and Gynaecology at Government Medical College, Ernakulam, from April 2018 to March 2020. A total of 66 low-risk singleton pregnancies with IO (AFI &lt;5 cm) between 34 and 40 weeks of gestation were compared with 132 low-risk pregnancies with normal AFI (AFI 5-24), matched by parity and gestational age. The obstetric outcomes measured were gestational age at delivery, mode of delivery, presence of Meconium-Stained Amniotic Fluid (MSAF), presence of Non-reassuring Foetal Heart Rate (NRFHR), stillbirth, and maternal complications. Neonatal outcomes measured were prematurity, birth weight, admission to the Neonatal Intensive Care Unit (NICU), duration of NICU stay, and the presence of Respiratory Distress Syndrome (RDS), Transient Tachypnea of the Newborn (TTN), Meconium Aspiration Syndrome (MAS), seizures, Necrotising Enterocolitis (NEC), Intraventricular Haemorrhage (IVH), Hypoxic Ischemic Encephalopathy (HIE), need for phototherapy, infectious morbidity like suspected or culture-proven sepsis, hypothermia, hypoglycaemia, and Neonatal Death (NND). A composite adverse neonatal outcome was defined as the presence of any one of the above. Continuous variables were calculated as mean with Standard Deviation (SD) or median with Interquartile Range (IQR) as appropriate. The test of significance done using the Student’s t-test. Categorical variables were calculated as numbers (%) and compared using the Chi-square test and Fisher’s exact test. All tests were two-sided, and a p-value of less than 0.05 was considered statistically significant. Results: The mean age of patients in the low AFI group was 26±4.87 years, while in the normal AFI group, it was 24.8±4.39 years. Pregnancies complicated by IO were characterised by a higher rate of labour induction {38 (57.6%) vs. 26 (19.7%), p-value&lt;0.001} and caesarean delivery {34 (51.5%) vs. 35 (26.5%), p-value&lt;0.001}. IO had a significantly higher rate of low birth weight babies {35 (53%) vs. 28 (21.2%), p-value&lt;0.001}, non-vertex presentations {6 (9.1%) vs. 0, p-value&lt;0.001}, and NRFHR {10 (15.2%) vs. 6 (4.5%), p-value=0.001}. Neonates in the low AFI group had a higher rate of admission to the NICU {20 (30.3%) vs. 20 (15.2%)} and composite adverse outcomes {24 (36.4%) vs. 20 (15.2%)}. Conclusion: The isolated oligohydramnios is associated with a higher rate of labour induction, caesarean delivery, and low birth weight babies. Adverse neonatal outcomes may be due to the combined effects of prematurity and low birth weight, rather than to IO per se.

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.

Admission and respiratory outcomes of late preterm infants in the setting of high cesarean section deliveries: A single center retrospective analysis

Background Late preterm infants (LPIs) account for most preterm births and are at high risk of developing prematurity-related morbidities. Due to the increasing rate of cesarean section delivery, it is expected that more LPIs with respiratory complications will be admitted to neonatal intensive care units (NICU). Objectives To assess the rate of NICU admission and respiratory complications among LPIs and to compare their outcomes based on the mode of delivery. Patients and Methods The list of all LPIs who were admitted in the period 2015–2020 was reviewed. Data collected about demographic characteristics, delivery information, NICU admission, respiratory complications, respiratory support, length of stay, and readmission. Infants were classified according to their mode of delivery into: vaginal delivery group (VD) and cesarean section group (CS). Results Out of 2236 LPIs included, 321 (14%) were born at 34-week gestation, 1137 (51%) were males. 1243 (56%) were admitted to NICU. The CS group comprised 77% (1719) while the VD group 23% (517). Compared to the VD group, infants in the CS group had a higher rate of NICU admission (57.1% vs. 50.7%, P = 0.006), respiratory distress syndrome (RDS) (22% vs. 17%, P = 0.000), and transient tachypnea of newborn (TTN) (17% vs. 11%, P = 0.019). Also, more babies in the CS group received CPAP (36.2% vs. 24.6%, P = 0.000) and surfactant therapy (6.6% vs. 4.6%, P = 0.02). After logistic regression analysis, CS remains an independent factor for NICU admission (OR 1.3, 95% confidence intervals [CI] 1.1–1.6, P = 0.01), respiratory complications (OR 1.6, 95% CI 1.2–2.2, P = 0.001), CPAP requirement (OR 1.6, 95% CI 1.3–2, P = 0.000), and a longer length of stay &gt; 3 days (OR 1.5, 95% CI 1.2–1.8, P = 0.000). Conclusion The rate of CS delivery among late preterm gestation is very high and alarming. CS delivery of LPI increases the rate of NICU admission, respiratory complications, and the need for respiratory support.

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.