Transient Tachypnea Of The Newborn Research Articles

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.

Prospective Evaluation of the Correlation of Lung Ultrasonography Score and Blood Gas Parameters in Neonates With Respiratory Distress.

Introduction Lung ultrasonography (LUS) has become frequently used in neonatal intensive care units (NICU) because it is diagnostic, useful, harmless, radiation-free, and practical for bedside use due to its portability. Objective This study aimed to evaluate the association between lung ultrasound (LUS) scores and diagnoses of neonates hospitalized for respiratory distress and determine the value of the combined use of laboratory and imaging methods in patient evaluation by looking at the correlation between blood gas parameters and LUS score. Materials and methods Between March and July 2022, a total of 55 patients who were born term or premature and admitted due to respiratory distress in the NICU of Malatya Training and Research Hospital were included in the study. In this observational, prospective study, demographic information such as birth weights, gestational weeks, mode of delivery, Apgar scores, blood gas sample results, LUS results and scores, ventilation types, and discharge time were recorded during hospitalization in our unit. According to the newborns' clinical, laboratory, and radiologic evaluations, the diagnoses of respiratory distress syndrome (RDS), transient tachypnea of the newborn (TTN), or congenital pneumonia were made, and the relationship between the diagnoses and LUS scores was evaluated. The pH value and PCO2 value in the venous blood gas obtained on the day of LUS were recorded. Correlation analysis was performed between the LUS score and pH value, LUS score and PCO2 value. Results Twenty-seven newborns were diagnosed with TTN, 18 with RDS, and 10 with congenital pneumonia. There was a statistical difference between LUS scores and diagnoses (p<0.001). According to Spearman correlation analysis, a significant negative moderate correlation was found between LUS scores and venous blood gas pH value (p<0.001, r:-0.49). There was also a significant positive low, moderate correlation with venous blood gas PCO2 value (p<0.001, r:0.36). Conclusion This study demonstrates that LUS scoring has a role in determining the severity of disease and making diagnoses in patients hospitalized for respiratory distress. When LUS is widely used, it will be informative about the severity and prognosis of the disease, together with laboratory evaluation.

Clinico-Demographic Profile of Term Newborns Admitted with Respiratory Distress at a Tertiary Hospital in India

Background: Respiratory distress (RD) is the most common cause of morbidity and mortality in newborns. Over the last three decades, significant improvements have been introduced to decrease the incidence, severity, and mortality of neonatal RD. This study aims to analyze the clinical and demographic profile of term newborns with RD and to explore associated risk factors and co-morbidities. Methods: This analytical cross-sectional study included 250 term newborns (gestational age: 37 to 42 weeks) diagnosed with RD. The study was conducted at the Department of Pediatrics, Santosh Medical College, over a one-year period from June 2018 to June 2019. Results: The male-to-female ratio was 1.7:1. Among the admissions, 65% were term pregnancies and 35% were late-term pregnancies. Severe RD was observed in 10% of newborns, while 35% had moderate RD. There was a significant correlation between gestational period and RD severity (P = 0.024), and hospital stay also exhibited a significant association with RD severity (P = 0.001). Meconium-stained amniotic fluid was the most common maternal risk factor (25%), while sepsis was the most prevalent co-morbidity (23%). Transient tachypnea of the newborn (TTNB) was the leading cause of RD, accounting for 47% of cases. Conclusions: A comprehensive clinical assessment and appropriate investigations are vital for accurate diagnosis and effective treatment of infants with RD. Swift identification of severe underlying conditions is essential for improving outcomes.

The epidemiology of neonatal respiratory distress in a tertiary care neonatal Centre Kashmir India

Background: Respiratory distress is most common cause of neonatal admission to NICU and has different etiologies with similar clinical presentation. Early diagnosis of specific cause for respiratory distress is very important as different etiologies have different specific treatment and require altogether different ventilatory strategies. Objectives were to study the demographic and etiological profile of neonatal respiratory distress. Method: Hospital based prospective observational study conducted in department of pediatrics, associated hospital of GMC Srinagar. Results: Respiratory distress was more common in males 56.30%, frequency of prematurity was 68% and most common mode of delivery lower section caesarian section (LSCS) 69.10%. Different maternal risk factors associated with adverse outcome premature rupture of membranes (PROM) (37.7%), meconium-stained amniotic fluid (MSAF) (34.60%), maternal hypertension (31.50%), gestational diabetes mellitus (GDM) (26.9%). Common causes for respiratory distress in neonate were transient tachypnea of newborn (TTN) (22.0%), respiratory distress syndrome (RDS) (20%), meconium aspiration syndrome (MAS) (16.90%), sepsis (14%) and perinatal asphyxia (12%). Conclusions: Early diagnosis of specific cause for respiratory distress is very important as different etiologies have different specific treatment and require altogether different ventilatory strategies. The TTN was the most common cause of distress in term newborns, followed by perinatal asphyxia, meconium aspiration, neonatal sepsis, and congenital heart diseases (CHD). Therefore, timely diagnosis and management of these conditions is very imperative to discharge an intact neonate from the NICU.

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

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

Next-generation sequencing-based detection of Ureaplasma in the gastric fluid of neonates with respiratory distress and chorioamnionitis

Background Respiratory distress is common in neonates admitted to neonatal intensive care units. Additionally, infectious diseases such as intrauterine infections or vertical transmission are important underlying causes of respiratory failure. However, pathogens often cannot be identified in neonates, and there are many cases in which antibacterial drugs are empirically administered. Next-generation sequencing (NGS) is advantageous in that it can detect trace amounts of bacteria that cannot be detected by culturing or bacteria that are difficult to cultivate. However, there are few reports on the diagnosis of infectious diseases using NGS in the neonatal field, especially those targeting respiratory distress. Objective The purpose of our study was to investigate the microorganisms associated with neonatal respiratory distress and to determine whether less invasive collection specimens such as plasma and gastric fluid are useful. Methods Neonates were prospectively recruited between January and August 2020 from Nagoya University Hospital. The inclusion criteria were as follows: 1) admission to the neonatal intensive care unit; 2) respiratory distress presentation within 48 h of birth; and 3) suspected infection, collection of blood culture, and administration of antibiotics. Plasma samples and blood cultures were simultaneously collected. Gastric fluid samples were also collected if the patient was not started on enteral nutrition. Information on the patients and their mothers were collected from the medical records. DNA was extracted from 140 µL of plasma and gastric fluid samples. DNA sequencing libraries were prepared, and their quality was analyzed. DNA libraries were sequenced using high-throughput NGS. The NGS data of plasma and gastric fluid samples were analyzed using the metagenomic pipeline PATHDET, which calculated the number of reads assigned to microorganisms and their relative abundance. Putative pathogens were listed. Results Overall, 30 plasma samples and 25 gastric fluid samples from 30 neonates were analyzed. Microorganism-derived reads of gastric fluid samples were significantly higher than those of plasma samples. Transient tachypnea of the newborn was the most common cause of respiratory distress with 13 cases (43%), followed by respiratory distress syndrome with 7 cases (23%). There were 8 cases (29%) of chorioamnionitis and 7 cases (25%) of funisitis pathologically diagnosed. All blood cultures were negative, and only two gastric fluid cultures were positive for group B Streptococcus (Patient 15) and Candida albicans (Patient 24). Putative pathogens that met the positive criteria for PATHET were detected in four gastric fluid samples, one of which was group B Streptococcus from Patient 15. In the gastric fluid sample of Patient 24, Candida albicans were detected by NGS but did not meet the positive criteria for PATHDET. Cluster analysis of the plasma samples divided them into two study groups, and the indicator genera of each cluster (Phormidium or Toxoplasma) are shown in Figure 1. Clinical findings did not show any significant differences between the two groups. Cluster analysis of the gastric fluid samples divided them into three study groups, and the indicator genera of each cluster (Ureaplasma, Nostoc, and Streptococcus) are shown in Figure 2. The incidence rate of chorioamnionitis was significantly higher in Ureaplasma group than in the other two groups. Conclusion Gastric fluid may be useful for assessing neonatal patients with respiratory distress. To the best of our knowledge, this was the first study to reveal that the presence of Ureaplasma in the gastric fluid of neonates with respiratory distress was associated with chorioamnionitis. The early diagnosis of intra-amniotic infections using gastric fluid and its treatment may change the treatment strategy for neonatal respiratory distress. Screening for Ureaplasma in neonates with respiratory distress may reduce the need for empirical antibiotic administration. Further research is required to confirm these findings.

Neonatal Outcomes of Term Infants Born with Meconium-Stained Amniotic Fluid.

Background Meconium-stained amniotic fluid (MSAF) is considered an alarming sign of possible fetal compromise and it has recently been reported that neonatal outcome correlates with the degree of meconium thickness. Methods We retrospectively studied 400 term infants allocated in clear amniotic fluid and grade 1, 2, and 3 MSAF groups on the basis of color and thickness of AF. Multivariable logistic regression analysis was performed to evaluate the potential independent effect of delivery with MSAF of different severity on the risk of a composite adverse neonatal outcome. Results We found that delivery with grade 2 (OR 16.82, 95% Cl 2.12-33.52; p = 0.008) and 3 (OR 33.79, 95% Cl 4.24-69.33; p < 0.001) MSAF is independently correlated with the risk of adverse neonatal outcome, such as the occurrence of at least one of the following: need of resuscitation in the delivery room, blood cord pH < 7.100, occurrence of meconium aspiration syndrome (MAS), persistent pulmonary hypertension (PPH), transient tachypnea of the newborn (TTN), acute respiratory distress syndrome (ARDS), hypoxic-ischemic encephalopathy (HIE), and sepsis. Conclusions There is a positive correlation between the severity of amniotic fluid meconium staining and thickness and the outcomes of term infants. Therefore, the evaluation and grading of MSAF during labor is useful in order to plan for the presence of a neonatologist at delivery for immediate and proper neonatal care.

Association between caesarean section and childhood asthma development

According to the World Health Organization (WHO), the rates of caesarean section delivery, which is the most common surgical procedure in gynecology and obstetrics, are increasing globally and amount to 21%. In Poland percentage of caesarean sections (CS) is one of the highest in Europe and amount to 42.2%. The reason for this is the extension of medical indications, but also an increase in the number of CS at the request of pregnant women. Although CS can be a lifesaving procedure, it can also cause many health complications for both - the woman and the child. Numerous studies indicate that caesarean delivery is associated with childhood asthma. Several hypotheses of the pathogenesis of this relationship have been presented. One of them, which is based on the hygiene hypothesis indicates that mode of delivery can cause different bacteria colonization in infants. Lack of contact of fetus with the mother’s vaginal flora during CS labor may cause improper immune system maturation. Another hypothesis is that reduced exposure to stress hormones and mechanical forces during CS labor can indicate infant respiratory complications such as respiratory distress syndrome (RDS) or transient tachypnea of the newborn (TTN). It is suggested that these abnormalities have an impact on asthma development in later life. On the other hand, there are studies which do not confirm that mode of delivery has an influence on the induction of asthma. Due to the significant heterogeneity of studies and unclear risk factors and pathomechanism of the childhood asthma it is impossible to strong confirm the association between caesarean section and asthma developing.

Assessment of myocardial function in late preterm and term infants with transient tachypnea of the newborn using tissue Doppler imaging - a pilot observational study.

The aim of this study was to compare conventional and tissue Doppler echocardiography parameters between transient tachypnea of the newborn (TTN) and healthy control infants. This cross sectional pilot observational study was conducted in a level 3 neonatal care unit of India. Consecutively born late preterm and term infants (LPTI) with TTN were eligible for enrollment. Control group was selected from healthy LPTI. Conventional and tissue Doppler (myocardial velocities, myocardial performance index (MPI)) echocardiography was done within first 12h (D1) and 48-72h (D3) of life. Conventional echocardiography parameters were fractional shortening (FS), ejection fraction (EF), ventricular output, E/A ratio, fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), pulmonary artery systolic pressure (PASP), and pulmonary artery acceleration to ejection time ratio (PATET). Baseline characteristics and echocardiography images were compared between TTN and control groups. Out of 60 infants enrolled, 34 from TTN and 20 from control group were finally analyzed. Mean (SD) gestational age and birth weight of the study population was 366/7(1.8) weeks and 2398(376) g respectively. Left ventricular (LV) parameters were similar between both groups. On D1, right ventricular (RV)e' was smaller (6.42(1) cm/s vs. 7.68(1.68) cm/s, p 0.022), and E/e' (7.79(1.51) vs. 6.08(2.59), p 0.037) was larger in TTN group, indicating RV diastolic dysfunction. RV MPI (0.61(0.11) vs. 0.44(0.12), p < 0.001) was also larger, signifying RV global myocardial dysfunction. Similar findings were observed on D3. PATET was lower in TTN group on both D1 (0.34 (0.05) vs. 0.42 (0.05), p < 0.001) and D3 (0.38 (0.05) vs. 0.43 (0.02), p 0.004) suggesting persistently raised pulmonary arterial pressure, although only 2 infants developed pulmonary hypertension identified by standard echocardiography. Conclusion: Myocardial tissue Doppler imaging of TTN infants revealed occult right ventricular diastolic dysfunction secondary to persistently raised pulmonary arterial pressure. What is Known: •Transient tachypnea of the newborn may be associated with pulmonary arterial hypertension. What is New: •Tissue Doppler imaging in infants with transient tachypnea of the newborn revealed occult right ventricular diastolic dysfunction secondary to raised pulmonary arterial pressure, not detected by standard echocardiography.

Comparison of Neonatal outcome of elective cesarean section done at 37–38 weeks of gestation and at 39-40 weeks of gestation

Objective: The study aimed to compare the CS between 37 and 38 weeks gestational weeks and those performed between 39-40 weeks gestational weeks in order to determine the neonatal outcome and complications. Study design: comparative cross-sectional. Place and Duration of study: The study was conducted on 200 pregnant women in the Department of Obstetrics and Gynecology, Baqai Medical University, Fatima Hospital, Gadap Karachi from January 2021 to December 2022. Methodology: Women with term singleton pregnancies scheduled for elective cesarean section at 37 - 38 weeks and 39-40 weeks of gestation without medical comorbidities were enrolled.. All the patients were distributed into two groups: Group-A composed of pregnant women with gestational age 37-38 weeks and Group-B pregnant women with gestational age of 39-40 weeks. Data such as maternal age, gestational age, parity, and neonatal complication neonatal weight were collected. Transient tachypnea of the newborn (TTN), sepsis, NICU admission, respiratory distress syndrome (RDS), and neonatal outcomes were noted. Repeat C-Section, malpresentation, Cephalopelvic Disproportionation (CPD), maternal request were different causes for elective cesarean section. Data was collected from those patients who were admitted in ward for elective cesarean section through a pre designed proforma. Data analysis was done in SPSS version 27.

ОЦЕНКА ЦЕРЕБРАЛЬНОЙ ОКСИГЕНАЦИИ ПРИ РАЗВИТИИ ТРАНЗИТОРНОГО ТАХИПНОЭ У НОВОРОЖДЕННЫХ

One of the most common respiratory diseases in term and late preterm infants is the Transient tachypnea of the newborn (TTN). The clinical picture of TTN is characterized by respiratory disorders with the development of hypoxemia, which is especially important for the functioning of the central nervous system and may cause its damage. One of the methods for functional assessment of the supply of oxygen to the brain is the determination of cerebral oxygenation (CO) using the Near-infrared spectroscopy (NIRS). The purpose of this research was to assess the CO in TTN using the NIRS technology. Materials and methods used: a single-center prospective cohort study was conducted from June 01 till Dec. 31, 2021. The study group consisted of 75 full-term newborns with the development of a clinical picture of TTN and a Downes score of ≥3 pts within 60 minutes after birth. Exclusion criteria: other causes of respiratory disorders. The control group consisted of 20 full-term healthy newborns after the C-section recruited by continuous sampling within 3 days from Dec. 21 to 23, 2021. The study of CO was performed only at the stage of the delivery room using the SenSmart™ Model X-100 device; the single-channel monitoring was performed with an SenSmart™ 8004CB-NA sensor (both - by Nonin Medical, Inc., USA). Results: based on the results of the analysis of the data obtained, an increase in the CO indicators in the study group was demonstrated from 72% at the 10th minute to 81% at the 60th minute of life with a further decrease to 80% to 79%. In contrast to healthy newborns, who’ve also showed an increase in CO from 75% at the 5th minute, and reaching a plateau level of 80% already at the 15th minute with a further decrease in indicators to 79% to 77%, a statistically significant difference between the groups was found at the 10th minute with a higher CO level in the group of healthy children (79 (78-82)% vs. 72 (70-73)%, p=0.007). Despite the fact that there was no statistically significant correlation between the severity of respiratory disorders, the development of cerebral ischemia and the CO indicators, there is a general trend towards a decrease and a slow increase in the CO level in full-term patients with TTN. Conclusion: the study showed that in the process of developing TTN, not only the respiratory function suffers, but also the processes of oxygenation of the brain. A prolonged period of low CO levels may have adverse outcomes for the CNS, the life and health of the child in general, this therefore requires further research.

Cardiopulmonary Ultrasound Patterns of Transient Acute Respiratory Distress of the Newborn: A Retrospective Pilot Study.

Acute transient respiratory distress in the first hours of life is usually defined as transient tachypnea of the newborn (TTN). TTN is a respiratory self-limiting disorder consequent to delayed lung fluid clearance at birth. While TTN is the most common etiology of respiratory distress near term, its pathogenesis and diagnostic criteria are not well-defined. Lung ultrasound and targeted neonatal echocardiography are increasingly being used to assess critically ill infants, although their combined use to improve diagnostic precision in neonatal intensive care units has not yet been described. This retrospective pilot analysis aimed to identify possible cardiopulmonary ultrasound (CPUS) patterns in term and late preterm infants suffering from transient respiratory distress and requiring non-invasive respiratory support. After retrospectively revising CPUS images, we found seven potential sonographic phenotypes of acute neonatal respiratory distress. Up to 50% of the patients presented with signs of increased pulmonary vascular resistance, suggesting that those patients may be diagnosed with mild forms of persistent pulmonary hypertension of the newborn. Approximately 80% of the infants with a history of meconium-stained amniotic fluid displayed irregular atelectasis, indicating that they may have suffered from mild meconium aspiration syndrome. CPUS evaluation may improve accuracy in the approach to the infants presenting with transient acute respiratory distress, supporting communication with the parents and carrying important epidemiological consequences.

Protocol for a multicenter, double-blind, randomized, placebo-controlled phase III trial of the inhaled β2-adrenergic receptor agonist salbutamol for transient tachypnea of the newborn (the REFSAL trial).

Transient tachypnea of the newborn (TTN), which results from inadequate absorption of fetal lung fluid, is the most common cause of neonatal respiratory distress. Stimulation of β-adrenergic receptors enhances alveolar fluid absorption. Therefore, the β2-adrenergic receptor agonist salbutamol has been proposed as a treatment for TTN. This study aims to evaluate the efficacy and safety of salbutamol as supportive pharmacotherapy together with non-invasive nasal continuous positive airway pressure (NIV/nCPAP) for the prevention of persistent pulmonary hypertension of the newborn (PPHN) in infants with TTN. This multicenter, double-blind, phase III trial will include infants with a gestational age between 32 and 42 weeks who are affected by respiratory disorders and treated in eight neonatal intensive care units in Poland. A total of 608 infants within 24 h after birth will be enrolled and randomly assigned (1:1) to receive nebulized salbutamol with NIV or placebo (nebulized 0.9% NaCl) with NIV. The primary outcome is the percentage of infants with TTN who develop PPHN. The secondary outcomes are the severity of respiratory distress (assessed with the modified TTN Silverman score), frequency of need for intubation, duration of NIV and hospitalization, acid-base balance (blood pH, partial pressure of O2 and CO2, and base excess), and blood serum ionogram for Na+, K+, and Ca2+. The Respiratory Failure with Salbutamol (REFSAL) study will be the first clinical trial to evaluate the efficacy and safety of salbutamol in the prevention of persistent pulmonary hypertension in newborns with tachypnea, and will improve short term outcomes. If successful, the study will demonstrate the feasibility of early intervention with NIV/nCPAP together with nebulized salbutamol in the management of TTN. The study protocol was approved by the Bioethics Committee of the Medical University of Warsaw, Warsaw, Poland on November 16, 2020 (decision number KB/190/2020). All procedures will follow the principles of the Declaration of Helsinki. The results of the study will be submitted for knowledge translation in peer-reviewed journals and presented at national and international pediatric society conferences. It is registered at ClinicalTrials.gov NCT05527704, EudraCT 2020-003913-36; Protocol version 5.0 from 04/01/2022.

Comparison of urine bisphenol A levels in transient tachypnea of the newborn and healthy newborns.

To investigate the relationship between neonatal urine bisphenol A (BPA) levels and the prevalence and prognosis of transient tachypnea of the newborn (TTN). This prospective study was conducted between January and April 2020 in the Neonatal Intensive Care Unit (NICU) of Gaziantep Cengiz Gökçek Obstetrics and Pediatric Hospital. The study group consisted of patients diagnosed with TTN and the control group was made up of healthy neonates housed together with their mothers. Urine samples were collected from the neonates within the first 6 hours postnatally. Urine BPA levels and urine BPA/creatinine levels were statistically higher in the TTN group (P < 0.005). The receiver operating characteristic (ROC) curve analysis determined the cut-off value of urine BPA for TTN to be 1.18 µg/L (95% confidence interval [CI]: 0.667-0.889, sensitivity: 78.1%, and specificity: 51.5%) and the cut-off value of urine BPA/creatinine to be 2.65 µg/g (95% CI: 0.727-0.930, sensitivity: 84.4%, and specificity: 66.7%). Furthermore, the ROC analysis indicated that the cut-off value of BPA for neonates requiring invasive respiratory support was 15.64 µg/L (95% CI: 0.568-1.000, sensitivity: 83.3%, and specificity: 96.2%) and the cut-off value for BPA/creatinine was 19.10 µg/g (95% CI: 0.777-1.000, sensitivity: 83.3%, and specificity: 84.6%) among the TTN patients. BPA and BPA/creatinine values were higher in the urine of newborns diagnosed with TTN which is a fairly common cause of NICU hospitalization, in samples collected within the first 6 hours after birth, which may be a reflection of intrauterine factors.