Transient Tachypnea Of The Newborn Research Articles

Accuracy and Reliability of Lung Ultrasound to Diagnose Transient Tachypnoea of the Newborn: Evidence from a Meta-analysis and Systematic Review.

Transient tachypnoea of the newborn (TTN) is one of the most common causes of neonatal respiratory distress (RD) during the newborn period. Chest radiography (CXR) is commonly used to rule out the diagnosis, but TTN is often misdiagnosed as neonatal respiratory distress syndrome (NRDS) on the basis of CXR alone. Increasing evidence suggests that lung ultrasound (LUS) may be a reliable diagnostic tool for transient tachypnoea of the newborn. However, studies of the diagnostic efficiency of LUS are still lacking. This study was aimed to evaluate the accuracy and reliability of LUS for diagnosing TTN by conducting a systematic review and meta-analysis. We searched for articles in the Embase, PubMed, and Cochrane Library databases from inception until May 31, 2020. The selected studies were diagnostic accuracy studies that reported the utility of LUS in the diagnosis of TTN. Two researchers independently extracted data and assessed quality using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Then, we created a bivariate model of mixed effects to calculate the sensitivity and specificity of LUS in diagnosing TTN. A summary receiver operator characteristic (SROC) curve was constructed to summarize the performance characteristics of LUS. Six studies involving 617 newborns were included in the review. LUS had a pooled sensitivity of 0.98 (confidence interval [CI]: 0.92-1.00) and a specificity of 0.99 (CI: 0.91-1.00). The area under the curve for LUS was 1.00 (0.98-1.0). Meta-regression revealed that LUS had a significant diagnostic accuracy for TTN. The performance of ultrasound for the detection of TTN was excellent. Considering the various advantages of LUS compared with chest radiographs in diagnosing TTN, this study supports the routine use of LUS for the detection of TTN. · Lung ultrasound is a highly accurate diagnostic tool, which may be a viable and superior alternative to CXR, in diagnosing TTN.. · Lung ultrasound can help differentiate TTN from other etiologies of respiratory distress in neonates.. · There are still some controversies on the ultrasound diagnostic criteria of TTN..

Spectrum of Respiratory Distress in Newborn: A Study From a Tertiary Care Military Hospital

Introduction: Respiratory distress (RD) is a common problem in neonatal period. It is an important cause of neonatal mortality. There are many causes of respiratory distress, among them, transient tachypnea of newborn (TTN), respiratory distress syndrome (RDS) and perinatal asphyxia are commonest causes. Timely and appropriate therapy is essential to prevent ongoing injury and improve outcome. The aim of this study was to determine the prevalence and to identify the causes of respiratory distress in neonatal intensive care unit (NICU) in Combined Military hospital (CMH) Sylhet and to observe the hospital outcome of these babies.
 Material and Methods: A descriptive type of crosssectional study was conducted in CMH Sylhet over a period of one year from April 2018 to March 2019. All live newborns delivered at CMH Sylhet during the study period were included and observed for development of respiratory distress.
 Results: All newborns (n=287), delivered at this hospital over the period of 12 months, were observed for respiratory distress. The overall prevalence of respiratory distress was 19.2 %. Prevalence was 10.8 % in full term, 7.3 % in preterm and 1.1% in post term. There was male predominance (54.5%) and two third (71.1%) were born by cesarean section. Transient tachypnea of newborn was found to be the commonest 47.3% cause of respiratory distress followed by respiratory distress syndrome 29.1%, perinatal asphyxia (10.9%), congenital pneumonia 3.6%, congenital heart disease 3.6%, septicaemia 3.6% and meconium aspiration syndrome (MAS) 1.9%. All babies required high flow oxygen initially, subsequently Bubble CPAP and mechanical ventilation was required in 8 (14.5%) and 1(1.8%) cases respectively. Mortality was 1.8% in neonates with respiratory distress syndrome with pneumothorax with septicaemia requiring mechanical ventilation.
 Conclusion: In this series, RDS in newborn majority of cases were due to TTN followed by respiratory distress syndrome and perinatal asphyxia. Mortality was mainly related to pneumothorax with septicaemia, RDS was more common in births related to caesarian section.
 J Bangladesh Coll Phys Surg 2021; 39(1): 4-8

Antenatal corticosteroids and short-term neonatal outcomes in term and near-term infants of diabetic mothers. Analysis of the Qatar PEARL-peristat registry.

A recent discussion surrounding the extension of antenatal corticosteroid (ACS) use beyond 34weeks of gestation did not include the subgroup of infants of diabetic mothers (IDM). We aimed to examine the association between ACS exposure and outcomes in neonates born at term and at near-term gestation in a large cohort of IDMs. We selected 13976 eligible near-term and term infants who were included in the PEARL-Peristat Perinatal Registry Study (PPS). We assessed the association of ACS exposure with neonatal outcomes in a multivariate regression model that controlled for diabetes mellitus (DM) and other perinatal variables. The incidence of DM was 28% (3,895 of 13,976) in the cohort. Caesarean section was performed in one-third of the study population. The incidence of ACS exposure was low (1.8%) and typically occurred>2weeks before delivery. The incidence rates of respiratory distress syndrome (RDS)/ transient tachypnoea of newborns (TTN), all-cause neonatal intensive care unit (NICU) admissions, NICU admissions for hypoglycaemia, and low 5-min Apgar scores were 3.5, 8.8, 1.3, and 0.1%, respectively. In a multivariate regression model, ACS was associated with a slight increase in NICU admissions (OR: 1.44; 95% CI: 1.04-2.03; p=0.028), but not with RDS/TTN. Although the low exposure rate was a limitation, ACS administration did not reduce respiratory morbidity in near-term or term IDMs. It was independently associated with an increase in NICU admissions. Randomized controlled trials are required to assess the efficacy and safety of ACS administration in diabetic mothers at late gestation.

Effect of sibship asthma on newborns with transient tachypnea of the newborn (TTN)

A number of studies have demonstrated that transient tachypnea of the newborn (TTN) is a risk factor for later asthma. The present study attempts to determine whether older sibling asthma is a risk factor for TTN. Medical records of 1318 newborns from neonatal intensive care and delivery units were studied. None of the subjects were first-born, and thus, all had older siblings. Clinical data of mothers and their children were obtained from medical records. Data items included date of birth, gestational age (GA) at birth, birth weight, gender, mode of delivery including Normal Spontaneous Delivery or caesarean section (CS) and whether pre-labour CS or not, reasons for CS, number of pregnancies, number of children, asthma of mothers and siblings, whether the newborn had TTN or not. Logistic regression analysis was used to assess the association between siblings' asthma and TTN. Pre-labour CS, maternal asthma, GA, babies with large and small birth weight for GA, number of pregnancies and children (three and more) were found to be significantly associated with TTN. Siblings' asthma was found to be independently associated with a diagnosis of TTN. Both pre-labour CS and mothers with asthma were common risk factors for the development of TTN. An association was present between TTN and siblings' asthma even in infants whose mothers did not have asthma.

Complications of antenatal corticosteroids in infants born by early term scheduled cesarean section

OBJECTIVE To compare neonatal hypoglycemia and respiratory morbidity rates in pregnancies complicated by diabetes following early term scheduled cesarean section (ETSCS) with and without maternal corticosteroid administration. RESEARCH DESIGN AND METHODS A retrospective cohort study of women with any form of diabetes in pregnancy undergoing ETSCS were included. Primary outcomes were admission rates to the neonatal intensive care unit (NICU) for Respiratory Distress Syndrome (RDS)/Transient Tachypnea of the Newborn (TTN) and/or neonatal hypoglycemia. RESULTS NICU admission rates for neonatal hypoglycemia were significantly higher (24.2% vs. 4.4%, P = 0.003), and RDS/TTN rates were nonsignificantly higher (15.2% vs. 7.2%, P = 0.209) following corticosteroid administration. CONCLUSIONS Corticosteroids were not beneficial among women with any form of diabetes in pregnancy undergoing ETSCS and, indeed, may be harmful. In our hospital, we have ceased the use of corticosteroids for women under these circumstances.

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

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

Timing of Repeat Cesarean Delivery for Women with a Prior Classical Incision.

This study aimed to compare neonatal outcomes for delivery at 36 weeks compared with 37 weeks in women with prior classical cesarean delivery (CCD). This was a secondary analysis of the prospective observational cohort of the Eunice Kennedy National Institute for Child and Human Development's Maternal-Fetal Medicine Unit Network Cesarean Registry. Data on cases of repeat cesarean delivery (RCD) in the setting of a prior CCD were abstracted and used for analysis. This study compared outcomes of women who delivered at 360/7 to 366/7 versus 370/7 to 376/7 weeks. The primary outcome was a composite of adverse neonatal outcomes that included neonatal intensive care unit (NICU) admission, respiratory distress syndrome (RDS), transient tachypnea of the newborn (TTN), hypoglycemia, mechanical ventilation, sepsis, length of stay ≥5 days, and neonatal death. A composite of maternal outcomes that included uterine rupture, blood transfusion, general anesthesia, cesarean hysterectomy, venous thromboembolism, maternal sepsis, intensive care unit admission, and surgical complications was also evaluated. There were 436 patients included in the analysis. Women who delivered at 36 weeks (n = 176) were compared those who delivered at 37 weeks (n = 260). There were no differences in baseline characteristics. Delivery at 37 weeks was associated with a reduction in composite neonatal morbidity (24 vs. 34%, adjusted odds ratio [aOR] = 0.61 [0.31-0.94]), including a decrease in NICU admission rates (20 vs. 29%, aOR = 0.63 [0.40-0.99]), hospitalization ≥5 days (13 vs. 24%, aOR = 0.48 [0.29-0.8]), and RDS or TTN (9 vs. 19%, aOR = 0.43 [0.24-0.77]). There was no difference in adverse maternal outcomes (7 vs. 7%, aOR = 0.98 [0.46-2.09]). Delivery at 37 weeks for women with a history of prior CCD is associated with a decrease in adverse neonatal outcomes, compared with delivery at 36 weeks. · Classical cesarean section may have increased risk of uterine rupture in future pregnancies.. · This study compares outcomes of delivery at 370/7 to 376/7 versus 360/7 to 366/7 weeks.. · Delivery at 370/7 to 376/7 weeks was associated with decreased neonatal morbidity..

Clinical profile and outcome of neonatal pneumothorax in resource-limited neonatal intensive care unit

Objective of study To determine the frequency, clinical profile, and outcome of pneumothoraxes in neonates in resource-limited neonatal intensive care unit (NICU) setting. Study design Prospective cohort. Place and duration of study The study was carried over a period of 4 years and 6 months at two NICUs of Combined Military Hospital (CMH) Multan (January 2011–August 2013) and CMH Abbottabad (September 2013–July 2015). Materials and methods All neonates fulfilling inclusion criteria were included in the study. Demographic and clinical parameters were recorded. All stable cases were initially managed on headbox oxygen, nasal oxygen, or improvised bubble continuous positive airway pressure devices (B-CPAP). In suspected cases, pneumothorax was confirmed on a portable chest X-Ray (CXR). Hemodynamically stable neonates were closely observed for spontaneous resolution whereas unstable neonates were managed by needle thoracocentesis or thoracostomy with or without ventilator support. End point of the study was either discharge or death of the neonate. Results Of a total of 1427 included neonates, 66 (4.6%) developed pneumothorax. Pneumothorax was more common in late pre-term and term infants with normal birth weight (>2.5 kg). Primary diseases leading to pneumothorax were respiratory distress syndrome (RDS) 38 (57.6%), meconium aspiration syndrome (MAS) 10 (15.2%), transient tachypnea of newborn (TTN) 9 (13.6%), birth asphyxia syndrome (BAS) 6 (9.1%), and pneumonia 3 (4.5%). Majority of the patients 58 (87.9%), required thoracostomy, 2 (3%) required only needle thoracocentesis while spontaneous resolution occurred in 6 (9.1%) patients. Out of 66 patients, 48 (72.7%) were discharged and 18 (27.3%) died. Average hospital stay was 10.5 ± 5.85 days. Conclusion Pneumothorax is not an uncommon complication in neonates presenting with respiratory distress in resource-limited NICUs. High index of suspicion is required for early recognition and timely management, as delay is associated with significant mortality.

Does Corticosteroids Administration after 37 Weeks for Elective Lower Segment Cesarean Section Reduce Neonatal Respiratory Morbidity? a Randomized Controlled Trial.

Background: Cesarean delivery is a known risk factor for neonatal respiratory complications, mostly transient tachypnea of the newborn (TTN) and respiratory distress syndrome (RDS) in infants at or near term. The current study aimed to assess the efficacy of steroids administered before performing term (37-39 weeks), elective caesarean section in reducing neonatal respiratory morbidity and. Methods: This is a randomized controlled study which was done on Benha University Hospital and Benha Teaching Hospital, Egypt. Four hundred cases were divided into two groups. Group A (Steroid Group): included 200 cases who received two intramuscular (IM) doses of 12 mg dexamethasone 12 hours apart, 24 hours before elective CS. Group B (Control Group): included 200 cases who received IM saline as a placebo in the same regimen as the steroid group. Results: There was no statistically significant difference between group A and group B regarding maternal age, BMI, gravidity, mean number of previous C.S. birth weight and gestational age. Mean value of Apgar scores at 1 and 5 minutes was statistically significant higher among group A than group B.TTN was statistically significant lower among group A than group B. Admission to NICU was statistically significant lower among group A than group B. There was statistically significant higher numbers of neonates in group A than in group B regarding neonatal need for CPAP. Conclusion : Prophylactic intramuscular injection of 12 mg dexamethasone 12 hours apart, 24 hours before elective CS at gestational age of 37 to 39 weeks can reduce neonatal respiratory morbidity

Prospective investigation of serial ultrasound for transient tachypnea of the newborn

Transient tachypnea of the newborn (TTN), which is diagnosed using typical clinical course and radiographic findings, is the most common cause of respiratory distress in late-preterm and term neonates. Lung ultrasound (LUS) is increasingly used to identify TTN according to the distinct characteristics of the disease. However, few studies have reported the application of LUS to monitor the clinical evolution of TTN. Using serial LUS, this prospective study assessed and monitored TTN severity. From November 2018 to October 2019, neonates ≥34 weeks of gestation admitted to the newborn center of Chang Gung Memorial Hospital were enrolled. Neonates diagnosed with TTN and requiring respiratory support comprised the TTN group (n=29), whereas those without respiratory disease served as the control group (n=23). LUS was performed and scored in both groups within 4h of admission and followed up at 24 and 48h. A total of 65 infants were screened for enrollment and 13 were excluded. Most of the enrollees in both groups exhibited a peak LUS score on the first day, which then gradually declined thereafter. In comparison with the control group, the LUS score of the TTN group was higher on day 1 and day 2, and it had a significantly greater decrease from day 1 to day 2. In the TTN group, LUS scores moderately correlated with respiratory severity scores. We conducted a serial and quantitative LUS investigation in late-preterm and term infants with TTN. The LUS score mirrored the respiratory status relatively well, and it can help to monitor the clinical course of TTN, in the case of either resolution or deterioration.

Association between Respiratory Morbidity and Labor in Pregnancies with Gestational Diabetes Mellitus.

This study aimed to the assess risk of respiratory morbidity in neonates born to women with gestational diabetes mellitus (GDM) delivered after labor compared with those delivered without exposure to labor. This is a secondary analysis of a prospective single-center cohort study of singleton pregnancies complicated by GDM. Neonates who were liveborn and delivered at ≥34 weeks' gestation were included. The primary outcome was respiratory morbidity defined as respiratory distress syndrome (RDS) or transient tachypnea of the newborn (TTN) resulting in neonatal intensive care unit (NICU) admission. Neonates born after labor (either spontaneous or induced) were compared with those delivered by cesarean delivery without labor. Associations between labor and neonatal morbidities were estimated using logistic regression. Covariates were adjusted for if they differed significantly between neonates exposed to and not exposed to labor (p < 0.05) and there was biologic plausibility that they would affect neonatal respiratory morbidity. Of the 581 neonates meeting study inclusion criteria, 23.2% delivered without exposure to labor. Those who did and did not experience labor delivered at similar gestational ages (38.6 vs. 38.4 weeks). Thirty-six neonates (6.2%) developed RDS or TTN and were admitted to the NICU. Exposure to labor was associated with a lower frequency of respiratory morbidity requiring admission to NICU, 4.9% (22/446) versus 10.4% (14/135) (p = 0.04). After adjusting for parity, body mass index, birth weight, gestational weight gain more than Institute of Medicine guidelines, race, and exposure to labor were associated with an adjusted odds ratio of 0.41 (95% confidence interval: 0.18-0.89). Exposure to labor was associated with decreased odds of respiratory morbidity in neonates born to mothers with GDM. Limiting elective cesarean in this population can reduce health care costs and optimize neonatal health. · Labor is associated with less respiratory morbidity.. · We should limit elective cesarean delivery with GDM.. · This approach could reduce health care costs..

Recent Advances in Pathophysiology and Management of Transient Tachypnea of Newborn.

Transient tachypnea of newborn (TTN) results from failure of the newborn to effectively clear the fetal lung fluid soon after birth. TTN represents the most common etiology of respiratory distress in term gestation newborns and sometimes requires admission to the neonatal intensive care unit. TTN can lead to maternal-infant separation, the need for respiratory support, extended unnecessary exposure to antibiotics and prolonged hospital stays. Recent evidence also suggests that TTN may be associated with wheezing syndromes later in childhood. New imaging modalities such as lung ultrasound can help in the diagnosis of TTN and early management with distending pressure using continuous positive airway pressure may prevent exacerbation of respiratory distress.

Comparison of Umbilical Cord Serum Vitamin D Levels between Infants with Transient Tachypnea of the Newborn and those without Respiratory Distress.

Transient tachypnea of the newborn (TTN) is one of the most frequent causes of respiratory distress in neonates. A relationship has been shown between vitamin D deficiency and respiratory disorders in neonates. This research was carried out to evaluate the serum level of vitamin D in TTN newborns and their mothers compared to the control group. This case-control research was conducted during 2016-2019 in a general hospital affiliated with Mashhad University of Medical Sciences, Iran. Thirty-four infants with TTN and 82 neonates in the control group as well as their mothers were investigated. The levels of umbilical cord serum vitamin D in infants with TTN and also their mothers were compared to the control group. The mean levels of serum vitamin D in infants with TTN and their mothers were 8.11 ± 4.32 and 12.6 ± 10.12 ng/mL, respectively (P<0.001), whereas they were 19.21 ± 12.71 and 25.96 ± 16.6 ng/mL in the newborns of the control group and their mothers, respectively (P<0.001). The mean differences (95% CI) of neonatal and maternal vitamin D level between the two groups were 11.10 (7.92-14.28) and 13.36 (7.90-18.08), respectively. In the TTN group, 100% of the infants had vitamin D levels less than 30 ng/mL (79.4% had severe, 17.6% had moderate and 2.9% showed mild deficiency). However, vitamin D levels lower than 30 ng/mL were observed in 76.4% of the neonates in the control group (28.8% had severe, 31.1% showed moderate and 16.3% had a mild deficiency) (P<0.001). The serum vitamin D levels of infants with TTN and their mothers were significantly lower than the control group. Therefore, TTN in infants may be reduced through the treatment of vitamin D deficiency in mothers.

The effects of inhaled β-adrenergic agonists in transient tachypnea of the newborn

Objective The objective of this study was to evaluate the efficacy of inhaled salbutamol for the treatment of transient tachypnea of the newborn (TTN). Background The most commonly reported cause of neonatal respiratory distress is TTN, with estimated incidence of 0.5–2.8% of all newborn. Patient and methods This is a randomized controlled trial study considering patient with even registration number as cases. Inhaled salbutamol or normal saline solution was administered to 60 infants diagnosed as having TTN. The response was evaluated by determining respiratory rate, heart rate, TTN clinical score, and level of respiratory support, before and at 30 min and 1 and 4 h after drugs therapy. The standard dose of salbutamol was 0.15 mg/kg added to 2 ml normal saline. The second group received dose of 2 ml nebulized (0.9%) normal saline only. Results The studied neonates were between 36 and 39 weeks of gestation. There were 30 (50%) males and 30 (50%) females. Comparing the two groups after 4 h of inhaled therapy, highly significant lower respiratory rate, oxygen, TTN score, respiratory support, and duration of hospitalization were detected in salbutamol group rather than saline group. Regarding arterial blood gas findings after 4 h of inhaled therapy, pH and partial pressure of arterial oxygen were significantly higher in salbutamol group than saline group. No significant difference was detected between the two groups regarding heart rate and serum potassium. Conclusion A single dose of inhaled salbutamol resulted in better clinical aspect and better laboratory outcome measures in cases of TTN.

THE CORRELATION BETWEEN THE DURATION OF FETAL EXTRACTION DURING ELECTIVE CESAREAN SECTION AND DEVELOPMENT OF TRANSIENT TACHYPNEA OF THE NEWBORN

Background: A cesarean section (C.S) is usually performed when a vaginal delivery would put the baby's or mother's life or health at risk. Delivery by cesarean section is one of the major risk factors for transient tachypnea of the new born (TTN). Objective: The current study was designed to assess the relation between the duration of fetal extraction during cesarean section and Apgar score. Patients and methods: Fifty pregnant women were included in the study fulfilling the inclusion and exclusion criteria. Time from incision of skin till clamping of the cord and time from incision of the uterus till clamping of the cord were recorded. Apgar score at 1 and at 5minutes, respiratory rate and weight of neonate were reported and the occurrence of TTN among the studied neonates. Results: No correlation between the duration of fetal extraction and Apgar score recorded at 5 minutes. It was noticed that absence of significant correlation between TTN development and history of previous cesarean section, there is no significant relation between BMI and development of TTN. It was noticed that absence of significant correlation between the time from incision of skin till clamping of the cord (S-C interval) and the development of TTN Also there is no statically significant correlation between development of TTN and between the time from incision of uterus till clamping of the cord (U-C interval). Conclusion: No correlation between the duration of fetal extraction during cesarean section and development of transient tachypnea of the newborn.

THE CORRELATION BETWEEN THE DURATION OF FETAL EXTRACTION DURING ELECTIVE CESAREAN SECTION AND DEVELOPMENT OF TRANSIENT TACHYPNEA OF THE NEWBORN

Background: A cesarean section (C.S) is usually performed when a vaginal delivery would put the baby's or mother's life or health at risk. Delivery by cesarean section is one of the major risk factors for transient tachypnea of the new born (TTN). Objective: The current study was designed to assess the relation between the duration of fetal extraction during cesarean section and Apgar score. Patients and methods: Fifty pregnant women were included in the study fulfilling the inclusion and exclusion criteria. Time from incision of skin till clamping of the cord and time from incision of the uterus till clamping of the cord were recorded. Apgar score at 1 and at 5minutes, respiratory rate and weight of neonate were reported and the occurrence of TTN among the studied neonates. Results: No correlation between the duration of fetal extraction and Apgar score recorded at 5 minutes. It was noticed that absence of significant correlation between TTN development and history of previous cesarean section, there is no significant relation between BMI and development of TTN. It was noticed that absence of significant correlation between the time from incision of skin till clamping of the cord (S-C interval) and the development of TTN Also there is no statically significant correlation between development of TTN and between the time from incision of uterus till clamping of the cord (U-C interval). Conclusion: No correlation between the duration of fetal extraction during cesarean section and development of transient tachypnea of the newborn.

Early Morbidities and Mortality among SGA and AGA Preterm Neonates in South India

Introduction: Pre-term birth is the main determinant of neonatal morbidity and mortality with long-term adverse health consequences. Infants born pre-term compared to term infants experience more difficulty with temperature instability, feeding intolerance, blood glucose regulation, jaundice, apnea, respiratory distress (RDS) and sepsis. Aim: To study the early neonatal morbidities of all pre-term neonates admitted in NICU and to know the immediate outcome during their stay. Also to compare rate of early morbidities and mortality among SGA and AGA pre-term neonates. Material and methods: It’s a prospective observational study carried out in a NICU of a Medical college in South India, for a period of 18 months. Preterm babies (less than 37 weeks gestation using Modified Ballard score) divided into SGA and AGA using growth charts. Total 100 preterm babies included of which SGA and AGA were 50 each. Neonates with TTN (Transient Tachypnea of the Newborn), Birth asphyxia, Neonatal sepsis, Hypoglycemia, Hypothermia, Neonatal hyperbilirubinemia, Respiratory insufficiency, Feed intolerance were included in present study. Results: Hyperbilirubinemia constituted 61% of morbidities, among which 47.5% are AGA neonates and 52.5% are SGA neonates. 24 newborns presented with sepsis, 15 newborns with feed intolerance. 80 newborns had hypoxia at admission. RDS was commonly seen in AGA neonates when compared to SGA neonates. 6 babies among AGA and 8 among SGA had mortality. One baby was discharged AGAinst medical advice. Conclusion: Most common morbidities among the SGA neonates were sepsis, hyperbilirubinemia, feed intolerance, hypoglycemia, Apnea, PDA, hypoxia. AGA neonates had metabolic disorders and RDS.

A Comparative Trial of the Effectiveness of Nasal Interfaces Used to Deliver Continuous Positive Airway Pressure for a Brief Period in Infants With Transient Tachypnea of the Newborn

IntroductionThere is insufficient data on the effectiveness of the interfaces used for nasal continuous airway pressure (nCPAP) in newborn infants. Transpulmonary pressure (PTP) calculated from a measured esophageal pressure (Pes) could be used as a surrogate for the pressure transmitted to the distal airways during nCPAP. We aimed to compare the effectiveness of two nasal interfaces, the nasal mask and bi-nasal short prongs, during a relatively brief period of respiratory support by calculated PTP (cPTP) in infants with transient tachypnea of the newborn (TTN). MethodsNewborns with TTN who needed respiratory assistance with nCPAP were randomized to use either bi-nasal short prongs or a nasal mask. Esophageal pressure measurements were done in order to calculate PTP with either interface. The primary outcome was the cPTP transmitted with each nasal interface. Esophageal pressure measurements were recorded and PTP values were calculated from Pes measurements at the 1st, 6th, 12th and 24th hours in each patient as long as the respiratory support lasted. ResultsSixty-two newborns with TTN and on nCPAP were randomized into two groups: Group 1 to use bi-nasal short prongs (n: 31) and Group 2 to use a nasal mask (n: 31). Inspiratory and expiratory Pes and cPTP values at the 1st, 6th, 12th and 24th hours were similar with the two interfaces (P<.05). ConclusionsA nasal mask is similarly effective and safe as bi-nasal short prongs during a brief period of non-invasive respiratory support with nCPAP in late preterm and term neonates with TTN.

The impact of cesarean section on neonatal outcomes at a university-based tertiary hospital in Jordan

BackgroundOver the past two decades, there has been a steady rise in the rate of Cesarean section delivery globally. As a result, short-term and long-term maternal and neonatal complications are rising. The objective of this study is to determine the rate and indications for Cesarean section at King Abdullah University Hospital (KAUH) in Jordan and to assess the resulting neonatal outcomes.MethodsA retrospective chart review was conducted for all women and neonates delivered by Cesarean section during the period January 2016 to July 2017 at KAUH tertiary academic center. Collected data include demographic characteristics, indication for delivery, and neonatal outcomes such as NICU admission, respiratory complications, sepsis, mortality, and length of hospitalization.ResultsTwo thousand five hundred ninety-five Cesarean section deliveries were performed over 18 months representing a rate of 50.5% of all deliveries. Sixty percent were scheduled procedures. Seventy-two percent were performed at full term gestation. The most common indication was previously scarred uterus (42.8%) followed by fetal distress (15.5%). The rate of admission to the neonatal ICU was 30% (800/2595). After multilogistic conditional regression analysis, the factors associated with increased risk of neonatal ICU admission were found to include grandmultiparity (Adjusted OR 1.46), gestational diabetes (Adjusted OR 1.92), maternal employment (Adjusted OR 1.84), prolonged rupture of membranes (Adjusted OR 5), fetal distress (Adjusted OR 1.84), prematurity (Adjusted OR 43.78), low birth weight (Adjusted OR 42), high order multiple gestation (Adjusted OR 9.58) and low 5-min APGAR score (Adjusted OR 10). Among the babies electively delivered at early term (37–38.6 weeks), 16% were admitted to the NICU for a median length of stay of 4 days (IQR 2, 8). The most common diagnoses for admitted term neonates were transient tachypnea of newborns and respiratory distress syndrome.ConclusionsCS deliveries account for more than half the number of deliveries at our institution and almost one third of the delivered babies are admitted to the NICU. Together with the resulting maternal and neonatal consequences, this carries a major burden on the newborns, health care facilities, and involved families. Local strategies and policies should be established and implemented to improve the outcome of births.

Non-invasive respiratory support for the management of transient tachypnea of the newborn.

Transient tachypnea of the newborn (TTN) is characterized by tachypnea and signs of respiratory distress. Transient tachypnea typically appears within the first two hours of life in term and late preterm newborns. Supportive management might be sufficient. Non-invasive (i.e. without endotracheal intubation) respiratory support may, however, be administered to reduce respiratory distress during TTN. In addition,non-invasive respiratorysupport might improve clearance of lung liquid thus reducing the effort required to breathe, improving respiratory distress and potentially reducingthe duration of tachypnea. To assess benefits and harms of non-invasive respiratory support for the management of transient tachypnea of the newborn. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 2), MEDLINE (1996 to 19 February 2019), Embase (1980 to 19 February 2019) and CINAHL (1982 to 19 February 2019). We applied no language restrictions. We searched clinical trial registries for ongoing studies. Randomized controlled trials, quasi-randomized controlled trials and cluster trials on non-invasive respiratory support provided to infants born at 34 weeks' gestational age or more and less than three days of age with transient tachypnea of the newborn. For each of the included trials, two review authors independently extracted data (e.g. number of participants, birth weight, gestational age, duration of oxygen therapy, need for continuous positive airway pressure [CPAP] and need for mechanical ventilation, duration of mechanical ventilation, etc.) and assessed the risk of bias (e.g. adequacy of randomization, blinding, completeness of follow-up). The primary outcomes considered in this review were need for mechanical ventilation and pneumothorax. We used the GRADE approach to assess the certainty of evidence. We includedthree trials (150 infants) comparing either CPAP to free-flow oxygen, nasal intermittent mandatory ventilation to nasal CPAP,or nasal high-frequency percussive ventilation versus nasal CPAP. Due to these different comparisons and to high clinical heterogeneity in the baseline clinical characteristics, we did not pool the three studies.The use of CPAP versus free oxygen did not improvethe primary outcomes of this review: need for mechanical ventilation (risk ratio [RR]0.30, 95% confidence interval [CI] 0.01 to 6.99; 1 study, 64 participants); and pneumothorax (not estimable, no cases occurred). Among secondary outcomes, CPAP reduced the duration of tachypnea as compared to free oxygen (mean difference [MD] -21.10 hours, 95% CI -22.92 to -19.28; 1 study, 64 participants).Nasal intermittent ventilation did not reduce the need for mechanical ventilation as compared with CPAP (RR 4.00, 95% CI 0.49 to 32.72; 1 study, 40 participants) or the incidence of pneumothorax (RR 1.00, 95% CI 0.07 to 14.90; 1 study, 40 participants); duration of tachypnea did not differ (MD 4.30, 95% CI -19.14 to 27.74;1 study, 40 participants). In the study comparing nasal high-frequency ventilation to CPAP, no cases of mechanical ventilation of pneumothorax occurred (not estimable; 1 study, 46 participants); duration of tachypnea was reduced in thenasal high-frequency ventilation group (MD -4.53, 95% CI -5.64 to -3.42;1 study, 46 participants).The quality of the evidence was very low due to the imprecision of the estimates and unclear risk of bias for detection bias and high risk of bias for reporting bias.Tests for heterogeneity were not applicable for any of the analyses as no studieswerepooled. Two trials areongoing. There is insufficient evidence to establish the benefit and harms of non-invasive respiratory supportin the management of transient tachypnea of the newborn. Though twoof the included trials showed a shorter duration oftachypnea, clinically relevant outcomes did not differ amongst the groups. Given the limited and low quality of the evidence available, it was impossible to determine whether non-invasive respiratory support was safe or effective for the treatment of transient tachypnea of the newborn.