Transient Tachypnea of the Newborn (TTN)
Some newborns have very fast or labored breathing in the first few hours of life because of a lung condition called transient tachypnea of the newborn (TTN).
Babies with TTN will be closely watched in the hospital and some might need extra oxygen for a few days. Most babies make a full recovery. TTN usually does not have any lasting effects on a child's growth or development.
While inside the mother, a developing fetus does not use the lungs to breathe — all oxygen comes from the blood vessels of the placenta. During this time, the baby's lungs are filled with fluid.
As the baby's due date nears, the lungs begin to absorb the fluid. Some fluid also may be squeezed out during birth as the baby passes through the birth canal. After delivery, as a newborn takes those first breaths, the lungs fill with air and more fluid is pushed out. Any remaining fluid is then coughed out or slowly absorbed through the bloodstream and lymphatic system.
In babies with TTN, though, extra fluid stays in the lungs or is cleared out too slowly. This makes it harder for a baby to breathe in oxygen properly. As a result, the baby must breathe faster and harder to get enough oxygen into the lungs.
Causes of TTN
Transient tachypnea of the newborn is often diagnosed in the first few hours after a baby is born. Transient means it does not last long (usually, less than 24 hours) and tachypnea refers to the baby's very fast breathing (more than 60 breaths per minute).
TTN can happen in babies of all ages, but is more common in:
- preemies because their lungs are not fully developed
- babies born via rapid vaginal deliveries or C-sections without labor. They don't undergo the usual hormonal changes of labor, so their lungs don't have time to absorb much fluid.
- babies whose mothers have asthma or diabetes
Signs and Symptoms of TTN
Symptoms of TTN include:
- very fast, labored breathing of more than 60 breaths a minute
- grunting or moaning sounds when the baby breathes out (exhales)
- flaring nostrils or head bobbing
- skin pulling in between the ribs or under the ribcage with each breath (known as retractions)
- bluish skin around the mouth and nose (this is called cyanosis)
To diagnose a baby with TTN, the doctor will do a physical examination, and also might order one or all of the following:
Chest X-ray. In a baby with TTN, an X-ray of the lungs will appear streaky and fluid may be seen. The X-ray will otherwise appear normal.
Pulse-oximetry monitoring. This sort of monitoring can tell doctors how well the lungs are sending oxygen to the blood. A small piece of tape with an oxygen sensor is placed around a baby's foot or hand, then connected to a monitor. Sometimes oxygen levels are checked with a blood test. If oxygen levels are low, extra oxygen may be given to the baby.
Complete blood count (CBC). Blood may be drawn from one of the baby's veins or a heel to check for signs of infection.
Babies with TTN are watched closely. Doctors check their heart rate, breathing rate, and oxygen levels to make sure breathing slows down and the oxygen level is normal. Sometimes, babies are admitted to the neonatal intensive care unit (NICU) for extra care.
Some babies with TTN need extra oxygen. They get this through a small tube under the nose called a nasal cannula.
A baby who gets extra oxygen but still struggles to breathe might need continuous positive airway pressure (CPAP) to keep air flowing through the lungs. With CPAP, a baby wears a special nasal cannula or a mask around the nose while a machine continuously pushes a stream of pressurized air into the nose to help keep the lungs open during breathing. Rarely, a baby will need support with a ventilator (a machine that pumps air in and out of the lungs).
Nutrition can be a problem when a baby is breathing so fast that he or she can't suck, swallow, and breathe at the same time. In that case, intravenous (IV) fluids will keep the baby hydrated while preventing blood sugar from dipping too low.
If your baby has TTN and you want to breastfeed, talk to your doctor or a nurse about maintaining your milk supply by using a breast pump while your newborn receives IV fluids. Sometimes babies can take breast milk or formula through a nasogastric (NG) or orogastric (OG) tube — a tube placed through the nose or mouth to deliver food directly to the stomach. If your baby has one of these tubes, ask the doctor about providing breast milk for your baby.
Symptoms of TTN usually improve within 24 to 72 hours. A baby can be sent home from the hospital once the breathing is normal and he or she has been feeding well for at least 24 hours.
Bringing Your Baby Home
Babies with TTN usually recover fully. But even after TTN goes away, watch for signs of breathing problems and call your doctor right away if you see any.
Call 911 if your baby:
- has trouble breathing
- breathes rapidly
- has skin that looks blue
- has skin in between the ribs or under the ribcage that pulls in during breathing