Risk factors for development of transient tachypnea of newborns

Abstract

Background: Transient tachypnea of the newborn (TTN) is a frequently encountered form of neonatal respiratory distress. The underlying mechanism involves residual lung fluid that is delayed in clearance. TTN primarily occurs soon after birth and can last from 24 to 72 hours. Risk factors for TTN include elective cesarean section, male sex, late prematurity, low birth weight, macrosomia, polycythemia, maternal asthma and maternal diabetes. Treatment is often supportive with observation and potential oxygen supplementation. Objective: To identify the risk factors associated with development of transient tachypnea of newborns who were delivered either normally or through cesarean section, at 36 weeks or beyound and to compare the results with those of others. Patients and methods: This is a case-control study of 200 newborns suffering from respiratory distress during a period from the 1 st of September 2011 to the 1 st of September 2013 in the neonatal intensive care unit at AL-Kansaa Teaching hospital in Mosul. The perinatal history of newborns was analyzed. TTN was diagnosed on clinical basis and by exclusion of other diseases affecting the respiratory system including sepsis. The study included 200 healthy newborns as control. Results: Multivariate analysis identified that the development of TTN was significantly associated with elective cesarean section 56% (p-value=0.001), male sex 66.5% (p-value=0.001), late prematurity 21% (p-value=0.009), maternal diabetes 8% (P-value=0.014), maternal asthma 10.5% (p-value=0.01), birth asphyxia (low APGAR score) 9.5% (p-value=0.005), low birth weight 16.5% (p-value=0.003), prolonged labor or using (forceps or vacuum) 22% (p-value=0.037) and in vitro fertilization 2.5% (p-value =0.024). Conclusion: Transient tachypnea of newborns is strongly related to elective cesarean section, male sex, late prematurity, maternal diabetes, maternal asthma, birth asphyxia, low birth weight (1500-2500g), prolonged labor or using forceps or vacuum and in vitro fertilization.

Respiratory Distress and Its Outcome among Neonates Admitted to Neonatal Intensive Care Unit of Mukalla Maternity and Child Hospital, Yemen

“…This is in agreement with the results of other studies [26,27]. It was also observed that full term was significantly higher in TTN, which is consistent with other results [6,26]. Birth asphyxia constituted 35(14%) of the total respiratory distress cases in our study.…”

“…In the current study, it was observed that male gender was significantly higher in TTN (59.6% versus 40.4% for female, p=0.03). This is in agreement with the results of other studies [26,27]. It was also observed that full term was significantly higher in TTN, which is consistent with other results [6,26].…”

“…In the current study, it was observed that cesarean delivery was significantly higher in TTN (57.4% versus 42.6% for babies with normal vaginal delivery, p=0.02). This is consistent with previously reported findings [7,26]. These have been attributed to delayed or abnormal fetal lung fluid clearance due to the absence of the hormonal changes that accompany spontaneous labor [27].…”

“…Transient tachypnea of newborn is believed to be secondary to slow absorption of fetal lung fluid, resulting in decreased pulmonary compliance and tidal volume and increased dead space [13]. It was also observed that prolonged labor was significantly higher in TTN (53.2% versus 46.8% for babies with normal labor, p=0.006), which is consistent with other results [26,27,28]. Prolonged labor may cause dysfunctional catecholamine regulation, mild pulmonary capillary leak and myocardial dysfunction [28].…”