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Original Question

A 28-year-old mother gave birth to a 2.8 kg female by cesarean section at 36 weeks’ gestation. Apgar scores were 6 at 1 minute and 9 at 5 minutes. The baby developed tachypnea with a respiratory rate of 93 breaths per minute soon after birth and had moderate work of breathing with mild nasal flaring and retractions. The patient was placed on 1 L/min of oxygen by nasal cannula and was transferred to the neonatal intensive care unit. The assessment revealed: heart rate 158 beats per minute; respiratory rate 80 breaths per minute; blood pressure 65/45 mm Hg. The infant was well perfused and breath sounds were clear to auscultation. The remainder of the exam was unremarkable. A chest radiograph was obtained which revealed normal lung expansion, fluid in the horizontal fissures and increased pulmonary vascularity. Differential diagnosis of transient tachypnea of the newborn was made. Over the next 24 hours the infant’s respi-ratory status worsened. Supplemental oxygen by high-flow nasal cannula was initiated at an FiO2 of 40% to maintain oxygen saturations >92%. By day 3 the patient’s status improved, a high-flow nasal cannula therapy was ordered. Within 6 hours the infant did not require any additional oxygen support. Vital signs were as follows: heart rate 145 beats per minute; respiratory rate 50 breaths per minute; blood pressure 60/40 mm Hg; and oxygen saturation >95% on room air. There were no further complications with respiratory function, and the patient was discharge to go home. 1. How can differential diagnosis of transient tachypnea of the newborn be confirmed? 2. How soon does TTN present after birth? 3. What are the typical clinical symptoms that present in the newborn? 4. What are possible predictors of TTN?

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