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The Neonate
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Laura De Angelis, Luca Ramenghi
Transient tachypnea of the newborn (TTN) is a benign, self-limiting condition affecting term or near-term infants soon after birth, and it is characterized by the development of tachypnea (60–120 breaths per minute) associated with other signs of mild to moderate respiratory distress, including nasal flaring, grunting, and retractions. Risk factors for TTN include cesarean delivery, precipitous delivery, fetal polycythemia, and maternal diabetes. This condition is caused by a delayed resorption of fetal lung fluid. Oxygen administration and support therapy are usually enough to resolve this condition, but severe cases may require continuous positive airway pressure (CPAP). If the infant’s condition does not quickly resolve, other diagnoses should be ruled out, including early-onset sepsis, pulmonary hypertension, congenital heart disease, pneumonia, pneumothorax, central hyperventilation, and congenital malformations.
Radiology of Interstitial Lung Disease in Children
Published in Lourdes R. Laraya-Cuasay, Walter T. Hughes, Interstitial Lung Diseases in Children, 2019
Fredric A. Hoffer, John A. Kirkpatrick
Transient tachypnea of the newborn, which has also been termed “wet lung syndrome”, is usually 24 to 48 hr in duration and is encountered in full-term infants. The radiographic pattern (Figure 11) is characterized by prominence of the interstitial spaces of the lung, suggesting increased pulmonary arterial vascularity. Lymphatic engorgement as well as edema in the interstitium probably compresses the airways to cause air trapping and hyperinflation. In addition, there is often fluid related to the major fissures, consistent with dilated lymphatics, subpleural edema and/or pleural effusion. This disorder is most likely the result of a delay in the absorption of fetal fluid which was in the alveoli in the newborn infant prior to delivery. Some of this fluid is expressed during a normal vaginal delivery, and the remaining is removed by the lymphatics; therefore, it is seen most frequently in those born by Caesarian section. Usually, it can be distinguished from cardiac lesions associated with increased pulmonary arterial blood flow or pulmonary edema by echocardiography.
Pharmacology and Toxicology of Loop Diuretics in Pediatrics
Published in Sam Kacew, Drug Toxicity and Metabolism in Pediatrics, 1990
Disturbances in fluid balance can result in pathologic increases in fluid volume leading to edema and congestion. In neonatology a primary site for fluid accumulation is the lungs with a consequential development of pulmonary edema and congestive heart failure. Various factors can facilitate the accumulation of fluids in pulmonary tissue (Table 1). In association with pulmonary edema, there is an impairment in lung functions as outlined in Table 2. Pulmonary edema and lymphangiectasis are characteristic pathological alterations believed to play a role in the early stages of infant respiratory distress syndrome (RDS).25,26 In addition the presence of a patent ductus arteriosus (PDA) was found to contribute to the development of RDS.27 It has been suggested that a common sequela to RDS is the development of chronic lung disease or bronchopulmonary dysplasia (BPD).28 Pulmonary edema has also been implicated in the disease transient tachypnea of the newborn (TTNB).1 Clearly, there are a number of neonatal diseases associated with fluid imbalance which provide a basis for the therapeutic use of diuretics.
The association between early life antibiotic use and allergic disease in young children: recent insights and their implications
Published in Expert Review of Clinical Immunology, 2018
Chinwe V. Obiakor, Hein M. Tun, Sarah L. Bridgman, Marie-Claire Arrieta, Anita L. Kozyrskyj
Preexisting infection may be another example of confounding by indication for associations with infant antibiotic treatment, as infection during infancy may lead to asthma development. The Sobko et al. [49] study of neonatal antibiotics implemented a design feature to adjust for neonatal infection, the testing of antibiotic regimens for suspected but not confirmed sepsis. As noted, this study documented a borderline association between antibiotic treatment ‘to rule out sepsis’ and childhood asthma, but it was of a stronger magnitude than that for confirmed sepsis following adjustment for multiple perinatal factors [49]. Another newborn condition of full-term infants, which is frequently treated with antibiotics but may not involve infection, is transient tachypnea of the newborn (TTN). Several studies have reported associations between TTN and future asthma [54,55]. However, the prevalence of TTN is much lower than that for childhood asthma and the presence of respiratory symptoms may also be a sign of subsequent respiratory illness. Infection may commence in utero. In their study of early life exposures in a US cohort born between 1995 and 2003 [45], Wu et al. found the greatest association between child asthma and multiple courses of antibiotics (eight or more) to be in the subgroup of infants who were delivered by CS following repeated urinary tract infection in pregnancy. This association was further increased in the absence of siblings at home (aOR = 7.77; 95% CI: 6.25–9.65).
Correlations of Enzyme Levels at Birth in Stressed Neonates with Short-Term Outcomes
Published in Fetal and Pediatric Pathology, 2018
Junya Nakajima, Norito Tsutsumi, Shonosuke Nara, Hiroki Ishii, Yusuke Suganami, Daisuke Sunohara, Hisashi Kawashima
Transient tachypnea of the newborn (TTN) and meconium aspiration syndrome (MAS) were diagnosed based on risk factors (i.e. meconium staining of amniotic fluid, premature rupture of membranes, and maternal infection) and characteristic chest X-ray findings. Perinatal asphyxia was diagnosed according to perinatal data (e.g., birth following placental abruption or fetal distress) and exclusion of other disorders such as TTN and MAS. At our institution, venous blood samples of either patients born at our institution or at other hospitals are routinely collected at the time of admission to the NICU, not in delivery rooms. Venous blood gas analysis, complete blood count, and blood chemistries, including the intracellular enzymes listed below, are drawn routinely. We collected patient background data, gestational age, birth weight, method of delivery, Apgar scores at 1 and 5 mins, and the duration between birth and the time of blood sampling. We recorded pH, base deficit, and levels of lactate, AST, ALT, LDH, and CK at the time of admission. We evaluated pH, base deficit, and lactate using the ABL800 FLEX (Radiometer, Copenhagen, Denmark), and AST, ALT, LDH, and CK using the VITROS5600 (Johnson and Johnson, New Jersey, USA) and LABOSPECT008 (Hitachi High-Technologies Corporation, Tokyo, Japan), according to manufacturer's instructions. The reference ranges for each parameter shown in the Tables were according to Japanese standards for healthy newborn infants (11).