Recent News and Articles on the Keywords: newborn + ttn + tachypnea  Related to the article below (Last Update: 12/1/2008)

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Recent News and Articles on the Keywords: ttn + newborn + tachypnea  Related to the article below (Last Update: 8/7/2008)

Transient Tachypnea of the Newborn (TTN)

After you endure labor and delivery, the first few cries of your newborn are a sweet reward that indicates your baby is healthy and strong. After all, a hearty yell means your infant was born with a healthy set of lungs, right?

But some newborns may experience breathing and lung function problems immediately after birth. Most of the time, these babies recover quickly and uneventfully, especially if they are full term. But others continue to have breathing complications that are more serious and require a longer course of treatment and intensive care.

Although persistent pulmonary hypertension of the newborn (PPHN) isn't common, it can seriously compromise a newborn's health and have long-term complications. Fortunately, better understanding of newborn lung function and technology has improved the outcome for infants affected by this serious condition. Keep reading to learn more about causes and treatment of PPHN.

What Is Persistent Pulmonary Hypertension of the Newborn?
In the womb, the pathway of your baby's blood circulation is different than it is after birth.

In the uterus, a baby's circulation bypasses the lungs. The lungs are not needed to exchange oxygen because the placenta (the organ that nourishes and protects your developing baby) supplies the baby with oxygen through the umbilical cord. The pulmonary artery - which, after birth, will carry blood from the heart to the lungs - instead sends blood directly back to the heart through a fetal blood vessel called the ductus arteriosus.

Normally, when a baby is born and begins to breathe air, his circulatory system quickly adapts to the outside world. The pressure in the lungs changes as air enters and inflates the lungs. As a result, the ductus arteriosus, which previously supplied the fetal heart with blood, permanently closes. Blood returning to the heart from the body can now be pumped into the lungs, where oxygen and carbon dioxide are exchanged. The blood is then returned to the heart and pumped back out to the body in an oxygen-rich state.

In a baby with PPHN, however, the fetal circulatory system doesn't "switch over." The ductus arteriosus remains open, and the baby's blood flow continues to bypass the lungs. Even though the baby is breathing, oxygen in the breathed air will not reach the bloodstream. Because the blood returning from the body is unable to enter the lungs properly - and instead flows through the still- open ductus arteriosus - it returns to the heart in an oxygen-poor state. This condition is known as persistent fetal circulation, or PFC. "The baby's circulation has not made the normal transition from fetal circulation to normal newborn circulation, because pressure in the lungs is increased and this causes distress," says Neal Cohn, MD, a pediatrician. Depending on the degree of PPHN causing the persistent fetal circulation, the oxygen in the air your baby breathes into his lungs is not adequately picked up and carried by the blood to other areas of the body that need it (such as the brain, kidneys, liver, and other organs). These organs soon become stressed from lack of oxygen.

PPHN sometimes develops as the result of another event during delivery or from a disease or congenital condition affecting the newborn (usually one that either directly affects the lungs or oxygen supply to the baby before or during birth). Often, however, PPHN occurs as an isolated condition, and its cause is not known. It is usually seen soon after birth, often within 12 hours after birth. PPHN occurs in approximately one in 700 births.

What Causes PPHN?
In an otherwise healthy newborn, the cause of PPHN is usually unknown. Some researchers believe that stress while the baby is in the uterus (associated with certain pregnancy complications, such as maternal diabetes, high blood pressure or anemia, or delivery after 40 weeks) may increase the risk of developing PPHN.

PPHN may occur with certain diseases or congenital conditions of the infant that affect the lungs in some way. Meconium aspiration syndrome, anemia, severe pneumonia, infection, hypoglycemia (low blood sugar), and birth asphyxia (when the baby is deprived of oxygen during a complicated delivery) have all been associated with PPHN.

These conditions may cause the pressure in the blood vessels leading to the lungs to increase to the point where the baby's blood continues to bypass the lungs after birth, resulting in PFC. These conditions are often temporary and reversible, with intensive care and time for the lungs and body to heal. Certain congenital conditions that result in immature or incomplete lung development (such as diaphragmatic hernia) may also be associated with PPHN.

Signs and Symptoms>
The following signs and symptoms may indicate a baby has PPHN:

• rapid breathing (also called tachypnea)
• rapid heart rate
• respiratory distress, including signs such as flaring nostrils and grunting
• cyanosis (when the skin has a bluish tinge), even while the baby is receiving extra oxygen to breathe

Sometimes when examining a baby with PPHN, the doctor will hear a heart murmur (an extra or abnormal heart sound). With PPHN, a baby may also continue to have low oxygen levels in the blood while receiving 100% oxygen.

How Is TTN Diagnosed?

Because TTN has symptoms that are initially similar to more severe newborn respiratory problems such as pneumonia or persistent pulmonary hypertension, doctors usually use chest X-rays in addition to physical examination to make a diagnosis. Doctors may also use other indicators to make a diagnosis of TTN:

• If an infant has TTN, the X-ray picture of the lungs will appear streaked, and fluid will usually be seen. The X-ray will otherwise appear fairly normal.
• Pulse-oximetry monitoring, which is when a small piece of tape containing an oxygen sensor is placed around a baby's foot or toe and connected to a monitor, can aid in diagnosis. This tells doctors how well the lungs are sending oxygen to the blood and is also useful in monitoring TTN.
• A complete blood count (CBC) may also be drawn from one of the baby's veins or the heel to check for signs of infection.

How Is TTN Treated?

As with any newborn who has a breathing problem, infants diagnosed with TTN are closely observed and monitored. Sometimes they'll be admitted to the neonatal intensive care unit (NICU) for extra care. The babies are typically attached to monitors so that heart rate, breathing rate, and oxygen levels can be closely watched.

Some babies with TTN are simply monitored to ensure that their breathing rates slow down and their oxygen levels remain normal. Sometimes they may need to receive extra oxygen through a mask or under a plastic oxygen hood (called a "headbox").

If a baby struggles to breathe in oxygen, even while under an oxygen hood, continuous positive airway pressure (CPAP) is sometimes used to keep air flowing through the lungs. With CPAP, a baby wears a special oxygen cannula (a type of tubing that is placed directly into the baby's nose) and a machine continuously pushes a stream of pressurized air into the baby's nose to help keep the lungs open as he or she breathes.

In the most severe cases of TTN, a baby would need ventilator support, but this is rare.

Nutrition can be a problem if an infant is breathing so fast that he or she can't suck, swallow, and breathe simultaneously. Intravenous (IV) fluids provide hydration and will prevent the infant's blood sugar from dipping to dangerously-low levels. If your baby has TTN and you want to breast-feed, talk to your doctor or a nurse about maintaining your milk supply by using a breast pump while your infant receives IV fluids.

Within 24 to 48 hours, the breathing in infants with TTN typically improves and returns to normal, and within 72 hours, all symptoms of TTN typically dissipate altogether.

If fluid persists in a baby's lung beyond that time, than doctors will likely look into other medical problems which may be causing the condition.

Bringing Your Baby Home

After babies with TTN receive special monitoring and treatment in the hospital, they usually recover fully and are at no increased risk for other respiratory conditions, or other health problems.

Even though you won't have to worry about TTN after the third day of life, it's a good idea to stay aware of the signs of respiratory distress so you can call your child's doctor if you suspect a problem. If your baby has trouble breathing, appears blue, or if the skin pulls in between the ribs or under the ribcage during rapid or labored breathing, it's important to call your child's doctor or emergency services (911) right away.