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Objective To evaluate surfactant production and function in term neonates with transient tachypnea of the newborn (TTN). Study design Samples of gastric aspirates collected within 30 minutes of birth from 42 term newborns with gestational age ≥37 weeks (21 patients with TTN and 21 control subjects), delivered via elective cesarean delivery, were analyzed with lamellar body count and stable microbubble test. Results Results of lamellar body counts and stable microbubble tests were significantly lower in the TTN group than in control subjects ( P = .004 and .013, respectively). Lamellar body counts were significantly lower in infants with TTN requiring oxygen for ≥24 hours after birth than in infants requiring oxygen for P = .029). When the cutoff point was 48 hours, the stable microbubble count was significantly lower in the group requiring oxygen for ≥48 hours than in the group requiring oxygen for P = .047). Conclusions Term infants with TTN had low lamellar body counts associated with decreased surfactant function, suggesting that prolonged disease is associated with surfactant abnormalities.

Transient tachypnea of newborn is associated with hypothyroxinemia in animals via decreased stimulation of beta-adrenergic receptors and Na-K-ATPase activity. In 26 549 term neonates, serum total thyroxine 14 ug/dL, male sex, and elective cesarean delivery were significantly associated with greater risk for transient tachypnea of newborn.

To evaluate the efficacy of inhaled salbutamol, a beta-2 adrenergic agonist, for the treatment of transient tachypnea of the newborn (TTN) and to determine whether inhaled salbutamol is safe in newborn infants.Inhaled salbutamol or normal saline solution was administered to 54 infants with gestational ages ranging from 34 to 39 weeks and TTN. The response to salbutamol therapy was evaluated by determining respiratory rate, clinical score of TTN, level of respiratory support, and fraction of inspired oxygen before and at 30 minutes and 1 and 4 hours after salbutamol nebulization.Among the 54 infants with TTN, 32 received salbutamol and 22 received normal saline solution. After one dose, the salbutamol group showed significant improvements in respiratory rate, clinical score of TTN, fraction of inspired oxygen, and level of respiratory support (P.05). After treatment, the mean pH, partial pressure of arterial oxygen, and partial pressure of arterial carbon dioxide values were better in the salbutamol group when compared with the placebo group (P.05). Duration of hospitalization in the neonatal intensive care unit was also shorter for the salbutamol group (P.05).Inhaled salbutamol treatment was effective with respect to both clinical and laboratory findings of TTN and without adverse events.

Objective To determine risk factors associated with transient tachypnea of the newborn (TTN) and whether TTN is associated with development of wheezing syndromes in early life. Study design The Population Health Research Data Repository at the Manitoba Centre for Health Policy is a healthcare administrative and prescription database. Data for children diagnosed with a wheezing syndrome (defined as bronchiolitis, acute bronchitis, chronic bronchitis, asthma, or prescription for asthma medication) were obtained. Term children diagnosed with TTN at birth were selected. Cox proportional hazards regression analysis for time to first event of hospitalizations, physician visits, or prescription for an asthma medication up to 7 years of age were calculated. The hazard ratios for wheezing in a child with TTN were compared with healthy newborns. Results Twelve thousand seven hundred sixty-three children were born at term in 1995 and currently live in the province of Manitoba. Of these children, 308 (2.4%) developed TTN. Maternal asthma, birth weight ≥4500 g, male sex, and urban location were risk factors for development of TTN. Infants with TTN at birth were at significantly increased risk of a wheezing disorder in childhood (adjusted hazard ratio [HR] = 1.17, 95% CI 1.02-1.34). Conclusion TTN is associated with development of wheezing syndromes in childhood.

Objective To determine the effect of mild fluid restriction on the hospital course of neonates with transient tachypnea of the newborn (TTN). Study design In this pilot prospective randomized controlled trial of 64 late preterm and term neonates diagnosed with TTN at a single tertiary care hospital in the United States, patients were randomized to receive standard fluid management or mild fluid restriction. The primary outcome was duration of respiratory support. Secondary outcomes were duration of admission to the intensive care unit, time to first enteral feed, and total and composite hospital costs. Results were analyzed by t -test, χ 2 test, Kaplan-Meier estimation, and proportional hazards regression. Results Fluid restriction did not cause adverse events or unsafe dehydration. Fluid management strategy did not affect primary or secondary outcomes in the total study population. Fluid restriction significantly reduced the duration of respiratory support ( P = .008) and hospitalization costs ( P = .017) in neonates with severe TTN. Conclusion Mild fluid restriction appears to be safe in late preterm and term neonates with uncomplicated TTN. Fluid restriction may be of benefit in decreasing the duration of respiratory support and reducing hospitalization costs in term and late preterm neonates with uncomplicated severe TTN.

To evaluate morbidity, mortality, and associated risk factors in late preterm term infants (34-0/7 to 36-6/7 weeks) requiring extra-corporeal membrane oxygenation (ECMO).We reviewed 21,218 neonatal ECMO runs in Extra-corporeal Life Support Organization registry data from 1986-2006. Infants were divided in 3 groups: late preterm (34-0/7 to 36-6/7 weeks), early-term (37-0/7 to 38-6/7 weeks), and full-term (39-0/7 to 42-6/7 weeks).There were 14,528 neonatal ECMO runs that met inclusion criteria. Late preterm infants experienced the highest mortality rate on ECMO (late preterm, 26.2%; early-term, 18%; full-term, 11.2%; P.001) and had longer ECMO runs; they also had higher rates of serious complications. Gestational age was a highly significant predictor for mortality. Late preterm infants with a primary diagnosis of sepsis and persistent pulmonary hypertension had 3-fold higher risk of mortality on ECMO than infants with meconium aspiration.Late preterm infants treated with ECMO have higher morbidity and mortality rates than term infants. This underscores the need for special consideration of this vulnerable population in the diagnosis and treatment of hypoxic respiratory failure.

Mean aortic blood pressure and blood volume were measured in true premature infants with respiratory distress syndrome. Seven infants had Type I RDS (hyaline membrane disease) and ten had transient tachypnea of the newborn (Type II RDS). Blood volume in the infants with Type I RDS was significantly lower than in the infants with Type II RDS. The difference was due to a low red cell volume. Mean aortic blood pressure was within the range of normal in all infants and therefore did not reflect the low blood volume of infants with Type I RDS. Normal mean aortic blood pressure does not indicate normal blood volume or normal circulation in infants with RDS.

DURING PASSAGE down the birth canal, compression of the infant's thoracic cage results in elimination of variable amounts fetal lung liquid. 1 Babies born by cesarean section are not subjected to this squeeze. Two studies have shown that the crying vital capacity is reduced in babies born by cesarean section compared with those born vaginally. 2. 3 Measurement of the thoracic gas volume by Milner et aP using the body plethysmograph has demonstrated a clear-cut difference between the lung volumes of vaginally born babies compared with those born by cesarean section in the first six hours after birth. There was, however, a suggestion that the differences may last only a few hours, although the time course for the resolution of transient tachypnea of the newborn, which is attributed to delayed clearing of lung fluid, is much longer. The present study was undertaken with two aims: (1) To determine for how long these differences in lung volumes and lung mechanics persist. (2) To determine whether the process of labor itself contributes to the clearance of liquid.

We studied the change in ion transport function by measuring the basal transepithelial potential difference (PD) across the ciliated epithelium of the nose in 85 term neonates during the first 72 hours of life. Differences in PD associated with the mode of delivery or the presence of respiratory disease and differences in the PD response to the superfusion of amiloride (10(-5) mol/L) were assessed. We also studied term neonates with transient tachypnea of the newborn (TTN) and acute respiratory insufficiency. Basal PDs during the first 24 hours of life were higher in neonates delivered by cesarean section without prior labor (-29.7 +/- 2.5 mV) and in those with TTN (-38.5 +/- 6.0 mV) than in neonates born during normal spontaneous vaginal delivery (-23.0 +/- 2.9 mV) or cesarean section with prior labor (-23.7 +/- 0.7 mV) or in those with respiratory insufficiency (-22.4 +/- 2.3 mV). The percentage inhibition of PD by amiloride superfusion (less than 24 hours) was significantly lower in infants with TTN (30.9 +/- 4.9%) and after cesarean section without prior labor (31.8 +/- 2.2%) than in other groups (37.6 +/- 1.6%). By 48 hours, nasal PDs after cesarean section without prior labor and in neonates with TTN had declined; and by 72 hours, values were similar to those in other groups; respiratory rate paralleled the decline in PD. The respiratory rate of neonates with respiratory insufficiency remained high and paralleled the persistence of respiratory distress. Amiloride sensitivity was similar for all groups by 72 hours. These findings indicate (1) that PDs vary with the mode of delivery and support a role for labor in the normal transition of respiratory epithelial ion transport and (2) that TTN is associated with abnormal epithelial ion transport.

SEVERAL STUDIES have indicated that clinical and radiographic findings fail to distinguish precisely neonates with early onset group B streptococcal septicemia from those with hyaline membrane disease or transient tachypnea of the newborn infant. I-:' Although countercurrent immunoelectrophoresis for the detection of bacterial antigen in body fluids has been shown to be useful for the rapid diagnosis of several bacterial infections, its value for the prospective diagnosis of early onset group B streptococcal disease has not been investigated. This study documents the utility of CIE for the rapid and specific diagnosis of GBS septicemia among infants admitted to high-risk newborn nurseries.