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Transient Tachypnea

By Arthur E. Kopelman, MD, Professor of Pediatrics and Neonatology (Emeritus), The Brody School of Medicine at East Carolina University

Transient tachypnea of the newborn (rapid breathing of the newborn, neonatal wet lung syndrome) is temporary difficulty with breathing and low blood oxygen levels due to excessive fluid in the lungs after birth.

  • This disorder can occur after a scheduled caesarean delivery done before the onset of labor in newborns born a few weeks before term or at term.

  • Affected newborns breathe rapidly and grunt when breathing out and may appear bluish if they are not getting enough oxygen into their blood.

  • The diagnosis is based on symptoms and is confirmed by a chest x-ray.

  • Almost all affected newborns recover completely in 2 to 3 days.

  • Most affected newborns need treatment with oxygen, and some need assistance with breathing.

This disorder usually occurs in newborns born a few weeks before term or at term. It is more common after a cesarean delivery and is especially likely to occur if the mother has not been in labor before a cesarean delivery (for example, a mother who has a scheduled caesarean delivery).

Before birth, the air sacs (alveoli) of the lungs are filled with fluid. Immediately after birth, the fluid must be cleared from the lungs so that the air sacs can fill with air and the newborn can breathe normally. Some of the fluid is squeezed out of the lungs by pressure on the chest during a vaginal delivery. More of the fluid is rapidly reabsorbed directly by the cells lining the air sacs. Hormones released during labor cause the cells in the air sacs to begin absorbing fluid. If this fluid reabsorption does not occur rapidly, then the air sacs continue to be partially filled with fluid and newborns have difficulty breathing.

Newborns with transient tachypnea have respiratory distress with rapid breathing, drawing in of the chest wall during breathing in, and grunting during breathing out. They may develop a bluish discoloration of the skin (cyanosis) if the level of oxygen in the blood becomes low. A chest x-ray shows increased fluid in the lungs.

Most newborns with transient tachypnea recover completely within 2 to 3 days. Treatment with oxygen is usually needed. Rarely, some newborns may need continuous positive airway pressure (CPAP)—a technique that allows newborns to breathe on their own while being given slightly pressurized oxygen or air given through prongs placed in the nostrils—or even assistance with a ventilator.