Diagnostic efficacy of lung ultrasound and X-ray for neonatal respiratory distress syndrome and transient tachypnea / 中国医学影像技术

Objective To compare the efficacy of lung ultrasound and chest X-ray for diagnosis of neonatal transient respiration syndrome (TTN) and respiratory distress syndrome (RDS).Methods Totally 120 infants with respiratory distress underwent lung ultrasound and chest X-ray within 6 h after birth.Taking clinical diagnosis as the standard,the sensitivity,specificity and accuracy of lung ultrasound and X-ray for diagnosis of TTN and RDS were calculated.Results According to clinical diagnosis,there were 75 infants of TTN and 34 of RDS.The sensitivity,specificity and accuracy of lung ultrasound in diagnosis of TTN was 96.00％ (72/75),88.89％ (40/45) and 93.33％ (112/120),respectively,higher than those of chest X-ray (85.33％ [64/75],84.44％ [38/45] and 85.00％ [102/120]).Lung ultrasound showed 85.29％ (29/34) of sensitivity,95.35％ (82/86) of specificity and 92.50％ (111/120) of accuracy for diagnosis of RDS,whereas chest X-ray showed 88.23％ (30/34) of sensitivity,89.53％ (77/86) of specificity and 89.17％ (107/120) of accuracy.Conclusion Lung ultrasound is accurate for the diagnosis of TTN and RDS.

Taquipnea transitoria del recién nacido asociada a cesárea con y sin labor de parto / Transient tachypnea of ​​the newborn associated with caesarean section with and without labor

Contexto: la taquipnea transitoria del recién nacido (TTRN) es una entidad frecuente en neonatos nacidos por cesárea. Objetivo: identificar factores de riesgo potencialmente modificables que contribuyan a la disminución de la patología respiratoria neonatal derivada de un parto por cesárea Sujetos y métodos: se presenta un estudio observacional retrospectivo de cohorte analítico que identifico expedientes clínicos de recién nacidos por cesárea, atendidos en el Hospital de la Policía Quito N°1 en el periodo enero de 2001 a diciembre de 2015; el estudio incorporó neonatos entre 35 y 41 semanas de gestación, a quienes se clasificaron en 2 grupos: con y sin labor de parto previo a la cesárea. Resultados: la frecuencia de recién nacidos con taquipnea transitoria que se determinó en el presente estudio fue 25,6%, 29,4% y 44,8% en los respectivos grupos de edad gestacional determinándose una proporción es 5,1:1; 1,9:1 y 0,5:1 para cada grupo por lo que la relación entre un pretérmino leve frente a RN a término es 10 veces mayor para el grupo que desarrolla TTRN. Existe una mayor frecuencia de TTRN en neonatos de cesáreas sin labor de parto previa comparado con el grupo de neonatos nacidos por cesárea con labor de parto previa; esta diferencia es estadísticamente significativa con un OR de 5,8. Conclusión: se determinó que la labor de parto previa a la cesárea, constituyo un factor protector para taquipnea transitoria del recién nacido en neonatos entre 35 y 38 semanas. La labor de parto previa a la cesárea no fue un factor de protección frente al riesgo de desarrollar taquipnea transitoria del recién nacido en neonatos de 39 o más semana de gestación.(AU)

Context: transient tachypnea of the newborn (TTRN) is a frequent entity in neonates born by caesarean section, Objective: identify potentially modifiable risk factors that contribute to the reduction of neonatal respiratory pathology derived from a cesarean delivery Subjects and methods: We present a retrospective observational study of an analytical cohort that identified clinical records of newborns by caesarean section, attended at Quito Police Hospital No. 1 in the period January 2001 to December 2015; The study included neonates between 35 and 41 weeks of gestation, who were classified into 2 groups: with and without labor prior to cesarean section. Results: the frequency of newborns with transient tachypnea that was determined in the present study was 25.6%, 29.4% and 44.8% in the respective gestational age groups determining a proportion is 5.1: 1; 1.9: 1 and 0.5: 1 for each group, so that the relationship between a preterm mild versus a term BN is 10 times higher for the group that develops TTRN. There is a greater frequency of TTRN in neonates of caesarean sections without previous labor compared with the group of neonates born by caesarean section with previous labor; this difference is statistically significant with an OR of 5.8. Conclusion: labor prior to caesarean section constitutes a protective factor for transient tachypnea of thnewborn in neonates between 35 and 38 weeks. Labor prior to cesarean section is not a protective factor againsthe risk of developing transient tachypnea of the newborn in infants of 39 or more weeks of gestation.(AU)

Comparação entre o método Reequilíbrio Toracoabdominal e a fisioterapia respiratória convencional em recém-nascidos com taquipneia transitória: um ensaio clínico randomizado / Comparison between Thoracic-abdominal Rebalance Method and conventional respiratory physiotherapy in neonates with transient tachypnea: a randomized clinical trial

Introdução: Recém-nascidos acometidos pela taquipneia transitória do recém-nascido (TTRN) cursam com desequilíbrio da biomecânica toracoabdominal e desconforto respiratório e necessitam de cuidados especiais. A fisioterapia respiratória convencional em recém-nascidos tem efeitos adversos, podendo ser o método reequilíbrio toracoabdominal (RTA) uma alternativa terapêutica. Objetivo: Comparar a fisioterapia respiratória convencional com o método RTA em recém-nascidos com TTRN. Métodos: Ensaio clínico intervencional, comparativo e randomizado. 49 recém-nascidos foram divididos em dois grupos: fisioterapia respiratória convencional (n=20) e RTA (n=29). Parâmetros fisiológicos (frequência respiratória, frequência cardíaca, saturação de pulso de oxigênio, temperatura axila), dor, estado comportamental, desconforto respiratório e desequilíbrio da biomecânica respiratória foram avaliados antes e após os manuseios. Resultados: A mediana da idade gestacional foi 38 semanas e a do peso de nascimento 2.940 g. Após os manuseios, não houve diferença entre os grupos quanto à dor (p=0,63), o estado comportamental (p=0,11) e os parâmetros fisiológicos (frequência respiratória, p=0,18; frequência cardíaca, p=0,82; SpO2, p=0,74; temperatura axila, p=0,29). O método RTA mostrou-se superior a fisioterapia respiratória convencional na melhora da biomecânica respiratória (elevação do esterno, p=0,01; elevação dos ombros, p=0,02) e do desconforto respiratório (p=0,009). Conclusão: O método RTA mostrou-se seguro e superior à fisioterapia respiratória convencional em recém-nascidos com TTRN. (AU)

Introduction: Newborn infants who are affected by transient tachypnea of the newborn (TTNB) have an imbalance of thoracoabdominal biomechanics and respiratory distress and so, require special care. The conventional respiratory physiotherapy in newborns has adverse effects, and the Thoracic-Abdominal Rebalance (TAR) method may be a therapeutic alternative. Objective: To compare conventional respiratory physiotherapy and TAR method in newborns with TTNB. Methods: Randomized, comparative, interventional clinical trial. 49 newborn infants divided into two groups: conventional respiratory physiotherapy (n=20) and TAR method (n=29). Physiological parameters (respiratory rate, heart rate, pulse oxygen saturation (SpO2), axilla temperature), pain, behavioral status, respiratory discomfort, and imbalance of respiratory biomechanics were evaluated before and after handling. Results: The median of gestational age of 38 weeks, and birthweight was 2,940 g. After the interventions, we did not observe difference between the groups regarding pain (p=0.63), behavioral status (p=0.11) and physiological parameters (respiratory rate, p=0.18; heart rate, p=0.82; SpO2, p=0.74 and axilla temperature, p=0.29). The TAR method was better than conventional respiratory physiotherapy in improvement of respiratory biomechanics (sternum elevation, p=0.01, elevation of the shoulders, p=0.02) and respiratory distress (p=0.009). Conclusion: The TAR method proved to be safe and superior to conventional respiratory physiotherapy in newborn infants with TTNB. (AU)

Empirical Antibiotic Therapy in Transient Tachypnea of the Newborn / 대한주산의학회잡지

PURPOSE: Transient tachypnea of the newborn (TTN) is a respiratory disorder resulting from delayed clearance of fetal lung fluid. Initiation of empiric antibiotic therapy for possible early-onset sepsis is usually recommended until negative blood cultures for 48 hours. The aim of this study was to compare outcomes of infants with TTN managed with a risk-factor-based restrictive antibiotic use policy. METHODS: A single institution retrospective study was conducted on full-term infants admitted with TTN from January, 2008 to December, 2013. Infants were stratified into two groups based on whether they received or did not receive antibiotics. The decision to administer antibiotics depended upon the covering physician at admission. The clinical and laboratory outcomes were evaluated between two groups. RESULTS: A total of 98 full-term infants diagnosed with TTN were admitted to the neonatal intensive care unit; of them 39 (39.8%) received and 59 (60.2%) did not receive antibiotics. Physicians had tendency to start antibiotics in patient with mild-to-moderate chest retraction, need oxygen therapy, high white blood cell count, segmented neutrophil and positive C-reactive protein. All of them had negative blood cultures, no readmission, and no late-onset sepsis. The duration of hospital stay was longer in patients received antibiotics group (10.7+/-3.0 days vs. 9.0+/-4.4 days, P=0.04). CONCLUSION: This study suggests that empiric antibiotic therapy may not be recommended for full-term infants with classic TTN without perinatal risk factors. With the application of strict criteria for classic TTN and the close observation, the empiric use of antibiotics may be avoidable.

Evaluación de la calidad de la atención de la taquipnea transitoria en recién nacidos afiliados al Seguro Médico Siglo XXI / Evaluation of the quality of care of transient tachypnea in newborns affiliated with the Medical Insurance Siglo XXI program

Introducción: La evaluación de la calidad de la atención del recién nacido con complicaciones es un elemento indispensable para las estrategias de mejora orientadas a reducir las tasas de mortalidad neonatal. El objetivo de este trabajo fue evaluar la calidad de atención técnica e interpersonal en el manejo de la taquipnea transitoria del recién nacido (TTRN) de pacientes afiliados al Seguro Médico Siglo XXI. Métodos: Se realizó un estudio transversal en 61 hospitales de la Secretaría de Salud, que durante el primer semestre de 2011 reportaron al menos dos casos de TTRN. Se analizaron diferentes variables con respecto a la madre, el embarazo, el nacimiento y las complicaciones neonatales, así como intervenciones realizadas al recién nacido y condiciones de salud al egreso. Para medir la calidad de atención, se definieron y validaron indicadores de calidad en los ámbitos de la prevención, diagnóstico y tratamiento. Resultados: Se analizaron 256 expedientes de casos con diagnóstico de TTRN. El 8.9% de las madres tenía alguno de los factores de riesgo (asma, diabetes) y el 53.5% presentó complicaciones en el embarazo. El 60% de los casos de TTRN nacieron por cesárea; un tercio tuvieron bajo peso al nacimiento y el 14% fueron trasladados a otro hospital. En cuanto a los indicadores de calidad, en el rubro de prevención se identificó que en más del 90% se registraron los factores de riesgo (tabaquismo, asma, parto por cesárea); los de diagnóstico reflejaron que en el 86-98% se buscaron manifestaciones de insuficiencia respiratoria. Los de tratamiento lograron cifras satisfactorias para las medidas de monitorización y soporte. Conclusiones: Los resultados permiten considerar que la mayoría de los casos con TTRN recibieron un tratamiento apropiado. Es recomendable desarrollar estrategias efectivas, como reducir la creciente tasa de partos por cesárea, para prevenir la TTRN.

Background: Evaluation of the quality of care of the newborn with complications is an indispensable element for the improvement of strategies directed to reduce newborn mortality rates. The aim of this work was to evaluate the quality of technical and interpersonal care in the management of transient tachypnea of the newborn (TTN) of patients affiliated with the program "Medical Insurance Siglo XXI". Methods: A cross-sectional study was conducted in 61 hospitals affiliated with the Health Ministry with at least two cases of TTN during the first semester of 2011. Variables such as mother's health, pregnancy, birth and birth complication characteristics were analyzed. Also, newborn interventions and health conditions upon discharge were included. To measure the quality of care according to prevention, diagnosis and treatment, quality indicators were defined and validated. Results: We analyzed 256 case files with a diagnosis of TTN; 8.9% of the mothers presented risk factors (asthma, diabetes) and 53.5% had complications during pregnancy. There were 60% of cases with TTN born by cesarean delivery; one third of these children had low birth weight and 14% were transferred to another hospital. As for the quality indicators in the area of prevention, more than 90% of risk factors (smoking, asthma, cesarean delivery) were identified. Diagnostic indicators showed that 86-98% of respiratory distress symptoms were sought. Indicators of treatment achieved satisfactory figures for monitoring and support measures. Conclusions: Prevention, diagnosis and treatment indicators made it possible to consider that most TTN cases received appropriate treatment. It is advisable to develop effective strategies to prevent TTN, such as increasing efforts to reduce the increasing rates of cesarean deliveries.

The Effects of Inhaled Albuterol in Transient Tachypnea of the Newborn

PURPOSE: Transient tachypnea of the newborn (TTN) is a disorder caused by the delayed clearance of fetal alveolar fluid. beta-adrenergic agonists such as albuterol (salbutamol) are known to catalyze lung fluid absorption. This study examined whether inhalational salbutamol therapy could improve clinical symptoms in TTN. Additional endpoints included the diagnostic and therapeutic efficacy of salbutamol as well as its overall safety. METHODS: From January 2010 through December 2010, we conducted a prospective study of 40 newborns hospitalized with TTN in the neonatal intensive care unit. Patients were given either inhalational salbutamol (28 patients) or placebo (12 patients), and clinical indices were compared. RESULTS: The duration of tachypnea was shorter in patients receiving inhalational salbutamol therapy, although this difference was not statistically significant. The duration of supplemental oxygen therapy and the duration of empiric antibiotic treatment were significantly shorter in the salbutamol-treated group. No adverse effects were observed in either treatment group. CONCLUSIONS: Inhalational salbutamol therapy reduced the duration of supplemental oxygen therapy and the duration of empiric antibiotic treatment, with no adverse effects. However, the time between salbutamol therapy and clinical improvement was too long to allow definitive conclusions to be drawn. Further studies examining a larger number of patients with strict control over dosage and frequency of salbutamol inhalations are necessary to better direct the treatment of TTN.

Serum Enzymes in Predicting Transient Tachypnea of Newborn and Respiratory Distress Syndrome / 대한주산의학회잡지

PURPOSE: Perinatal asphyxia is a major factor correlated with diseases that cause respiratory distress in a neonate. So we aimed to investigate the relationship between respiratory distress syndrome (RDS) and transient tachypnea of newborn (TTN) with plasma biological markers of perinatal asphyxia in full-term neonates. METHODS: Full-term neonates with transient tachypnea of the newborn (TTN) and respiratory distress syndrome (RDS) who were admitted within 24 hours after birth were enrolled in a study group. And control group are infants with premature rupture of amniotic membrane without significant findings. Serum lactate dehydrogenase (LDH), aspartate transaminase (AST), alanine transaminase (ALT), creatine kinase (CK) and myoglobin were measured at admission. RESULTS: Of the total 80 infants, 54 were of the study group and 26 were of the control group. The numbers of RDS and TTN groups were 27 and 27, and the numbers of RDS with hypoxic-ischemic encephalopathy (HIE) and RDS without HIE were 6 and 21 retrospectively. Serum AST, ALT, LDH and CK were significantly higher in the study group than the control group (P<0.05). When RDS group and TTN group were compared AST and LDH were significantly higher in RDS group than TTN group (P<0.05). Serum AST, ALT and LDH were significantly higher in RDS with HIE group than RDS without HIE group (P<0.05). A prediction of RDS by LDH analysis showed good correlation by receiver operating characteristic curve (P<0.05). A cut off level of 720 IU/L for LDH was the best predictor of RDS (sensitivity 63% and specificity 86%). CONCLUSION: LDH is an excellent predictor to differentiate RDS from TTN soon after birth in full-term neonates with respiratory distress.

Predictable risk factors and clinical courses for prolonged transient tachypnea of the newborn / 소아과

PURPOSE: Transient tachypnea of the newborn (TTN) is usually benign and improves within 72 hours. However, it can also progress to prolonged tachypnea over 72 hours, profound hypoxemia, respiratory failure, and even death. The aim of this study is to find predictable risk factors and describe the clinical courses and outcomes of prolonged TTN (PTTN). METHODS: The medical records of 107 newborns, >35(+0) weeks of gestational age with TTN, who were admitted to the NICU at Seoul Asan Medical Center from January 2001 to September 2007 were reviewed. They were divided into 2 groups based on duration of tachypnea. PTTN was defined as tachypnea > or =72 hours of age, and simple TTN (STTN) as tachypnea 90/min, FiO2 >0.4, and required ventilator care more frequently than STTN infants. PTTN had lower level of serum total protein and albumin than STTN. The independent predictable risk factors for PTTN were grunting, maximal respiration rate >90/min, and FiO2 >0.4 within 6 hours of life. CONCLUSION: When a newborn has grunting, respiration rate >90/min, and oxygen requirement >0.4 of FiO2 within 6 hours of life, the infant is at high risk of having persistent tachypnea > or =72 hours. We need further study to find the way to reduce PTTN.

Neonatal respiratory distress: recent progress in understanding pathogenesis and treatment outcomes / 소아과

Transient tachypnea of the newborn (TTN), respiratory distress syndrome (RDS), and persistent pulmonary hypertension (PPHN) are the three most common disorders that cause respiratory distress after birth. An understanding of the pathophysiology of these disorders and the development of effective therapeutic strategies is required to control these conditions. Here, we review recent papers on the pathogenesis and treatment of neonatal respiratory disease.

Clinical Study of Transient Tachypnea of the Newborn

Transient tachypnea of the newborn(TTN) is a benign self-limited disease characterized by early onset and rapid recovery of tachypnea although it may occasionally have a more prolonged and protracted course. A retrospective clinical study was mad on 29 neonates with TTN admitted to NICU of Pohang St. Mary's Hospital from January 1992 to June 1993. The results were as follows: 1) TTN(36.2%) was the most common cause of respiratory distress in the neonate followed by idiopathic respiratory distress syndrome(23.8%), pneumonia(18.8%), meconium aspiration syndrome(6.2%), perinatal asphyxia(6.2%), polycythemia(3.8%), anemia(1.2%), persistent fetal circulation(1.2%), paroxysmal supraventricular tachycardia(1.2%) and tracheoesophageal fistula(1.2%) 2) TTN was more frequent in the male term infants but can occur in premature(41.4%) and low birth weight infants(34.5%). 3) The associated perinatal conditions were oxytocin-induction(8 cases, 27.6%), Cesarean delivery(10 cases, 34.5%) and asphyxia(7 cases, 24.2%) 4) Arterial blood gas analysis showed respiratory acidosis in 3 cases and metabolic acidosis in 3 cases but none of TTN showed hypoxia unresponsive to oxygen 5) Chest X-ray showed hyperaeration in 10 cases(34.5%), increased pulmonary vascularity in 8 cases(27.6%), hyperaeration and increased pulmonary vascularity in 6 cases(20.6%) and cardiomegaly in 12 cases(53%). 6) Tachypnea usually appeared within 6hours and abated by 48-72hours but sustained more than 73hours in 7 cases(24.1%) 7) In majority of cases, maximal respiratory rates were below 100 rates/min and administered oxygen concentrations were 20-40%, and their mean values were 81 rates/min, 37.6% respectively. 8) TTN with more prolonged course(> or=48hours) was associated with low birth weight infants, prematurity and higher respiratory rates(> or=100 breaths a minute)(p<0.05).

Clinical Study of Transient Tachypnea of the Newborn

Transient tachypnea of the newborn(TTN) is a benign self-limited disease characterized by early onset and rapid recovery of tachypnea although it may occasionally have a more prolonged and protracted course. A retrospective clinical study was mad on 29 neonates with TTN admitted to NICU of Pohang St. Mary's Hospital from January 1992 to June 1993. The results were as follows: 1) TTN(36.2%) was the most common cause of respiratory distress in the neonate followed by idiopathic respiratory distress syndrome(23.8%), pneumonia(18.8%), meconium aspiration syndrome(6.2%), perinatal asphyxia(6.2%), polycythemia(3.8%), anemia(1.2%), persistent fetal circulation(1.2%), paroxysmal supraventricular tachycardia(1.2%) and tracheoesophageal fistula(1.2%) 2) TTN was more frequent in the male term infants but can occur in premature(41.4%) and low birth weight infants(34.5%). 3) The associated perinatal conditions were oxytocin-induction(8 cases, 27.6%), Cesarean delivery(10 cases, 34.5%) and asphyxia(7 cases, 24.2%) 4) Arterial blood gas analysis showed respiratory acidosis in 3 cases and metabolic acidosis in 3 cases but none of TTN showed hypoxia unresponsive to oxygen 5) Chest X-ray showed hyperaeration in 10 cases(34.5%), increased pulmonary vascularity in 8 cases(27.6%), hyperaeration and increased pulmonary vascularity in 6 cases(20.6%) and cardiomegaly in 12 cases(53%). 6) Tachypnea usually appeared within 6hours and abated by 48-72hours but sustained more than 73hours in 7 cases(24.1%) 7) In majority of cases, maximal respiratory rates were below 100 rates/min and administered oxygen concentrations were 20-40%, and their mean values were 81 rates/min, 37.6% respectively. 8) TTN with more prolonged course(> or=48hours) was associated with low birth weight infants, prematurity and higher respiratory rates(> or=100 breaths a minute)(p<0.05).