Transient tachypnea of the newborn (TTN)
Meconium aspiration
respiratory acidosis ensue.
Diagnosis
Best initial diagnostic test—chest radiograph
Findings: ground-glass appearance, atelectasis, air bronchograms
Most accurate diagnostic test—L/S ratio (part of complete lung
profile; lecithin-to-sphingomyelin ratio)
Done on amniotic fluid prior to birth
Best initial treatment—oxygen
Most effective treatment—intubation and exogenous surfactant
administration
Primary prevention
Avoid prematurity (tocolytics)
Antenatal betamethasone
Slow absorption of fetal lung fluid → decreased pulmonary compliance and
tidal volume with increased dead space
Tachypnea after birth
Generally minimal oxygen requirement
Common in term infant delivered by Cesarean section or rapid second
stage of labor
Chest x-ray (best test)—air-trapping, fluid in fissures, perihilar streaking
Rapid improvement generally within hours to a few days
Meconium passed as a result of hypoxia and fetal distress; may be aspirated in
utero or with the first postnatal breath → airway obstruction and pneumonitis
Diaphragmatic hernia
→ failure and pulmonary hypertension
Chest x-ray (best test)—patchy infiltrates, increased AP diameter,
flattening of diaphragm
Other complications—air leak (pneumothorax, pneumomediastinum)
Prevention—endotracheal intubation and airway suction of depressed
infants with thick meconium
Treatment—positive pressure ventilation and other complex NICU therapies
Failure of the diaphragm to close → abdominal contents enter into chest,
causing pulmonary hypoplasia.
Born with respiratory distress and scaphoid abdomen
Bowel sounds may be heard in chest
Diagnosis—prenatal ultrasound; postnatal x-ray (best test) reveals bowel in
chest
Best initial treatment—immediate intubation in delivery room for known or
suspected CDH, followed by surgical correction when stable (usually days)