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Wednesday, May 25, 2011

Transient Tachypnea of the Newborn May be an early Clinical Manifestation of wheezing symptoms.

Tachypnea means rapid breathing.  Some newborns have a disorder called “Transient Tackypnea of the Newborn (TTN)”.  This means that the baby has episodes of rapid breathing starting shortly after birth.  This usually normalizes within 2-5 days. TTN occurs more frequently in babies born by cesarean, babies born pre-term (before their due date) and in male babies.  For the most part, TTN resolves well without long term effects.  Some studies have shown a higher rate of wheezing problems in preschool children who had TTN at birth.

Research question:  Is TTN associated with increased risk of wheezing problems in children in early life?  What factors play a role in the increased risk?

Researchers analyzed the records of all children born at term in Manitoba in 1995.

They looked at their birth records as well as records of children diagnosed with a wheezing related respiratory illness in the first 7 years of life.  This includes seeing the doctor or hospital for acute bronchitis or bronchiolitis, chronic bronchitis, asthma or a prescription for asthma medications.

2.4 % of children born in Manitoba in 1995 developed TTN at birth. 

Children who had TTN were more likely to have wheezing problems in early life.  These wheezing problems may be longer term than originally thought and may develop into asthma.

Risk factors for developing TTN are:
  • birth weight greater than 4500gm (10 lbs)
  • being male child
  • living in urban (city) environment
  • babies born by cesarean section
  • mother with asthma

Children whose mothers have asthma are more at risk of developing TTN.  These children are also genetically more at risk of developing asthma. TTN may therefore be the first indication of asthma rather than a cause of asthma.

Certain chemicals are released in the baby during vaginal delivery that helps clear the lungs of fluid. The surge in this chemical is absent during a cesarean section, possibly leading to TTN.

Environmental factors may also play a role in the increased risk.  Most children admitted to the intensive care with TTN had also received antibiotics for 48 hours.  Early antibiotic use changes the normal bacteria in the baby’s intestines, putting them at increased risk for developing allergies.  

Conclusion: TTN is associated with higher risk of asthma. TTN may therefore be an early sign of asthma. It is possible that the combination of genetic risk (mother with asthma) and an environmental change (use of antibiotics, cesarean birth) together increases the risk of asthma.

Transient tachypnea of the newborn may be an early clinical manifestation of wheezing symptoms. Liem JJ, Huq SI, Ekuma O, Becker AB, Kozyrskyj AL. J Pediatr. 2007 Jul;151(1):29-33.