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Antibiotics in transient respiratoy tachypnea


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Transient tachypnea of the newborn (TTRN) is a non-infectious disease that generally occurs in preterm infants (<37 weeks of gestation) or near term, born by cesarean section. It is characterized by a respiratory rate > 60x ́, and respiratory distress after the first six hours of life. It is due to retention of lung fluid with secondary air trapping.
The elimination of lung fluid begins with labor up to 45%, six hours before birth, due to the increase in maternal catecholamines. This causes a functional change of the epithelial sodium channel (eNaC) which drives the absorption of sodium and lung fluid into the interstitium; later this fluid will be drained through the lymphatics and into the pulmonary venous circulation. 
The elimination of lung fluid begins with labor up to 45%, six hours before birth, due to the increase in maternal catecholamines. This causes a functional change of the epithelial sodium channel (eNaC) which drives the absorption of sodium and lung fluid into the interstitium; later this fluid will be drained through the lymphatics and into the pulmonary venous circulation. Elimination of lung fluid usually requires up to six hours; however, it can be obstructed, which increases the thickness of the alveolus-capillary membrane and promotes TTRN.     Among the factors that hinder the drainage of lung fluid are:
- Obstetric factors: Birth by cesarean section, prolonged labor, late clamping of the umbilical cord, maternal asthma, gestational diabetes, maternal disease (cervicovaginitis and UTI) in the first trimester of pregnancy and rupture of membranes (> 12 h).
- Neonatal factors: Male newborn, Apgar < 7 points and macrosomia.                     A chest x-ray shows hyperaeration with eight to nine visible intercostal spaces, horizontalization of the rib cage, and flattening of the hemidiagraphs; cardiomegaly and parahilar interstitial infiltrate due to increased pulmonary vascularity (“hairy heart”). Gasometry: Shows mild respiratory acidosis and hypoxemia.

Treatment: ir consists of increasing pulmonary capillary vasodilation and airway pressure, so that the air moves the liquid to the interstitium so that it can be absorbed in the pulmonary capillaries, which requires:
1. In case of severe respiratory distress and respiratory rate > 100 per minute, keep the patient fasting, with parenteral solutions.
2. Administration of 40% supplemental oxygen through the head shell.

3. If symptoms persist or respiratory difficulty increases, administer airway pressure to improve residual lung volume (nasal CPAP with FIO2 40 - 60%)     4. Avoid the use of diuretics, albumin infusions and hypertonic solutions.

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@agoz this is a nice subject to discuss, thanks,

In our unit if the newborn was born inhouse, we give antibiotics to patients with TTN only if there is an indication for administrating antibiotics beside TTN. i.e. TTN is not an indication per se for administrating antibiotics. 

However, for patients born in other hospitals or maternal centers and transferred to our unit we do administer antibiotics for 48hrs ampicillin and gentamicin until we receive culture results of no growth.

@manuel perez valdez In our unit our main target of treatment in decrease WOB by mostly nCPAP (with a PEEP of 6cmH2O) or less commonly HHHFNC (with a flow of 8 L). 

Oxygen supplementation only to keep saturations (SpO2) within the target range for GA.

If FIO2 needs increases reaching to 40% or above besides giving a nCPAP of 6cmH2O, or high pCO2 causing respiratory acidosis, we would consider Biphasic nCPAP 10/6 or NIPPV or intubation and surfactant.

 

 

 

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