CASE REPORT

Transient Tachypneu of
the Newborn
Supervisor:
dr. Nazardi Oyong Sp. A

Present by :
Annisa Septia
Jevanlia Karlina H
Nurfa Erin
Wella Fadillah
Background
 Respiratory Distress

Clinical manifestation of respiratory system

unable to do gass changed normally
INTRODUCING
Respiratory Distress of Newborn

P22.0 RDS

P22.9
P22
Respiratory
Respiratory
distress of P22.1 TTN
distress of
newborn,
newborn
unspecified

P22.8
Other
respiratory
distress of
newborn
 5% of
Newborn at
gestational
age 35-36
weeks
10% of <1% of
Newborn at Newborn at
gestational aterm
age 33-34 gestational
weeks age

Transient
Tachypneu
of the
Newborn
TTN is one of the most common causes of
Neonatal Respiratory distress

Quick and precise management and provide a

good prognosis without leaving the sequele
References
 Definition

• TTN  also known as wet lung

• It is a benign disease of near-term,
term, or large premature infants who
have respiratory distress shortly after
delivery that usually resolve within 3-5
days
Clinical Manifestation
PATOFISIOLOGY
 Cairan dalam alveoli digantikan
oleh udara

Cairan
paru-paru
janin

Napas pertama Napas kedua Napas selanjutnya

Dilatasi pembuluh darah paru saat lahir

Konstriksi Dilatasi

Cairan dalam O2 dalam

alveoli alveoli
 Risk Factors
1. Elective cesarian delivery without
preceding labor (especially with
gestational <38 weeks)
2. Male sex
3. Birth to ashmatic mother
4. Prolonged labor
5. Macrosemia and multiple gestatons
6. Premature ( less frequent)
7. Infant of drug dependent mother
 Diagnosis

Anamnesis Physical examination Additional examination

• Delivery under 39 • Premature of newborn • Thorax imaging,
weeks gestational with birth weight < 1500 • Complete Blood Count),
gram, • Blood culture,
age,
• Takipnea, • Arterial blood gas
• Sectio cesarea
• nostril, analysis,
without any sign of
• Retraction intercostal, • C-reactive protein (CRP).
delivery,
subcostal, and or
• Mother with Diabetes retraction suprasternal,
Mellitus Gestasional • Decrease of breath,
and asthma, • Ronkhi,
• Prematuritas. • Letargis ,
• Sianosis.
Lung Ultrasonography
 Therapy
Nutrition and
Respiratory relief Medication
hidration
• Keep warm in a • Nasal canul, • Diuretic
range • Nasal CPAP. therapy,
36,5−37,5oC, • Inhalation of
• Intake of fluids ephinefrin and
start at barrier b2-
40mL/kgBB/day agonis.
until
60mL/kgBB/day
in premature
baby use
Dextrose 10%.
CASE REPORT
 PATIENT’S IDENTITY
 Name : By. YS
 Age : 40 minutes
 Address : Rokan Hulu
 Addmision Date : 7th February 2018
Alloanamnesis was given by Patient’s mother

Chief
Complaint

Neonatus 40 minutes transfered

from Emergency Operating
Room with Respiratory distress
 History of Present Illness
• Neonatus was born on february, 07 2018 in Emergency
Operating Room RSUD Arifin Achmad by Electif Sectio
Cesarea with indication breech position and previous
sectio secaria . AS 7/8

• Resuscitation is done until free flow Oksigen. The

neonatus is aterm, clearest remaining amnionitic fluid,
crying after birth and cyanosis in extremity

• Neonatus was given vit K1 injection and eyes ointment.

 History of Present Illness

• After 40 minutes, neonatus seen Grunting,

tachypneu, substernal retraction and cyanosis in
extremity.

• The neonatus carries to IPN

History of Present Illness
• At the IPN, the temperature of baby is 34,9 C
RR 72 times/min, SPO2 78 % wihtout oxygen,
cyanosis in extremity, HR 126 times/min and
downe score is 5, is given CPAP FiO2 35% PEEP
7

• After the 5 minutes of treatment, the RR is 72

times/min, SPO2 95%, HR is 126 times/min and
cyanosis (-). The baby used OGT and fasting.
seizures (-) Vomit (-). the baby is hospitalized in
NICU and Incubator is 34 C
History Pragnancy
• ANC was 4 times with SpOG, last USG,
baby with breech presentation

• No history of bleeding, febris, trauma,

hypertention or diabetic during
pregnancy

• Mother had history of leukore and no

treatment
 History of Mother
1. Weight before pregnancy 50 kg, weight at
pregnancy 74 kg.
2. Mother’s height 137 cm.
3. Good nutrition.
4. BP: 110/70 mmHg.
5. Fundus uteri 30 cm
6. Mother was consumed iron tablets during
pregnancy.
7. Tetanus-Toxoid vaccine (-)
8. Pregnant exercise (-).
9. Blood examination (-) during pregnancy.
10. History of asthma (-), hypertension (-), diabetic (-),
allergic (-)
 History of Labour
Weight at Dibantu
Child Sex Year Delivery place
birth oleh

SC ai
1 F 2014 3800 breech Doctor HS
position

2 Now
 House and Enviroment Condition

•Permanent house
•Lighting and ventilation are good enough
•Fresh water from well
•Drinking water from gallon
•Income : Rp. 2.500.000,
 Parent’s Occupation

• Mother : Housewife
• Father : Entrepreneur
 Physical Examination
• General condition : Severe Illness
• Conciousness : alert

Vital Signs Nutrition

• BP :- • BL : 43cm
• Temp : 34,90C • BW : 2.450 g
• Pulse:125x/min • HC : 33 cm
• RR : 72 x/min • CW : 2.450 g
 HEAD & HAIR
EYES & EARS • Normocephal
• Pale conjungtival (-/-) • Normal sutura
• Sclera icteric (-/-)
• Pupil isokor
• Light reflex (+/+)
• None abnormality in
ears

THORAX
• Inspection: simmetrical
movement,retraction
ABDOMEN
(+) intercosta and
substernal • Inspection: normal
• Palpation: VF difficult • Palpation: hepar and
to defined spleen not palpable
• Percusion: sonor • Percusion: thympanic
• Auscultation: normal (+)
heart sound 1 & 2, • Auscultation: normal
vesicular (+/+) • Paten anus

GENITALIA:
Girls, no abnormality
 Problem List
 Aterm (36-38 weeks), Appropriate for
Gestation age , Low Birth Weight (2,450
grams)
 Respiratory distress e.c Susp. Transient
Tachypneu of Newborn (TTN), DD
Congenital Pneumonia, DD Early Onset
Sepsis
 Hypothermi
Lubchenco
Kurv
 THERAPY
• Hospitalized in NICU
• Keep warm in incubator
• Oxygenation with CPAP FiO2 35, PEEP 7
• IVFD D10% 80 cc/w/d
• NPO
• Ampicilin Sulbactam 175 mg/12 jam
• Amikasin 17,5 mg/12 jam
 Additional Examination
1. Routine Blood ,Septic Marker (SM)
(CRP,IT Ratio)
2. Glucose ( First hours)
2. Rotgen Babygram
Follow up
First Hours
NCB, SMK, BBLR Ocygen therapy with
Dyspneu Conciousness : Alert Respiratory distress BCPAP 35/7
(+),Grunting (-), HR : 125 x/menit sups ec TTN IVFD Dextrose 10% 8
Fever (-), Stool (-), RR : 72 x/menit Hiperglikemia cc/hr change with
Urine (-) Susp Sepsis Dextrose 5% 8 cc/h
Temp: 37,2 oC
Hospitalizing in
Blood glucose serial incubator
: 222 mg/dl NPO
Thorax: symetrical
movements,
retraction (+)
inetrcosta and
substernal,
bronkovesicular
breath, normal 1 dan
2 regular heart sounds
warm acral, CRT <2
sec, cyanosis (-).
 23.00 pm

Dyspneu Conciousness : Alert NCB, SMK, BBLR Ocygen therapy with

(+),Grunting (-), HR : 125 x/menit Respiratory distress BCPAP 35/7 tobe
Fever (-), Stool (+), RR : 72 x/menit ec susp TTN 25/6
Urine (+) Susp Sepsis IVFD Dextrose 10% 8
Temp: 37,2 oC
cc/hr
Blood glucose serial Hospitalizing in
: 111 mg/dl incubator
Thorax: symmetrical NPO
movements,
retraction (+)
intercosta and
substernal,
bronkovesicular
breath, normal 1 dan
2 regular heart sounds
warm acral, CRT <3
sec, cyanosis (-).
 07/02/2018

Laboratorium examination
Hemoglobin : 19,4 gr/dl
Hematokrit : 56,9 %
Trombosit : 168.000 u/L
Leukosit : 21.820 u/L
CRP : Reaktif 24 mg/dl
IT Ratio : 0,08
07/02/2018

Cor : Normal
Pulmo: infiltrate at the
fisura minor of dextra
lobe, prominen line at
perihiler
Abdomen : normal
Result : Suspect TTN
Thursday, Dyspneu Conciousness : NCB, SMK, BBLR Nasal canul
8/02/2018 (+),Grunting (-), Alert Respiratory Distress 0.5 L/menit
Day-2 Fever (-), icterik (- HR : 136 x/menit ec susp TTN ASI 5-10
), seizure (-),
RR : 62 x/menit cc/kgbb/3 hr
Stool (+), Urine
(+) Temp: 36,6 oC Cairan total
Blood glucose 80 ml /day
serial : 84 mg/dl Amikasin
Thorax: 17,5 mg /
symmetrical 12hr
movements, Ampisilin
retraction (+) Sulbactam
inetrcosta and 175 mg / 12hr
substernal, D10 % 1/5
bronkovesicular NS 80 cc/kg
breath, normal 1
dan 2 regular heart
sounds warm acral,
CRT <3 sec,
cyanosis (-).

Neonatus moves to
SCN 2
Friday, Dyspneu (+),Grunting (-), Conciousness : NCB, SMK, BBLR Stop Ocygen
09/02/2 Fever (-), icterik (-), Alert Respiratory Distress Stop D10%
018 seizure (-), Stool (+), ec susp TTN 1/5 NS
HR : 140
Urine (+)
x/menit ASI 30-40 cc/
.
Day-3 RR : 60 x/menit 3hr
Temp: 36,6 oC Ampicilin
sulbactam 175
Blood glucose
mg / 12hr
serial : 78 mg/dl
Amikasim
Thorax:
17,5 mg /
symmetrical
12hr
movements,
retraction (+)
inetrcosta and
substernal
bronkovesicular
breath, normal 1
dan 2 regular
heart sounds
warm acral, CRT
<2 sec, cyanosis
(-).
 Saturday/ Dyspneu (+),Grunting (-), Conciousness : NCB, SMK, BBLR ASI 50 cc / 3
10-02-2018 Fever (-), icterik (+), Alert Respiratory Distress hr
seizure (-), Stool (+), HR : 140 x/menit TTN Bactasin 17,5
Urine (+) Neonatus joundice
Day -4 RR : 60 x/menit mg / 12hr
Temp: 36,8 oC Amikasim
Blood glucose 17,5 mg / 12
serial : 78 mg/dl hr
Thorax: Fhototerapi
symmetrical
movements,
icteric(+),
Kremer grade
III
 Sunday Dyspneu (+),Grunting (-), Conciousness : NCB, SMK, BBLR ASI 50 cc / 3 jam
11-02-2018 Fever (-), icterik (+), Alert Respiratory Education to family
seizure (-), Stool (+), Urine HR : 137 x/menit Distress ecTTN Patient already go
(+) Neonatus jaundice home.
Day- 5 RR : 50 x/menit
.
Temp: 36,8 oC
Thorax:
symmetrical
movements,
retraction (+)
inetrcosta and
substernal,
Lab :
Hb : 17,6 g/dl
Ht : 46,7 %
Leukosit : 10.880
Ul
Trombosit :
288.000 Ul
Total Bilirubin :
9,02
Direct bilirubin :
0,22
Indirec bilirubin :
8,82
IT rasio : 0,14
CRP : Reaktif
192
Monday, Dyspneu (-),Grunting (-), Conciousness :  NCB, SMK,
12-02- Fever (-), icterik (-), Alert BBLR
2018 seizure (-), Stool (+), HR : 136  TTN
Urine (+). Baby active (+)
x/menit
.
Day-6 RR : 48 x/menit
Temp: 36,2 oC
Blood glucose
serial : 78
mg/dl
Thorax:
symmetrical
movements,
retraction (-)
Rooting reflex
(+)
DISCUSSION
 RISK
FACTOR
• Delivery under 39 weeks gestational age
• Elektif Sectio cesarea without any sign of
delivery
 Diagnosis
Physical
examination Additional
Anamnesa examination
- Tachypneu
- Delivery by SC X-baby gram
- Grunting
- Aterm finding: Suspect
- Retraction TTN
Sign and symptoms of respiratory distress can
happen in few hours of birth, in this case sign
and symptoms of respiratory distress happen in
first hours of birth.

The patient was given oxygenation with BCPAP

FiO2 35 % PEEP 7, nutrition was given by IVFD
D10% 80cc/Kg/day and NPO
First hour of life, was checked blood glucose serial, the
Result is 222 mg/dl. The conclusion is Hiperglikemia of
Newborn. This is because of the newborn have
respiratory distress.

After 6 hour, the blood glucose serial was checked

again. The Result is 111 mg/dl. The is stable blood
glucose
 In this Pasient with suspect Sepsis of Neonaturus because :
•RR > 60 x/I
• Hypotermi : 34,9 C
• mother with vaginal discharge, bad smell without treatment
In 3rd Day, The Newborn seen joundice. From the face to
abdomen. The conclusion is kramer grade 3 than was do
fhototherapy among 24 hours. The Recommended
examination are blood routine, Bilirubine and septic marker.
The result of Bilirubine total is 9,02 mg/dl

this is fisiology joundice of newborn. Because of : the

joundice occur after 24 hours of life, total birubine < 15
mg/dl, there is no abnormal fases. it will be normally for 14
days without treatment. The treatment of the fhototerapy
stopped.
Guidelines for phototherapy in hospitalized infant of 35 or
weeks gestations
Comparison other x-Ray of TTN with X-ray This
Case
Similar X-Ray TTN
 Similar Case Report about TTN
• A 3.2-kg female infant is delivered by caesarean section at
38 weeks’ gestational age without a trial of labor. Her
Apgar scores are 9 and 9 at 1 and 5 minutes, respectively.
She develops tachypnea and subcostal retractions with
nasal flaring at 1 hour of life. Temperature is 97.9°F
(36.6°C), pulse is 165 beats per minute, and respiratory
rate is 74 breaths per minute. Aside from increased work of
breathing, her physical examination findings are normal.
• The chest radiograph is shown in the picture. She requires
supplemental oxygen via nasal cannula with a fraction of
inspired oxygen (Fio2) of 0.3 for 36 hours. She then weans
to room air. Her respiratory rate is 35 breaths per minute,
and she has no increased work of breathing
Radiology
The treatment in this case to decrease morbidity
of the newborn with supportive treatment
The prognosis in this case is good, because
TTN is self limited disease
THANK YOU