PURPOSE: Respiratory morbidity is the most common problem among neonates admitted to neonatal intensive care units. Therefore, the aim of this study was to make a differential diagnosis between transient tachypnea of the newborn (TTN), respiratory distress syndrome (RDS), and pneumonia through comparison of clinical features and test results. METHODS: This retrospective study was conducted in 86 infants with TTN, RDS, or pneumonia. These were infants who had respiratory distress, were born after ≥34 weeks of gestation, and transferred to the neonatal intensive care unit of Kosin University Gospel Hospital between June 1, 2011 and June 30, 2016. RESULTS: The numbers (percentage) of infants with TTN, RDS, and pneumonia were 51 (59.3%), 20 (23.3%), and 15 (17.4%), respectively. Late-preterm and early-term newborns accounted for 65.1% of the infants. Tachypnea was observed in 74.4% of the neonates. The median age at admission was 4 hours (0 to 116) after birth. The infants with RDS had significantly lower birth weights, pH levels, base excess and oxygen saturation levels at admission, longer duration of total ventilator therapy, and hospital stay than those in the other two groups. The infants with pneumonia showed significantly high initial high-sensitivity C-reactive protein levels and significant chest radiographic findings. CONCLUSION: Early differential diagnosis for TTN, RDS, and pneumonia is challenging because they show similar respiratory symptoms at an early stage. Clinical features and test results can be used to determine the etiology of respiratory distress and early antibiotic treatment.
Birth Weight ; C-Reactive Protein ; Diagnosis, Differential ; Humans ; Hydrogen-Ion Concentration ; Infant ; Infant, Newborn* ; Intensive Care Units, Neonatal ; Intensive Care, Neonatal* ; Length of Stay ; Oxygen ; Parturition ; Pneumonia ; Pregnancy ; Radiography, Thoracic ; Respiration Disorders ; Retrospective Studies ; Tachypnea ; Transient Tachypnea of the Newborn ; Ventilators, Mechanical

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.
Anti-Bacterial Agents ; C-Reactive Protein ; Humans ; Infant ; Infant, Newborn ; Intensive Care, Neonatal ; Length of Stay ; Leukocyte Count ; Lung ; Neutrophils ; Oxygen ; Retrospective Studies ; Risk Factors ; Sepsis ; Thorax ; Transient Tachypnea of the Newborn*

OBJECTIVETo completely compare the risk factors, respiratory therapies and complications between respiratory distress syndrome (RDS) and transient tachypnea of newborn (TTN) in preterm infants.

METHODData were collected from preterm infants in Department of NICU, Peking University Third Hospital from January, 2013 to December, 2013. Components of clinical variables, including perinatal risk factors, ventilation therapies, pulmonary surfactant (PS) therapy, blood gas analysis and complications, were retrospectively analyzed. χ² test or Fisher's test or t test were used.

RESULTNinety-nine preterm infants mean gestational age was (31.9 ± 2.2) weeks and birth weight was (1 661 ± 501) g . Sixty-nine infants were diagnosed with TTN and 30 were diagnosed with RDS. There were significant differences in gestational age ((29.5 ± 2.5) vs. (32.0 ± 3.2) weeks, t = 6.046, P = 0.002), birth weight ((1 115 ± 415) vs. (1 660 ± 531) g, t = 5.916, P = 0.001). Nine cases in the RDS group had Apgar score ≤ 7 while four cases in the TTN group had Apgar score ≤ 7 (P = 0.001). Fourteen cases in RDS group were born through C-section while 55 cases of TTN group were born through C-section (P = 0.025). During 0-2 hours after birth, pH (7.25 ± 0.09 vs. 7.30 ± 0.01, t = -2.144, P = 0.046) was significantly lower in the RDS group. PaO₂((55 ± 20) vs. (41 ± 2) mmHg, 1 mmHg = 0.133 kPa, t = 2.963, P = 0.001) and oxigination index (OI) ((149 ± 58) vs.(100 ± 9) mmHg, t = 3.379, P = 0.003) were significantly lower in the TTN group. In the RDS group, all cases received PS therapy. Twenty-five cases received mechanical ventilation and five cases received noninvasive ventilation. In the TTN group, 12 cases received PS therapy. Forty-four cases received noninvasive ventilation and 25 cases received oxygen inhalation. The cases developing complications, including ventilator associated pneumonia (14(46.7%) vs.4(5.8%), P = 0.038), patent ductus arteriosus (19(63.3%) vs. 9(13.0%), P = 0.025), intraventricular hemorrhage (9(30.0%) vs. 2(2.9%), P = 0.041), bronchopulmonary dysplasia (12(40.0%) vs. 5(7.2%), P = 0.019), were significantly more in the RDS group.

CONCLUSIONRDS and TTN are common causes leading to early dyspnea in preterm infants. Preterm infants with RDS are characterized by younger gestational age, lower birth weight, severer acidosis and more complications. Preterm infants with TTN show lower hypoxemia and OI.

Apgar Score ; Birth Weight ; Blood Gas Analysis ; Bronchopulmonary Dysplasia ; Cesarean Section ; Ductus Arteriosus, Patent ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Infant, Premature ; Pregnancy ; Pulmonary Surfactants ; Respiration, Artificial ; Respiratory Distress Syndrome, Newborn ; Retrospective Studies ; Risk Factors ; Transient Tachypnea of the Newborn

INTRODUCTIONLate preterm (LP) neonates (34 to 36 weeks gestation) are often managed like term neonates though current literature has identified them to have greater complications. The primary objective of our study was to evaluate and compare morbidity and resource utilisation in LPs especially in view of paucity of Asian studies in this regard.

MATERIALS AND METHODSA retrospective audit was carried out on 12,459 neonates born in KK Women's and Children's Hospital (KKWCH). The chief outcome measures were hypoglycaemia, hypothermia, respiratory morbidity, feeding problems and neonatal jaundice. Resource utilisation included neonatal intensive care unit (NICU) admission, mechanical ventilation, parenteral nutrition and length of hospitalisation.

RESULTSOf 12,459 deliveries, 1221 (10%) were LP deliveries with a significantly increasing trend of 8.6% to 10% from 2002 to 2008 (P = 0.001). Neonatal morbidity in the form of hypoglycaemia (34 weeks vs 35 to 36 weeks vs term: 26% vs 16% vs 1%); hypothermia (5% vs 1.7% vs 0.2%); feeding difficulties (30% vs 9% vs 1.4%); respiratory distress syndrome (RDS) (4% vs 1% vs 0.1%); transient tachypnea of the newborn (TTNB) (23% vs 8% vs 3%) and neonatal jaundice (NNJ) needing phototherapy (63% vs 24% vs 8%), were significantly different between the 3 groups, with highest incidence in 34-week-old infants. Resource utilisation including intermittent positive pressure ventilation (IPPV) (15% vs 3.5% vs 1%), total parenteral nutrition/intravenous (TPN/IV) (53% vs 17% vs 3%) and length of stay (14 ± 22 days vs 4 ± 4.7 days vs 2.6 ± 3.9 days) was also significantly higher (P <0.001) in LPs.

CONCLUSIONLP neonates had significantly higher morbidity and resource utilisation compared to term infants. Among the LP group, 34-week-old infants had greater complications compared to infants born at 35 to 36 weeks.

Clinical Audit ; Feeding Behavior ; Female ; Humans ; Hypoglycemia ; epidemiology ; Hypothermia ; epidemiology ; Infant, Newborn ; Infant, Premature ; Intensive Care Units, Neonatal ; utilization ; Intermittent Positive-Pressure Ventilation ; utilization ; Jaundice, Neonatal ; epidemiology ; therapy ; Length of Stay ; statistics & numerical data ; Male ; Parenteral Nutrition ; utilization ; Parenteral Nutrition, Total ; utilization ; Phototherapy ; Premature Birth ; epidemiology ; Respiration, Artificial ; utilization ; Respiratory Distress Syndrome, Newborn ; epidemiology ; Retrospective Studies ; Singapore ; epidemiology ; Transient Tachypnea of the Newborn ; epidemiology

PURPOSE: This study aimed to investigate the respiratory morbidities in term neonates, as well as their relationship with mode of delivery and gestational age. METHODS: Medical records of term infants with respiratory symptoms, who were admitted to the neonatal intensive care unit (NICU) of Dong-A University Hospital from Jan 2008 to Dec 2013, were retrospectively reviewed. Term neonates with respiratory diseases, such as transient tachypnea of the newborn (TTN), respiratory distress syndrome (RDS), neonatal pneumonia, meconium aspiration syndrome (MAS), pneumothorax, and persistent pulmonary hypertension of the newborn (PPHN), were included. The respiratory morbidities were investigated according to the gestational age (<39 weeks vs. > or =39 weeks) and/or mode of delivery (with labor vs. without labor). RESULTS: A total of 260 term neonates were enrolled in the study. The average gestational age was 38(+6)+/-1.3 weeks, while the birth weight was 3,233.7+/-462.0 g. The most common respiratory disease encountered in term neonates was TTN (n=98, 37.7%), followed by MAS (n=76, 29.2%), spontaneous pneumothorax (n=27, 10.4%), PPHN (n=24, 9.2%), neonatal pneumonia (n=19, 7.3%), and RDS (n=16, 6.2%). Incidence of TTN and RDS was higher in neonates aged <39 weeks than in those aged > or =39 weeks. Higher incidence of spontaneous pneumothorax and RDS was observed in neonates delivered before the onset of labor. The incidences of TTN, spontaneous pneumothorax, and RDS were higher in the elective cesarean section group before 39 weeks of gestation. CONCLUSION: Respiratory morbidities in term neonates are affected by the gestational age (<39 weeks vs. > or =39 weeks) and/or mode of delivery (with labor vs. without labor).
Birth Weight ; Cesarean Section ; Female ; Gestational Age ; Humans ; Hypertension, Pulmonary ; Incidence ; Infant ; Infant, Newborn* ; Intensive Care, Neonatal ; Meconium Aspiration Syndrome ; Medical Records ; Pneumonia ; Pneumothorax ; Pregnancy ; Retrospective Studies ; Transient Tachypnea of the Newborn

PURPOSE: This study aimed to evaluate serum 25-hydroxyvitamin D [25(OH)D3] levels of full-term neonates in Daegu and Gyeongbuk province of Korea to determine the association between maternal and neonatal diseases, known to be affected by low 25(OH)D3 levels. METHODS: Serum 25(OH)D3 levels were evaluated in full-term neonates (n=122) who were born at Kyungpook National University Hospital. Normal full-term neonates (control group, n=38) were classified by sex, season of birth, and delivery mode (normal or caesarean section). Serum 25(OH)D3 levels in neonates (n=84) with maternal diseases (gestational diabetes mellitus, hypothyroidism, pregnancy induced hypertension, premature rupture of membrane and systemic lupus erythematosus) and neonatal diseases (small for gestational age, transient tachypnea of newborn and pneumonia) were compared with those in control group. RESULTS: The mean serum 25(OH)D3 level in the control group was 9.2+/-5.0 ng/mL. There were no statistically significant differences of serum 25(OH)D3 level between the control group and the disease group. In the control group, 63.2% of serum 25(OH)D3 levels referred to vitamin D deficiency, and 34.2% referred to vitamin D insufficiency. In the maternal disease group and the neonatal disease group, 56.1% and 63.0% of serum 25(OH)D3 levels referred to vitamin D deficiency, and 35.0% and 33.3% referred to vitamin D insufficiency. CONCLUSION: High percentages of neonates were found to be deficient or insufficient in vitamin D. Although low 25(OH)D3 levels have previously been associated with maternal and infant diseases, the association was not observed in this study.
Daegu* ; Diabetes Mellitus ; Female ; Gestational Age ; Gyeongsangbuk-do* ; Humans ; Hypertension, Pregnancy-Induced ; Hypothyroidism ; Infant ; Infant, Newborn* ; Korea* ; Membranes ; Parturition ; Pregnancy ; Rupture ; Seasons ; Transient Tachypnea of the Newborn ; Vitamin D Deficiency ; Vitamin D* ; Vitamins*

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.
Absorption ; Adrenergic beta-Agonists ; Albuterol* ; Humans ; Infant, Newborn ; Inhalation ; Intensive Care, Neonatal ; Lung ; Methods ; Oxygen ; Prospective Studies ; Tachypnea ; Transient Tachypnea of the Newborn*

BACKGROUND: This study was conducted to investigate the epidemiological features, clinical courses, and diagnoses of neonates who are transferred to neonatal intensive care unit of Yeungnam University Hospital due to tachypnea soon after birth. METHODS: Based on medical records, we performed a retrospective study of neonatal intensive care unit admissions due to tachypnea from January 2010 to December 2013. RESULTS: A total of 311 neonates were included in this study. The patient characteristics showed male predominance at 2.65:1. Among the 311 neonates with tachypnea, 127 (40.8%) neonates needed oxygen supply, and 54 (17.4%) neonates needed assisted mechanical ventilation. Transient tachypnea of the newborns (TTN) (158, 50.8%) showed the highest incidence, followed by pneumonia (63, 20.3%), extrapulmonary infection (37, 11.9%), respiratory distress syndrome (21, 6.8%), air leak (16, 5.1%), meconium aspiration syndrome (12, 3.9%), congenital heart disease (5, 1.6%), metabolic acidosis (3, 1%), primary pulmonary hypertension of newborns (2, 0.6%) and anemia (2, 0.6%). CONCLUSION: Although the neonates with tachypnea showed no other respiratory distress symptom, clinicians should be aware of the possibility of other pulmonary diseases as well as TTN and their extra-pulmonary causes. If tachypnea does not improve within a few hours, the clinician should consider further evaluation and management as soon as possible.
Acidosis ; Anemia ; Diagnosis* ; Heart Defects, Congenital ; Humans ; Hypertension, Pulmonary ; Incidence ; Infant, Newborn* ; Intensive Care, Neonatal ; Lung Diseases ; Male ; Meconium Aspiration Syndrome ; Medical Records ; Oxygen ; Parturition* ; Pneumonia ; Respiration, Artificial ; Retrospective Studies ; Tachypnea ; Transient Tachypnea of the Newborn

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.
Alanine Transaminase ; Amnion ; Aspartate Aminotransferases ; Asphyxia ; Biomarkers ; Creatine Kinase ; Humans ; Hypoxia-Ischemia, Brain ; Infant ; Infant, Newborn ; L-Lactate Dehydrogenase ; Myoglobin ; Parturition ; Plasma ; Retrospective Studies ; ROC Curve ; Rupture ; Sensitivity and Specificity ; Transient Tachypnea of the Newborn*

PURPOSE: We evaluate respiratory morbidities in infants beyond 35 weeks of gestation born via elective cesarean section by gestational age. METHODS: This is a retrospective study of 443 infants who were born at Seoul National University Hospital by elective cesarean section beyond 35 weeks of gestation from January 2011 to December 2012. We compared respiratory morbidities in four groups classified by gestational age (35(+0)-36(+6) weeks, 37(+0)-37(+6) weeks, 38(+0)-38(+6) weeks, 39(+0)-40(+6) weeks). RESULTS: There were significantly lower Apgar scores in the late-preterm infant group (35-36 weeks) compared to other term infant groups and the proportion of infants born from mothers with preeclampsia gradually decreased as gestational age increased. There were significant differences in O2 supplement, duration of O2 (>24 hours), checked chest radiography, transient tachypnea of newborn (TTN), transfer to neonatal intensive care unit (NICU), endotracheal intubation, and ventilator uses including nasal continuous positive airway pressure in four groups (P<0.05). By logistic regression analysis, compared to births at 38 weeks, births at 35-36 weeks and at 37 weeks were associated with an increased risk of respiratory morbidities [odds ratios (OR) and 95% confidence intervals (CI) for births at 35-36 weeks, 122.5 (17.4-863.4) for TTN; 54.0 (10.1-289.4) for transfer to NICU; 99.5 (14.9-666.2) for ventilator apply; OR and 95% CI for births at 37 weeks, 8.8 (1.6-50.1) for TTN; 5.3 (1.1-24.7) for transfer to NICU; 8.4 (1.5-47.7) for ventilator apply; P<0.05]. There were no significant differences in respiratory morbidities between births at 38 weeks and births at 39-40 weeks. CONCLUSION: Postponing the timing of elective cesarean section to beyond 38 weeks of gestation would be helpful in reducing the neonatal respiratory morbidities.
Cesarean Section* ; Continuous Positive Airway Pressure ; Female ; Gestational Age* ; Humans ; Infant ; Infant, Newborn* ; Intensive Care, Neonatal ; Intubation, Intratracheal ; Logistic Models ; Mothers ; Parturition ; Pre-Eclampsia ; Pregnancy ; Pregnancy* ; Radiography ; Respiration Disorders ; Retrospective Studies ; Seoul ; Term Birth ; Thorax ; Transient Tachypnea of the Newborn ; Ventilators, Mechanical