Definition: Rapid breathing in the early days of life due to immaturity of the lungs or
decreased absorption of fetal lung fluid.
1. What caused this condition?
Rapid breathing (tachypnea) is a sign of an abnormality in the lungs. Causes for the rapid breathing can be lung fluid that did not clear quickly (transient tachypnea of newborn), inadequate levels of a substance (surfactant) in the lungs that prevents them from collapsing (respiratory distress syndrome), or infection (pneumonia).
2. What is actually taking place in the lungs?
The lungs are stiffer than normal and have a decreased ability to get oxygen into the bloodstream and carbon dioxide out. In some cases, there may be gradual collapsing of the small air sacs that, as it progresses, makes the condition worse.
3. How does it differ from pneumonia?
Pneumonia is caused by an infection. This condition is caused by either too much fluid in the lungs after delivery or decreased amounts of a chemical that stops the air sacs in the lungs from collapsing.
4. What tests are needed to further define this condition?
Chest X rays are the main test, but many of these conditions can appear the same on chest X ray. Often the way the baby acts after several hours will determine whether there is just fluid or if there is collapse occurring. Since infection is always a concern, a blood count and blood culture are also almost always done. A blood gas to deter- mine how well the lungs are functioning is also frequently performed.
5. How dangerous is this condition, and can we expect a complete recovery?
If there is extra fluid only, the condition is mild, and the baby gener- ally starts to get better several hours after treatment. If there are decreased amounts of surfactant present, then the baby will most likely need some type of breathing support. Decreased surfactant is a more significant condition with potentially more complications and a longer need for treatment. In both conditions the affected newborn generally makes a complete recovery.
6. What kind of treatment will be needed, and are there any potential negative side effects from the treatment?
In most cases either additional oxygen support and/or breathing support with a machine will be needed. An artificial form of the chemical to prevent lung collapse, surfactant, will be given to babies meeting levels of support to warrant its use. If artificial surfactant replacement is needed, then a breathing tube will be placed into the baby’s airway (trachea), and the chemical will be given directly into the lungs. The breathing tube may then be removed or kept in place and a form of breathing support will be started. This breathing support can either be through prongs that go in the baby’s nose or by a breathing machine (ventilator) attached to the breathing tube.
As with any abnormality in the lungs and need for breathing assis- tance, a hole can develop in the lung(s) that allows air to escape from the lung into the chest cavity (pneumothorax). As this air accumulates, it may compress the lungs and cause further worsening of the breathing condition. Many of these leaks require a drainage tube (chest tube) placed into the chest to remove this trapped air. Occasionally, these leaks can also occur within the lungs (pulmonary interstitial emphysema), under the skin, or around the heart. These may require different drainage tubes or special ventilators to treat.
7. How long will my baby need to stay in the hospital?
Depending on the severity and whether it is excess fluid or low levels of surfactant, the baby may stay in the hospital from three days to several weeks. Infants with excess fluid and mild surfactant shortage respond quickly and will have shorter stays. In all cases, the breathing concerns have to be resolved and the baby feeding by mouth prior to going home.
8. Will the treatment or the disorder weaken the lungs in the future and predispose my baby to future respiratory tract problems?
In most babies that are close to their due date or at their due date there are minimal long-term effects on the lungs. The majority of these babies will have no further respiratory concerns.
9. Will I be able to stay in the hospital until my baby is fully recovered?
The usual hospital stay for a mother is two to four days, depending on the type of delivery. Babies with excess fluid have a better chance of being able to be discharged with the mother. Mothers of infants with surfactant immaturity will most likely be discharged prior to the baby’s recovery.
10. Will any treatment be needed at home following discharge, and, if so, who will help me administer it?
It is unusual for babies that are not very premature to require any treatments after discharge. More premature babies may require supplemental oxygen, intermittent breathing treatments, or rarely, additional breathing support. Parents of babies with these needs will be trained prior to discharge and often spend one to two days and nights in the hospital with their baby prior to discharge. Sometimes a home nurse may assist or check in regarding the care of the baby after discharge.
11. Do we need to consult with a neonatologist (newborn specialist) or a pulmonary (lung) specialist?
Most babies with breathing issues that require them to be transferred to the neonatal intensive care unit will be cared for by a neonatologist. Pulmonary specialists are generally consulted near discharge if the baby is going to require breathing support at home.
12. Is this hospital capable of dealing with this disorder, or does my baby need to be transferred to another hospital that is more capable of dealing with difficult illnesses?
This depends on each hospital’s capabilities and pediatrician’s comfort level in treating sick newborns. Many smaller hospitals will attempt to take care of babies with excess fluid that just need additional oxygen and are stable or improving. If the baby’s condition is getting worse and breathing support is needed, that is generally done at larger hospitals that have special areas called neonatal intensive care units (NICUs) and neonatologists (newborn specialists).
13. After discharge from the hospital, what kind of follow-up will be needed?
This is dependent on the age of the baby at birth. If the baby was near its expected birth date, then usually care with the pediatrician is needed. The more premature the baby was will increase the potential need for pulmonology and developmental specialty care.
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