Evaluating Clinical Outcomes and Physiological Perspectives in Studies Investigating Respiratory Support for Babies Born at Term With or at Risk of Transient Tachypnea: A Narrative Review
Frontiers in Pediatrics, vol. 10, pp. 878536
Abstract
Respiratory distress in the first few hours of life is a growing disease burden in otherwise healthy babies born at term (>37 weeks gestation). Babies born by cesarean section without labor (i.e., elective cesarean section) are at greater risk of developing respiratory distress due to elevated airway liquid volumes at birth. These babies are commonly diagnosed with transient tachypnea of the newborn (TTN) and historically treatments have mostly focused on enhancing airway liquid clearance pharmacologically or restricting fluid intake with limited success. Alternatively, a number of clinical studies have investigated the potential benefits of respiratory support in newborns with or at risk of TTN, but there is considerable heterogeneity in study designs and outcome measures. A literature search identified eight clinical studies investigating use of respiratory support on outcomes related to TTN in babies born at term. Study demographics including gestational age, mode of birth, antenatal corticosteroid exposure, TTN diagnosis, timing of intervention (prophylactic/interventional), respiratory support (type/interface/device/pressure), and study outcomes were compared. This narrative review provides an overview of factors within and between studies assessing respiratory support for preventing and/or treating TTN. In addition, we discuss the physiological understanding of how respiratory support aids lung function in newborns with elevated airway liquid volumes at birth. However, many questions remain regarding the timing of onset, pressure delivered, device/interface used and duration, and weaning of support. Future studies are required to address these gaps in knowledge to provide evidenced based recommendations for management of newborns with or at risk of TTN.
Authors 6
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Erin V. McGillick corresponding
Hudson Institute of Medical Research · Monash University
Affiliation as printed
Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia
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Arjan B. te Pas Aachen Division of Neonatology Department of Pediatrics, Leiden University Medical Center
Leiden University Medical Center
Affiliation as printed
Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
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Leiden University Medical Center · Vrije Universiteit Amsterdam
Affiliation as printed
Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, Netherlands
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Jiska Keus Aachen Division of Neonatology Department of Pediatrics, Leiden University Medical Center
Leiden University Medical Center
Affiliation as printed
Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
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Royal Women's Hospital · The University of Melbourne · Murdoch Children's Research Institute
Affiliation as printed
Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, VIC, Australia
Newborn Research, The Royal Women's Hospital, Melbourne, VIC, Australia
The Murdoch Children's Research Institute, Melbourne, VIC, Australia
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Hudson Institute of Medical Research · Monash University
Affiliation as printed
Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia
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