Transient Tachypnea of the Newborn

(Neonatal Wet Lung Syndrome)

ByArcangela Lattari Balest, MD, University of Pittsburgh, School of Medicine

Reviewed ByAlicia R. Pekarsky, MD, State University of New York Upstate Medical University, Upstate Golisano Children's Hospital

Reviewed/Revised Modified Sept 2025

v1090017

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Transient tachypnea of the newborn is transient respiratory distress caused by delayed resorption of fetal lung fluid. Symptoms and signs include tachypnea, retractions, grunting, and nasal flaring. Diagnosis is suspected when there is respiratory distress shortly after birth and is confirmed by chest radiograph. Treatment is supportive care and oxygen.

Symptoms and Signs
Diagnosis
Treatment
Prognosis

Extensive physiologic changes accompany the birth process, sometimes unmasking conditions that posed no problem during intrauterine life. For that reason, a clinician with neonatal resuscitation skills should attend each birth. Gestational age and growth parameters help identify the risk of neonatal pathology.

Alveoli are fluid-filled before and at birth. Fluid clearance depends on hormones normally released during labor that stimulate alveolar fluid resorption and, to a lesser extent, on mechanical compression during labor and vaginal delivery.

Transient tachypnea of the newborn affects preterm infants, term infants delivered by elective cesarean delivery, and infants born with respiratory depression, all of whom may have delayed clearance of amniotic fluid from the fetal/neonatal lungs (1). Other risk factors include macrosomia, maternal diabetes and/or asthma, lower gestational age, and male sex (2). In infants delivered via cesarean, the absence of labor leads to reduce alveolar resorption as well as reduce mechanical compression. In premature infants, one causative factor is immaturity of the sodium channels in lung epithelial cells; these channels are responsible for absorbing sodium (and thus water) from the alveoli. (Mechanisms for normal resorption of fetal lung fluid are discussed in Neonatal Pulmonary Function.)

General references

1. Alhassen Z, Vali P, Guglani L, Lakshminrusimha S, Ryan RM. Recent Advances in Pathophysiology and Management of Transient Tachypnea of Newborn. J Perinatol. 2021;41(1):6-16. doi:10.1038/s41372-020-0757-3
2. Neri C, Sartorius V, De Luca D. Transient tachypnoea: new concepts on the commonest neonatal respiratory disorder. Eur Respir Rev. 2025;34(175):240112. Published 2025 Feb 5. doi:10.1183/16000617.0112-2024

Symptoms and Signs of Transient Tachypnea of Newborn

Transient tachypnea of the newborn is suspected when the infant develops respiratory distress shortly after birth.

Symptoms include tachypnea, intracostal and subcostal retractions, grunting, nasal flaring, and possible hypoxemia or cyanosis.

Diagnosis of Transient Tachypnea of Newborn

Physical examination, including respiratory rate and work of breathing
Chest radiograph
Complete blood count (CBC) and blood cultures

Tachypnea, retractions, or other signs of increased work of breathing are noted on physical examination.

Pneumonia, respiratory distress syndrome, and sepsis may have similar manifestations, so chest radiograph, CBC, and blood cultures usually are performed.

Chest radiograph shows normally inflated or hyperinflated lungs with streaky perihilar markings, giving the appearance of a shaggy heart border while the periphery of the lungs is clear. Fluid is often seen in the lung fissures.

If initial findings are indeterminate or suggest infection, antibiotics (eg, ampicillin, gentamicin) are given while awaiting culture results.If initial findings are indeterminate or suggest infection, antibiotics (eg, ampicillin, gentamicin) are given while awaiting culture results.

Treatment of Transient Tachypnea of Newborn

Oxygen
Sometimes additional respiratory support

Treatment of transient tachypnea of the newborn is supportive and involves giving oxygen and monitoring arterial blood gases or pulse oximetry.

Less frequently, infants with transient tachypnea of the newborn (TTN) may require continuous positive airway pressure (CPAP) and occasionally even mechanical ventilation.

No intervention clearly reduces the risk of or need for mechanical ventilation, but bronchodilators may slightly reduce the duration of tachypnea or hospital stay (1, 2).

Treatment references

1. Bruschettini M, Hassan KO, Romantsik O, Banzi R, Calevo MG, Moresco L. Interventions for the management of transient tachypnoea of the newborn - an overview of systematic reviews. Cochrane Database Syst Rev. 2022;2(2):CD013563. Published 2022 Feb 24. doi:10.1002/14651858.CD013563.pub2
2. Moresco L, Bruschettini M, Macchi M, Calevo MG. Salbutamol for transient tachypnea of the newborn. Cochrane Database Syst Rev. 2021;2(2):CD011878. Published 2021 Feb 5. doi:10.1002/14651858.CD011878.pub3

Prognosis for Transient Tachypnea of Newborn

A small number of infants with TTN develop persistent pulmonary hypertension or pneumothorax.

Recovery usually occurs within 2 to 3 days with minimal or no treatment.

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