Predicting the severity of the course of transient tachypnea in full-term newborns in the delivery room

The aim of the work is to develop a method for predicting the severe course of transient tachypnea in full-term newborns in the delivery room to optimize treatment tactics and improve disease outcomes.

Materials and methods. Retrospective, clinical, observational, cohort study. The analysis included 201 newborns and 51 signs characterizing the history of pregnancy and childbirth, as well as the features of the clinical course of the disease.

Results. As a result of modelling the prognosis of the severity of the course of transient tachypnea newborns (TTNT), 3 variables were identified: the severity of respiratory distress syndrome according to the Downes scale in points, the Apgar score at 1 and 5 minutes in points. The practical solution of the presented method is to predict the risk of hospitalization of TTN patients in the neonatal intensive care unit at the stage of the delivery room with the development of primary respiratory disorders based on clinical data.

Discussion. Making a decision by a neonatologist about the need for early consultation of a TTN patient by a resuscitator is an important point in predicting the course of the disease, and the method we developed is an effective tool with high accuracy (80.9%), sensitivity (82.5%), and specificity (80.3%). The prognosis is carried out directly in the delivery room within a few minutes, it is not traumatic for the newborn, does not require the collection of biological material, expensive reagents or special equipment. We recommend the developed prognostic model to be introduced into the practice of maternity hospitals and perinatal centers to predict the severity of TTN and the risk of hospitalization in the NICU.

Contribution:
Shestak E.V. — the concept and design of the study, the collection and processing of material, writing the text;
Kovtun O.P. — research concept and design, editing;
All co-authors — approval of the final version of the article, responsibi­lity for the integrity of all its parts.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: April 02, 2022
Accepted: April 26, 2022
Published: May 07, 2022

1. Volodin N.N. Neonatology. National Leadership [Neonatologiya Natsional’noe rukovodstvo]. Moscow: GEOTAR-Media; 2019. (in Russian)

2. Raju T.N., Higgins R.D., Stark A.R., Leveno K.J. Optimizing care and outcome for late-preterm (near-term) infants: a summary of the workshop sponsored by the National Institute of Child Health and Human Development. Pediatrics. 2006; 118(3): 1207–14. https://doi.org/10.1542/peds.2006-0018

3. Kasap B., Duman N., Ozer E., Tatli M., Kumral A., Ozkan H. Transient tachypnea of the newborn: predictive factor for prolonged tachypnea. Pediatr. Int. 2008; 50(1): 81–4. https://doi.org/10.1111/j.1442-200X.2007.02535.x

4. Jain L. Respiratory morbidity in late-preterm infants: prevention is better than cure! Am. J. Perinatol. 2008; 25(2): 75–8. https://doi.org/10.1055/s-2007-1022471

5. Guglani L., Lakshminrusimha S., Ryan R.M. Transient tachypnea of the newborn. Pediatr. Rev. 2008; 29(11): e59–65. https://doi.org/10.1542/pir.29-11-e59

6. Yurdakök M. Transient tachypnea of the newborn: what is new? J. Matern. Fetal Neonatal Med. 2010; 23(Suppl. 3): 24–6. https://doi.org/10.3109/14767058.2010.507971

7. Gizzi C., Klifa R., Pattumelli M.G., Massenzi L., Taveira M., Shankar-Aguilera S., et al. Continuous positive airway pressure and the burden of care for transient tachypnea of the neonate: retrospective cohort study. Am. J. Perinatol. 2015; 32(10): 939–43. https://doi.org/10.1055/s-0034-1543988

8. Kahvecioğlu D., Çakır U., Yıldız D., Alan S., Erdeve Ö., Atasay B., et al. Transient tachypnea of the newborn: are there bedside clues for predicting the need of ventilation support? Turk. J. Pediatr. 2016; 58(4): 400–5. https://doi.org/10.24953/turkjped.2016.04.009

9. Weintraub A.S., Cadet C.T., Perez R., DeLorenzo E., Holzman I.R., Stroustrup A. Antibiotic use in newborns with transient tachypnea of the newborn. Neonatology. 2013; 103(3): 235–40. https://doi.org/10.1159/000346057

10. Ramachandrappa A., Rosenberg E.S., Wagoner S., Jain L. Morbidity and mortality in late preterm infants with severe hypoxic respiratory failure on extra-corporeal membrane oxygenation. J. Pediatr. 2011; 159(2): 192-8.e3. https://doi.org/10.1016/j.jpeds.2011.02.015

11. Lakshminrusimha S., Keszler M. Persistent pulmonary hypertension of the newborn. Neoreviews. 2015; 16(12): 680–92. https://doi.org/10.1542/neo.16-12-e680

12. Rocha G.M., Flor-De-Lima F.S., Guimaraes H.A. Persistent grunting respirations after birth. Minerva Pediatr. 2018; 70(3): 217–24. https://doi.org/10.23736/S0026-4946.16.04490-X

13. Moons K.G., Altman D.G., Reitsma J.B., Ioannidis J.P., Macaskill P., Steyerberg E.W., et al. Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD): explanation and elaboration. Ann. Intern. Med. 2015; 162(1): W1–73. https://doi.org/10.7326/M14-0698

14. Bolat F., Haspolat N.Y., Bolat G., Şahin M. Simple hematological markers in predicting the severity of transient tachypnea of newborn: new wine in old bottles. J. Trop. Pediatr. 2021; 67(6): fmab100. https://doi.org/10.1093/tropej/fmab100

15. Ilhan O., Bor M. Platelet mass index and prediction of severity of transient tachypnea of the newborn. Pediatr. Int. 2019; 61(7): 697–705. https://doi.org/10.1111/ped.13899

16. Oztekin O., Kalay S., Tayman C., Namuslu M., Celik H.T. Levels of ischemia-modified albumin in transient tachypnea of the newborn. Am. J. Perinatol. 2015; 30(2): 193–8. https://doi.org/10.1055/s-0034-1381319

17. Aydemir O., Aydemir C., Sarikabadayi Y.U., Altug N., Erdeve O., Uras N., et al. The role of plasma N-terminal pro-B-type natriuretic peptide in predicting the severity of transient tachypnea of the newborn. Early Hum. Dev. 2012; 88(5): 315–9. https://doi.org/10.1016/j.earlhumdev.2011.08.026

18. Bak S.Y., Shin Y.H., Jeon J.H., Park K.H., Kang J.H., Cha D.H., et al. Prognostic factors for treatment outcomes in transient tachypnea of the newborn. Pediatr. Int. 2012; 54(6): 875–80. https://doi.org/10.1111/j.1442-200X.2012.03693.x

19. Ozkiraz S., Gokmen Z., Boke S.B., Kilicdag H., Ozel D., Sert A. Lactate and lactate dehydrogenase in predicting the severity of transient tachypnea of the newborn. J. Matern. Fetal Neonatal Med. 2013; 26(12): 1245–8. https://doi.org/10.3109/14767058.2013.776532

20. Downes J.J., Vidyasagar D., Boggs T.R. Jr., Morrow G.M. 3rd. Respiratory distress syndrome of newborn infants. I. New clinical scoring system (RDS score) with acid-base and blood-gas correlations. Clin. Pediatr. (Phila). 1970; 9(6): 325–31. https://doi.org/10.1177/000992287000900607

21. Kovtun O.P., Shestak E.V. A method for predicting the course of transient tachypnea of newborns in full-term children. [Sposob prognozirovaniya techeniya tranzitornogo takhipnoe novorozhdennykh u donoshennykh detey]. Patent RF RU 2 766 813 С1; 2022. (in Russian)