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Virtual Pediatric Hospital: Paediapaedia: Wet Lung Disease (Transient Tachypnea of the Newborn) (TTN) (Retained Fetal Lung Liquid) Paediapaedia: Neonatal Chest Diseases

Wet Lung Disease (Transient Tachypnea of the Newborn) (TTN) (Retained Fetal Lung Liquid)

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed


Clinical Presentation:
Term infant delivered via cesarean section or a precipitous delivery with transient respiratory distress that develops in the first 6 hours of life, peaks between 6-36 hours of life, and gradually disappears by 48 to 72 hours of life. Clinically tachypnea, expiratory grunting, substernal retraction, and mild cyanosis are seen.

Etiology/Pathophysiology:
Retention or delay in clearing fetal lung liquid. Prior to birth the fetal lungs and airways are filled with fluid formed from an ultrafiltrate of plasma. During a normal vaginal delivery, 30% of this fluid is expelled by thoracic compression during transit through the vagina, 30% is cleared by the pulmonary lymphatics, and 40% is cleared by the pulmonary capillaries. When the thoracic compression is lacking or inefficient, such as in delivery via cesarean section or a precipitous delivery, there is retention and subsequent delay in the resorption of normal fetal lung liquid. Other causes of delay in the resorption of fetal lung liquid include prematurity, maternal diabetes, oversedation, and hypervolemic states.

Pathology:
Greater than normal amounts of fluid in the airways, alveoli, capillaries, and lymphatics.

Imaging Findings:
Symmetrical pattern of pulmonary congestion consisting of bilateral reticulonodular densities that are most prominent in the perihilar regions along with a slightly enlarged heart. icon gifPeripheral air trapping is present, leading to increased lung volume and scattered atelectasis. Small bilateral pleural effusions may be present. Air leak is rare. The chest x-ray returns to normal in 48-72 hours. icon gif

DDX:

References:
See References Chapter.

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