Maternal, perinatal, and neonatal factors associated with transient tachypnea of the newborn and its clinical course: a retrospective cohort study
Year: 2026
Type: article
Abstract: Transient tachypnea of the newborn (TTN) is one of the most common causes of respiratory distress in late-preterm and term neonates. Although TTN is generally considered a self-limiting condition, some infants require non-invasive or invasive respiratory support and prolonged hospitalization. Identifying perinatal and clinical factors associated with TTN development and disease severity may help improve early risk stratification and neonatal management. This study aimed to determine the maternal, perinatal, and neonatal risk factors associated with the development of TTN in infants born at ≥ 35 weeks of gestation and to evaluate factors related to disease prognosis, including respiratory support requirement, oxygen duration, and length of hospitalization. This retrospective cohort study was conducted in a tertiary neonatal intensive care unit between October 2018 and October 2020. Medical records of 3,974 infants born at ≥ 35 weeks of gestation were reviewed. Infants meeting the predefined clinical and radiological criteria for TTN were considered eligible. Infants whose respiratory distress was attributable to metabolic or hematologic disorders, meconium aspiration, hemodynamically significant congenital heart disease, congenital pneumonia, respiratory distress syndrome, or culture-proven sepsis, as well as those with major congenital or chromosomal anomalies, were excluded. Demographic characteristics, maternal and perinatal factors, laboratory findings, respiratory support modalities, treatment strategies, oxygen requirement, and length of hospitalization were recorded. Factors associated with TTN development and its clinical course, including respiratory support requirements, were analyzed. During the study period, 419 infants were initially identified as having TTN. After application of the prespecified exclusion criteria, 327 infants constituted the confirmed TTN cohort. Cesarean delivery was observed in 72% of cases, and 60% of affected infants were male. The frequency of twin pregnancy was significantly higher among infants with TTN ( p < 0.001). Maternal smoking during pregnancy was associated with increased rates of intubation and nSIMV requirement, longer duration of nSIMV support, prolonged oxygen therapy, and extended hospitalization (all p < 0.05). In the NICU, 94.2% of infants received nCPAP, 34.9% received nSIMV, and 9.5% underwent invasive mechanical ventilation; these modality-specific frequencies were not mutually exclusive because some infants received sequential escalation of respiratory support. Greater physiologic weight loss on the first postnatal day was associated with shorter oxygen requirement and hospitalization duration, whereas persistent weight loss on subsequent days was associated with increased FiO₂ requirement, longer oxygen therapy, and prolonged hospitalization. Pneumothorax occurred in five infants (1.5%), three of whom required invasive mechanical ventilation. All five infants recovered, and no TTN-related mortality occurred. In unadjusted comparisons, cesarean delivery, male sex, twin pregnancy, and maternal smoking during pregnancy were significantly associated with TTN. Maternal smoking was also associated with a more severe clinical course, including increased respiratory support requirement and prolonged hospitalization. Early physiologic weight loss appeared to be associated with a more favorable prognosis, whereas persistent weight loss during follow-up was linked to worse respiratory outcomes. These findings may contribute to early risk stratification and optimization of neonatal management strategies in infants with TTN.
Source: BMC Pediatrics
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,090
OpenAlex ID: W7225817760
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