Clinical Analyses Of 1354 Cases Of Transient Tachypnea Of The Newborn

Objective :To explore the clinical features of 1354 cases of transient tachypnea of the newborn (TTN) with different gestational age, and to compare the relevant factors that impact the severity of the disease , provide theoretical basis to prevent the TTN and to increase the level of clinical diagnosis and treatment .Method:The clinical data of 1354 subjects with TTN that treated in our hospital from January in 2004 to January in 2010 were retrospectively analyzed , all the patients were divided into 4 groups according to gestational age, small gestational age preterm infants(GA<34w), late-preterm infants(34w≤GA<37w),term infants(34w≤GA<37w), post-term infants (GA≥42w).The main content included the basic information of the children, perinatal factors, clinical manifestations, chest X-ray examination treatment and outcome. Divided the cases of different gestational age (GA) into two groups depending on whether application of respiratory support (continuous positive airway pressure (CPAP) and mechanical ventilation),and compared the clinical factors with the two groups.The rank sum test was used to compare the continuous variables in skewed distribution and ordered categorical variable the chi square test was used to compare disordered categorical variables.Results: In the 1354 cases, all the gestational age patients are male dominated, each with 61.7%, 61.8%, 67.1%, and 62.5%. The patients with different GA have significant differences (P<0.05) in the mode of delivery, Apgar score, chest radiograph changes and maternal complications. Except for natural mode of delivery (51.2%) is dominated in patients less than 34 weeks, elective cesarean section are more common in the rest of gestational age patients (each 53.8%, 61.8%, and 50%). And the smaller the gestational age, more patients with Apgar score≤7 at 1minute,with 29.7% of patients less than 34 weeks , 24.3% of Late-preterm infants, 13% of term infants. There is significant difference (P <0.05) in Late-preterm and term infants compared with other gestational age patients. The rates of maternal complication of patients with different GA were high, each 57.8%, 70.5%, 60.8% and 62.5%, but the incidence of late-preterm and term infants compared with other gestational age was statistically significant (P < 0.05). In addition to the normal chests were more common (50%) in the patients of GA≥42w, the rest of patients are mainly typical wet lung(Alveolar fluid, interstitial fluid, pulmonary congestion) in X-ray chest changes, each with 55.5%, 51.2%, 43.3%, but the uneven ventilation in term infants were more common than patients in other gestational age (P <0.05). In our study, there was no complication in patients of GA≥42w, while patients with other GA were commonly complicated with pneumonia, each with 18.8%, 9.8%, 7.8%, there was statistically significant in the complication of pneumonia between patients less than 34w and the other two groups (P<0.01).Besides, the incidence of neonatal asphyxia was significantly higher in patients less than 34w than other gestational age (P <0.01). CPAP respiratory support were the mainly therapy of all the gestational age patients, each 82.3%, 72.3%, 48.4% and 37.5%, CPAP ventilation last for different time, the median were 4.30 days, 2.48 days, 1.82 days and 0.38 days separately, while the CPAP needed for longer time in patients less than 34w,which was significantly different (P<0.05).In the study of risk factor that impact the TTN severity, we found that all the GA patients were severity with admission respiratory frequent more than 60 per minute except for the patients of GA≥42w.Elective cesarean section was significant difference between the late-preterm and term patients who application of continuous positive airway pressure (CPAP) and mechanical ventilation or not(P <0.05), and to the term patients, the difference of recombinant, maternal complications, complications were also significant between two group ( P <0.05).Conclusion: 1.All patients of different GA were mainly mail gender; 2. elective cesarean section was the risk factors for patients in serious condition; 3. maternal complications and complications were risk factors for term infants in serious condition;4. The patients less than 34w were characteristic with low 1 minute Apgar score, high complication with pneumonia, CPAP respiratory support time.