Transient Tachypnoea of the Newborn (TTN)
A short-term cause of fast breathing in newborns that settles within 1–3 days with supportive care.
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- Dr Jubal John, FRACP
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- medical guides
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Take-home
TTN (“transient tachypnoea of the newborn”) means temporary fast breathing in a newborn from delayed lung-fluid clearance after birth. Most babies need only oxygen and time, typically resolving within 72 hours, and recover completely.
Why it happens
Before birth, your baby’s lungs are filled with fluid, and oxygen comes through the placenta. At birth, that fluid has to clear so the lungs can fill with air. Hormones released during labour help drive this clearance.
When the fluid clears more slowly, the baby’s lungs are still a little “wet” in the first hours of life. Breathing is harder and faster while the fluid absorbs.
Who is more likely to get TTN?
Risk factors
- Birth by caesarean section, especially before labour started
- Early term birth (37–38 weeks)
- Very quick vaginal delivery
- Babies of mothers with diabetes
- Babies of mothers with asthma
- Large birth weight
- Male babies (slightly more common)
None of these cause TTN on their own, many babies with these factors breathe normally. They just make TTN more likely.
What TTN looks like
Symptoms usually appear within 2 hours of birth and include:
- Fast breathing: more than 60 breaths per minute
- Grunting with each breath out
- Flaring nostrils
- Chest pulling in (between or under the ribs) with each breath
- Slight blue tinge around the mouth that settles with oxygen
- Baby may be too breathless to feed easily
This is different from the occasional irregular breathing or brief pauses (up to about 10 seconds) that are normal for all newborns.
How it is diagnosed
TTN is diagnosed after other more serious causes of fast breathing have been ruled out. Your baby’s care team will:
- Listen to the chest
- Check oxygen saturation continuously
- Take blood tests to check for infection
- Sometimes do a chest X-ray, which often shows extra fluid in the lung spaces
- Review breathing rate and work of breathing over time
TTN is a diagnosis by exclusion
Because TTN looks similar to infection (pneumonia or sepsis) or respiratory distress syndrome, babies are often started on antibiotics while tests come back. Antibiotics are stopped once infection is ruled out.
Treatment in the special care nursery
Most babies with TTN are cared for in Frances Perry House’s special care nursery. Treatment is supportive: helping your baby’s body do the work while the lungs clear.
Common supports
- Oxygen delivered through nasal prongs or cot oxygen
- CPAP (gentle positive pressure) for some babies to help keep airways open
- IV fluids if feeding is not safe until breathing settles
- Temperature control in an incubator or warmer
- Continuous monitoring of breathing, heart rate, and oxygen
- Antibiotics until infection is excluded
What happens over the next few days
- 0–6 hours: symptoms are usually most obvious; oxygen support often needed
- 12–24 hours: gradual improvement; oxygen may start to be reduced
- 24–72 hours: most babies breathe normally and can go back to mum’s room
- Full recovery: no long-term effects on the lungs are expected
How you can help
- Visit as much as you can: hearing your voice and feeling your touch is calming
- Skin-to-skin contact once your baby is stable, it stabilises heart rate, breathing, and temperature
- Express breast milk early and often even if your baby cannot feed yet; the nurses will store it for when feeding starts
- Ask questions: the team wants you to understand what they are seeing
- Take breaks: having a baby in special care is exhausting. Rest and eat.
Support for parents
Available support
- Frances Perry House has social work and pastoral care available to families during a special-care stay.
- The Royal Women’s Hospital next door can extend additional psychology and social work for transferred families.
- PANDA (1300 726 306) supports new parents through perinatal anxiety and depression.
When to be concerned
In hospital, nurses and doctors check your baby frequently, but tell staff straight away if:
Watch closely — MCH Line 13 22 29 for advice
Tell the nurse or midwife if:
- Breathing looks like it is getting harder, not easier
- Your baby’s colour is looking paler or more blue
- Your baby is feeding much less than before
- Your baby seems much more tired or floppy
Urgent: staff will respond immediately:
- Long pauses in breathing (over 15 seconds)
- Very blue lips or face
- Baby floppy and not responding
- Seizure-like movements
While your baby is in the hospital, your midwife or nurse can contact our specialist team 24 hours a day. At home, any severe breathing concern is a 000 call.
After discharge
Most babies with TTN go home on day 2–4, feeding normally, breathing at a normal rate (under 60 breaths per minute when settled), and needing no oxygen. Before discharge, the team will go through:
- A feeding plan (breast or bottle)
- A safe sleep refresher
- What to watch for over the next few weeks
- Your MCH and GP follow-up appointments
At home: when to seek help
Call 000 if at any point:
- Your baby is breathing very fast (over 60 breaths per minute at rest) or struggling
- Blue lips, tongue, or face
- Chest pulling in strongly with each breath
- Your baby is floppy, unresponsive, or having a seizure
- You cannot wake your baby for a feed
For non-emergency concerns (feeding, unsettled behaviour, jaundice, colour), ring us, your GP, or the Maternal & Child Health Line 13 22 29 (24 hours).
Long-term outlook
TTN is a self-limiting condition. After recovery:
- Lungs develop normally
- No increased risk of asthma or other lung conditions
- Normal growth and activity levels
- No special follow-up usually needed beyond routine checks
Summary
Key points to remember
- TTN is temporary fast breathing caused by slow lung-fluid clearance after birth
- Treatment is supportive, oxygen, monitoring, and time
- Most babies recover fully in 1–3 days
- There are no long-term effects on the lungs
- In hospital, speak up if anything worries you, the team is there 24/7