A term neonate born by elective cesarean section at 38 weeks develops tachypnea of 90 breaths per minute at 1 hour of life with mild retractions and oxygen requirement of 28%. He is otherwise vigorous with normal perfusion. Chest X-ray shows prominent pulmonary vascular markings, fluid in the minor fissure, and mild hyperinflation. Blood cultures are sent. What is the MOST appropriate next step?
- A Supportive care with supplemental oxygen and observe, expecting resolution within 72 hours ✓
- B Start broad spectrum antibiotics and intubate for surfactant
- C Start high frequency oscillatory ventilation
- D Administer furosemide to accelerate lung fluid clearance
Correct answer: A. Supportive care with supplemental oxygen and observe, expecting resolution within 72 hours
Explanation
This is transient tachypnea of the newborn, caused by delayed resorption of fetal lung fluid, classically after cesarean delivery without labor. The radiograph showing perihilar streaking, fluid in the fissures, and hyperinflation is characteristic. It is self-limiting, resolving within 24 to 72 hours with supportive oxygen. Surfactant and mechanical ventilation are reserved for RDS, and diuretics do not hasten resolution of TTN.
Reference: Nelson Textbook of Pediatrics, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.