Empirical Antibiotic Therapy in Transient Tachypnea of the Newborn

Purpose: Transient tachypnea of the newborn (TTN) is a respiratory disorder resulting from delayed clearance of fetal lung fluid. Initiation of empiric antibiotic therapy for possible early-onset sepsis is usually recommended until negative blood cultures for 48 hours. The aim of this study was to compare outcomes of infants with TTN managed with a risk-factor-based restrictive antibiotic use policy. Methods: A single institution retrospective study was conducted on full-term infants admitted with TTN from January, 2008 to December, 2013. Infants were stratified into two groups based on whether they received or did not receive antibiotics. The decision to administer antibiotics depended upon the covering physician at admission. The clinical and laboratory outcomes were evaluated between two groups. Result: A total of 98 full-term infants diagnosed with TTN were admitted to the neonatal intensive care unit; of them 39 (39.8%) received and 59 (60.2%) did not receive antibiotics. Physicians had tendency to start antibiotics in patient with mild-to-moderate chest retraction, need oxygen therapy, high white blood cell count, segmented neutrophil and positive C-reactive protein. All of them had negative blood cultures, no readmission, and no late-onset sepsis. The duration of hospital stay was longer in patients received antibiotics group (10.7±3.0 days vs. 9.0±4.4 days, P=0.04). Conclusion: This study suggests that empiric antibiotic therapy may not be recommended for full-term infants with classic TTN without perinatal risk factors. With the application of strict criteria for classic TTN and the close observation, the empiric use of antibiotics may be avoidable.