الفهرس 
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Abstract
Transient tachypnea of the newborn (TTN) is a parenchymal lung disease characterized by pulmonary edema caused by delayed absorption and removal of fetal alveolar fluid. TTN is the most common cause of neonatal respiratory distress in full term infants. It consists of a period of rapid breathing. Usually, this condition resolves over 24–72hours. TTN is a diagnosis of exclusion, it is primarily diagnosed based on medical history, typical clinical presentation, arterial blood gas analysis and chest X-ray may show a radiopaque line (fluid) in the horizontal fissure of the right lung, fluid infiltrate throughout alveoli or fluid in individual lung lobes and the lungs may also appear hyperinflated. Lung ultrasound (LUS) has been used to diagnose lung diseases in newborns with high accuracy, reliability, and simplicity and with no risk of radiation injury. LUS is an accurate, non invasive and reliable tool for diagnosing TTN and is valuable for the early and differential diagnosis of TTN. The most common ultrasonographic manifestations of TTN were double lung point (DLP), interstitial syndromes or white lungs, pleural line abnormalities. Electrical cardiometry has been proposed as a safe, accurate, and reproducible technique for hemodynamic measurement in children and infants. Fluid Status using electrical cardiometry was shown as thoracic fluid content (TFC), stroke volume variation (SVV) and corrected flow time (FTC). TFC is derived from the thoracic electrical base impedance (1/base impedance), which is dependent on thoracic intravascular and extravascular fluid content. TFC correlated both with the presence of respiratory distress and with its resolution in newborns with TTN. TFC correlated well with ultrasound in the estimation of extravascular lung fluid. The aim of this study was to evaluate TFC by electrical cardiometry versus lung ultrasound findings in the diagnosis of transient tachypnea of newborn in late preterm and full-term neonates. This was a prospective observational study that was conducted at Neonatal Intensive Care Unit (NICU) of Tanta University Hospitals. Eighty neonates with gestational age ≥ 34 weeks were enrolled during the period from January 2022 till December 2022. The study was approved by the local ethical committee of faculty of medicine, Tanta University (No. 34987/10/21). The study was registered at www.ClincalTrials.gov with ID: NCT05538780. Written parental consent was signed before the enrollment. Eighty newborns with gestational age ≥ 34 weeks were eligible for the study. Neonates with gestational age less than 34 weeks, major congenital abnormalities, congenital heart diseases, neonatal sepsis, other causes of respiratory distress (RD) were excluded from the study. All neonates included in the study were divided into two groups; TTN group in which 40 neonates with gestational age ≥ 34 weeks and diagnosed with TTN was included and control group which include 40 neonates with gestational age ≥ 34 weeks without respiratory distress. The diagnostic criteria for TTN were based on clinical and radiological criteria with exclusion of other causes for respiratory distress. All neonates were subjected to the followings: complete history taking (which include Peri-natal history and natal history of labor and delivery), clinical examination ( which include APGAR scoring in the first 5 minutes of birth, assessment of the gestational age (GA) at birth by the modified New Ballard score, Downs’ scoring and clinical TTN scoring and routine laboratory investigations (which include CBC, CRP, liver function tests (LFTs), renal function tests (RFTs), RBS, blood gases (ABG/CBG) and Serum electrolytes level. LUS were performed on all 40 neonates diagnosed with TTN (TTN Group) within the first 24 hours of life and repeated after 72 hours , and was also performed on the 40 neonates of control group within the first 24 hours of life by single neonatologist using Siemens Acuson X300 ultrasound machine (Siemens Health Care GmbH, Erlangen, Germany) with 13-5 MHz transducer along standardized vertical plans of the anterior and lateral chest walls of both lungs in the supine position, while the baby is quiet. Each area is scanned from the apex to the base. Lung ultrasound score: Basically, each lung was divided into 3 areas (upper anterior, lower anterior, and lateral) and for each lung area, a 0- to 3-point score was given (total score ranging from 0-18). Thoracic fluid content (TFC), corrected flow time (FTC) and stroke volume variation (SVV) were measured on all 40 neonates diagnosed with TTN (TTN group) within the first 24 hours of life and were repeated after 72 hours, and was also performed on the 40 neonates of control group (group II) within the first 24 hours of life by single neonatologist using EC, ICON (Osypka Medical GmbH, Berlin, Germany). Measurements were continuously done for 30s, and the average of the highest and lowest values was recorded, while the baby was quiet and in supine position. Also, chest X-ray to assess radiological signs consistent with TTN and exclusion of other causes of respiratory distress and echocardiography examination to exclude other causes of respiratory distress were done to all cases. The study revealed that: There was no statistically significant difference between TTN group and control group as regards sex, gestational age, APGAR 1 min, APGAR 5 min, birth weight, length, head circumference and ponderal index. There was a statistically significant difference between the two studied groups as regards mode of delivery as CS is associated with an increased occurrence of TTN. There was no statistically significant difference between the TTN group and control group as regards antenatal risk factors as antenatal steroids, DM, HTN, PROM, Placenta previa, multiple pregnancies, others as UTI and chorioamnionitis. There was no statistically significant between the TTN group and control group as regards pulse, blood pressure (systolic, diastolic, and mean), or temperature. There was no statistically significant difference between the TTN group and control group as regards Hb level, PLT, TLC, and IT ratio. As regards TFC, there was statistically significant increase in TFC in TTN group (D1) compared to control group, there was statistically significant decrease in TFC in D3 compared to D1 in TTN group. But there was no statistically significant difference between TTN group (D3) & control group. As regards FTC and SVV, there was no statistically significant difference between TTN group (D1 and D3). Also, there was no statistically significant difference between TTN group (D1) & control group and between TTN group (D3) & control group. Ultrasound findings in TTN as, double lung point sign (DLP) was present in 77.5 % TTN patients, pleural line abnormalities were found in all the cases of TTN, Alveolar interstitial syndrome (AIS) was observed in 85% TTN patients, White lung was present only in 15% TTN cases, and no pleural effusion was found in any of the patients. As regards LUS score, there was statistically significant increase in LUS score in TTN group (D1) compared to control group, there was statistically significant decrease in LUS score in D3 compared to D1 in TTN group. But, there was no statistically significant difference between TTN group (D3) & control group. There was significant positive correlation between TFC and (duration of O2 therapy, Downes’ score and TTN score) in the TTN group (D1 and D3). While, there was no significant correlation between TFC and (APGAR 1 min, APGAR 5min, Weight (kg), FTC, and SVV) in the TTN group (D1 and D3). There was no significant correlation between FTC or SVV and (gestational age, APGAR 1 min, APGAR 5 min, Downes’ score, TTN score, weight, duration of O2 therapy, TFC, and LUS score) in the TTN cases (D1 and D3). There was significant positive correlation between LUS score and duration of O2 therapy, Downes’ score and TTN score in the TTN group (D1 and D3). While, there was no significant correlation between LUS score and (APGAR 1 min, APGAR 5min, weight, FTC, and SVV) in the TTN group (D1 and D3). There was significant positive correlation between LUS score and TFC in the TTN group (D1 and D3). Sensitivity and specificity of TFC (D1) were 97.50 & 95.0 respectively (with cutoff > 40), while that of LUS (D1) were 92.50 & 72.50 respectively.