In TTN versus RDS, which statement accurately describes TTN’s typical course and appropriate management?

• A. TTN occurs in term or late preterm infants with rapid onset and basilar atelectasis; TTN typically improves within 24-72 hours with supportive care; RDS often requires surfactant and ventilation.
• B. TTN requires surfactant therapy; RDS resolves spontaneously.
• C. TTN and RDS have identical radiographs; management is identical.
• D. TTN is caused by congenital infection and resolves only after antibiotics.

Answer: (B)

TTN is a self-limited form of neonatal respiratory distress caused by delayed clearance of fetal lung fluid. It most often affects term or late preterm infants and tends to present soon after birth with rapid breathing and subtle basilar atelectasis on exam and imaging. The usual course is improvement with supportive care over 24 to 72 hours, without the need for surfactant or invasive ventilation. Oxygen or careful nasal CPAP is often all that’s required, and the infant stabilizes as the fluid is reabsorbed.

In contrast, respiratory distress syndrome arises from surfactant deficiency, so it commonly affects preterm infants and may require exogenous surfactant and, if needed, ventilation to maintain adequate oxygenation. Radiographs in RDS typically show a diffuse ground-glass appearance with possible air bronchograms, reflecting widespread alveolar collapse and poor aeration.

The statement that TTN requires surfactant therapy and that RDS resolves spontaneously is not accurate. TTN usually improves with supportive care alone, while RDS commonly needs surfactant replacement and ventilation.