You weren’t expecting this. Your full-term baby arrived after a normal pregnancy, and then within hours, they’re in the NICU. Sometimes it’s due to a condition called transient tachypnea of the newborn (TTN), rapid, laboured breathing that resolves within days. In more serious cases, it’s due to persistent foetal circulation (PFC), a cardiac emergency where the baby’s heart fails to redirect blood properly after birth. As a paediatrician in Johannesburg, I explain these two conditions in newborns so parents understand what’s happening and why their baby needs temporary support.
From Womb to World: How Newborn Breathing Works
Before birth, your baby’s lungs aren’t breathing air, they’re filled with foetal lung fluid. Oxygen comes directly from mom through the umbilical cord. This is a remarkable system, but everything changes the moment your baby is born.
During vaginal delivery, contractions squeeze foetal lung fluid out of the lungs. When your baby takes that first breath, the lungs inflate, blood vessels open, and oxygen flows in. The transition is seamless.
After a caesarean section, there’s no squeezing action. Your baby must rely on their first breath to expel the fluid. Sometimes this doesn’t happen quickly enough, which is why caesarean section babies are more susceptible to this condition.
Transient Tachypnea of the Newborn: The Most Common Scenario
TTN is temporary; that’s what “transient” means. Babies struggle with rapid breathing (more than 60 breaths per minute) for 24 to 72 hours, then recover completely. It’s not very serious, but your baby will need NICU monitoring and support.
What causes transient tachypnea:
- Birth by caesarean section (most common)
- Premature birth
- Maternal asthma or diabetes
- Male gender (boys are more susceptible)
Signs your baby has TTN:
- Rapid, laboured breathing starting shortly after birth
- Flaring nostrils
- Grunting sounds
- Retractions (ribs pulling in with each breath)
- Blue-tinged lips or skin
How TTN Is Treated
Your doctor will confirm the diagnosis with a chest X-ray and blood test to check oxygen levels. Treatment depends on severity:
Mild cases: Oxygen via mask
Moderate cases: CPAP machine (provides continuous air pressure to keep airways open)
Supportive care: Tube feeding while your baby focuses energy on breathing
Most babies settle within 72 hours. Once recovered, there are no lasting effects, your child won’t experience ongoing breathing problems.
Persistent Foetal Circulation: The More Serious Condition
Normally, when your baby is born and takes that first breath, pressure in the heart changes, and a valve closes. Blood flows to the lungs, picks up oxygen, and normal circulation begins. With Persistent foetal circulation (PFC) or persistent pulmonary hypertension of the newborn (PPHN), this doesn’t happen. The valve stays open, blood bypasses the lungs, and your baby becomes dangerously oxygen-starved, which is why it requires immediate medical intervention.
PFC causes:
- Birth stress or difficult labour
- Meconium aspiration (baby swallows stool during delivery)
- Infection (sepsis or pneumonia)
- Physical abnormalities like diaphragmatic hernia
Signs of PFC:
- Severe blue discolouration (cyanosis)
- Extreme distress
- Rapid heart rate
- Severe breathing difficulty
Treatment requires:
- High-flow oxygen immediately
- Medications to relax lung vessels and balance pH
- Mechanical ventilation
- Urgent specialised care
Most full-term babies with PFC survive when medical staff recognise it quickly and provide intensive support.
Why NICU Admission Isn’t a Failure
The transition from womb to world is complex. So many incredible processes happen in those first minutes and hours. Sometimes babies need temporary help making this shift, and that’s what NICU exists for. Your healthcare team is there to support you both through this temporary challenge.
Worried about your newborn or had a NICU experience? Book a consultation at my Johannesburg practice. I’m here to answer your questions, review what happened, and support your family’s adjustment.
