- Design
- Quality-improvement initiative, before and after, Model for Improvement
- Population
- Infants ≥35 weeks with TTN in a level III and a level IV NICU
- Primary outcome
- NICU length of stay
- Effect
- 90 to 51 hours, with no rise in readmission or hypoglycaemia
This quality-improvement project in a level III and a level IV US neonatal unit targeted babies of 35 weeks or more admitted with transient tachypnoea of the newborn (TTN). Teams agreed a guideline, audited cases and built an electronic order set. Published in Pediatrics on 8 October 2026.
NICU stay fell from 90 to 51 hours. Babies fed sooner, spent less time on respiratory support, and had fewer cannulas, fewer intravenous fluids and less hyponatraemia. More went home on the same day as their birth parent. Readmissions, hypoglycaemia and breast milk exposure did not worsen.
TTN is common and usually self-limiting, yet babies often accumulate drips, nil-by-mouth orders and blood tests that prolong separation from their mothers. This shows much of that can be safely removed.
It is a before-and-after project in two units, so local practice and case mix will shape how far the results transfer. The principle is portable: feed early when breathing allows, avoid routine fluids, and wean support promptly.
- Start enteral feeds in TTN once the respiratory rate and work of breathing allow
- Avoid routine intravenous fluids and cannulas in babies who can feed
- Limit blood draws to those that will change management
- Wean respiratory support as soon as criteria are met, using a written protocol
- Keep mother and baby together wherever the baby's condition permits
Why it matters
Much of the care given to babies with a self-limiting condition may be prolonging their separation from their mothers.
Don't overread it
This was a before-and-after improvement project in two units, not a randomised trial.
The statistics, in plain English
Control charts track change over time against the unit's own baseline. A sustained shift after the interventions suggests a real change, but other changes in the units over the same period cannot be ruled out.
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