Mike: Hello, I'm Mike Clarke, podcast editor for the Cochrane Library. The Cochrane Neonatal Group has produced more than 400 reviews over the last two decades and, in February 2022, they published their overview of reviews of treatments for rapid breathing in babies. We asked two of the co-authors, Olga Romantsik and Matteo Bruschettini from Skåne University Hospital in Lund, Sweden, to tell us about the latest findings.

Matteo: Hello Olga. Let's begin with a few words about rapid breathing in babies.

Olga: Thanks Matteo. Rapid breathing shortly after birth, or more technically, transient tachypnoea of the newborn, is the most common cause of respiratory distress amongst babies. It's characterised by two elements: rapid breathing, that is more than 60 breaths per minute, and signs of difficulty in breathing. It typically appears within the first two hours of life in babies born at or after 34 weeks' of pregnancy and, although it usually improves without treatment, it might be associated with wheezing in late childhood and so it's important to review the evidence on possible ways to treat it. Hence this Cochrane overview and, Matteo, perhaps you might say something about this type of review.

Matteo: Sure. Among the hundreds of reviews from the Cochrane Neonatal Group, there are several assessing treatments for transient tachypnoea of the newborn and our overview has summarized this evidence base in a single coherent document. An Overview like this provides a broader, comprehensive approach than a standard Cochrane Review, where the primary studies are reported. By doing this, we hope to improve professional, patient and public understanding of the effectiveness and safety of various treatments for these tiny patients.

Olga: We included six Cochrane Reviews. Three of which assessed drugs which remove excess fluid from the lungs: salbutamol, epinephrine, corticosteroid, and another assessed diuretics, that promote the secretion of lung fluid in the urine. The other two reviews were of the effects of giving the babies a lesser quantity of fluids and of using respiratory support without putting a tube into their lungs. Matteo, I'll pass back to you to summarize the results for the duration of rapid breathing.

Matteo: We found that salbutamol may reduce the duration of rapid breathing compared to placebo but the studies on epinephrine, corticosteroids and giving a lesser quantity of fluids did not provide information on this outcome. In regard to the effect of diuretics compared to placebo or the effect of providing various types of respiratory support without inserting a tube into the lungs compared to oxygen or another type of breathing support, the evidence is very uncertain. Olga, please continue on the effects on need for mechanical ventilation.

Olga: There's also a lot of uncertainty about the effects on mechanical ventilation, in which a tube is inserted into the baby's lungs and a machine is used to help them breathe. Firstly, the studies on diuretics did not provide information on this outcome. While, for the other interventions, existing studies aren't able to show us clearly whether or not the tested drugs reduce the need for mechanical ventilation, or whether respiratory support without insertion of a tube into the lungs, or giving a lesser quantity of fluids is beneficial. This means that there are still many areas that need more research.

Matteo: Yes, we need large, randomised trials if we are to get reliable evidence on both the benefits and harms of these interventions for newborn babies with transient tachypnoea. These studies need to include assessment of the clinical course of the condition and it would also be good to see the testing of combinations of interventions, such as using non‐invasive respiratory support and salbutamol in the same infants.

Olga: Thanks. If someone would like to learn more about this topic how can they get hold of the review?

Matteo: That's easy, the review is published online, at Cochrane Library dot com. If people go to the website and search for 'overview tachypnea' they'll see the link to it.