Cyanosis in newborns: Difference between revisions

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==Overview==
==Overview==
[[Cyanosis]] is costructed from the word '''''kuaneos''''' which is greek for '''dark blue'''. It is categorized into two major types: peripheral and [[central cyanosis]]. [[Cyanosis]] is observed with an increase in the absolute [[concentration]] of deoxygenated [[hemoglobin]] to a level of 3-5g/dl. A structured way of grouping the common causes of [[cyanosis]] in [[newborns]] is by using the '''ABC''' which stands for '''''[[Airway]]''''', '''''[[Breathing]]''''', and '''''[[Circulation]]'''''. Persistent [[pulmonary hypertension]] of the [[newborn]] and [[Congenital heart diseases]] (CHD) are the common causes of [[newborn]] [[cyanosis]]. Common [[risk factors]] in the development of [[cyanosis]] in [[newborns]] are evident in the [[pregnancy]] and [[labor]] period. Prompt recognition, and administration of [[treatment]] modalities, with appropriate referral to the ideal [[hospital]] setting equipped to manage the [[diagnosis]], can improve prognosis. The primary [[symptom]] is the bluish/dark colored lips, [[mucous membrane]], and/or hands and feet. [[Breathing]] difficulties such as [[nasal]] flaring, chest retractions. Findings from [[physical examination|Exam]] include lethargy, [[conjunctival injection]], features of [[shock]], [[tachypnea]]. [[Laboratory findings]] include a [[Complete blood count]] and differentials showing ↑Packed cell volume([[PCV increased|PCV]]) suggesting [[polycythemia]], [[White blood cells|White cell]] count ([[Septicemia]]). It is seldom used however, an [[ECG]] may aid in the [[diagnosis]] of [[arrhythmias]] and [[dextrocardia]]. [[X-rays]] can show [[pulmonary]] causes like [[pulmonary]] [[hypoplasia]] and increased [[lung]] [[vascular]] markings in [[pulmonary edema]], [[bronchopneumonia]]. [[Echocardiography]] an be used when the diagnosis is equivocal or when [[physical exam]] findings and/or failed [[hyperoxia]] test suggests the presence of [[congenital heart disease]]. There are other imaging techniques used as adjuncts to making diagnoses. The immediate priority will be to optimize the [[neonate]], especially in severe [[cyanosis]]. [[Surgery]] is employed for more definitive treatment. The [[preventive care|preventive]] measures that can be adopted are; pre-conceptual [[counseling]] for expectant mothers especially women who are above the age of 35 years, routine [[prenatal]] and [[postnatal]] care for early detection of [[congenital anomalies]], and adequate preparedness for its management during [[pregnancy]], [[labor]], and [[delivery]].
[[Cyanosis]] is derived from the word '''''kuaneos''''' which is Greek for '''dark blue'''. It is categorized into two major types: [[Peripheral cyanosis|peripheral]] and [[central cyanosis]]. [[Cyanosis]] is observed with an increase in the absolute [[concentration]] of [[Deoxygenation|deoxygenated]] [[hemoglobin]] to a level of 3-5g/dl. A structured way of grouping the common [[causes]] of [[cyanosis]] in [[newborns]] is by using the '''ABC''' which stands for '''''[[Airway]]''''', '''''[[Breathing]]''''', and '''''[[Circulation]]'''''. Persistent [[pulmonary hypertension]] of the [[newborn]] and [[congenital heart diseases]] ([[CHD]]) are the common [[causes]] of [[newborn]] [[cyanosis]]. Common [[risk factors]] in the [[development]] of [[cyanosis]] in [[newborns]] are evident in the [[pregnancy]] and [[labor]] period. Prompt recognition, and administration of [[treatment]] modalities, with appropriate referral to the ideal [[hospital]] setting equipped to manage the [[diagnosis]], can improve the [[prognosis]]. The primary [[symptom]] is the [[Bluish lips|bluish]]/dark [[Color|colored]] [[lips]], [[mucous membrane]], and/or [[hands]] and [[feet]]. [[Patients]] can have [[breathing difficulties]] which can be seen as [[nasal]] flaring and [[chest]] retractions. Findings from [[physical examination|exam]] include [[lethargy]], [[conjunctival injection]], features of [[shock]], and [[tachypnea]]. [[Laboratory findings]] include a [[complete blood count]], and differentials showing [[Packed cell volume increased|packed cell volume]] ([[PCV increased|PCV]]) suggesting [[polycythemia]], and [[White blood cells|white cell]] count ([[septicemia]]). ECG is used seldomly, however, it may aid in the [[diagnosis]] of [[arrhythmias]] and [[dextrocardia]]. [[X-rays]] can show [[pulmonary]] [[causes]] such as [[pulmonary]] [[hypoplasia]] and increased [[lung]] [[vascular]] markings in [[pulmonary edema]], and [[bronchopneumonia]]. [[Echocardiography]] can be used when the [[diagnosis]] is equivocal or when [[physical exam]] findings and/or failed [[hyperoxia]] test suggests the presence of [[congenital heart disease]]. There are other [[Imaging studies|imaging techniques]] used as adjuncts to making [[Diagnosis|diagnoses]]. The immediate priority is to optimize the [[neonate]], especially in severe [[cyanosis]]. [[Surgery]] is employed for more definitive [[treatment]]. The [[preventive care|preventive]] [[Measure (mathematics)|measures]] that can be adopted include pre-conceptual [[counseling]] for expectant mothers especially [[women]] who are above the [[age]] of 35 [[Year|years]], routine [[prenatal]] and [[postnatal]] care for early [[Detection theory|detection]] of [[congenital anomalies]], and adequate preparedness for its management during [[pregnancy]], [[labor]], and [[delivery]].


==Historical Perspective==
==Historical Perspective==


*[[Cyanosis]] is built from the word '''''kuaneos''''' which is greek for '''''dark blue'''''. This is as a result of the bluish discoloration of the skin or [[mucous membranes]] depending on etiology. <ref name="pmid19727322">{{cite journal| author=Steinhorn RH| title=Evaluation and management of the cyanotic neonate. | journal=Clin Pediatr Emerg Med | year= 2008 | volume= 9 | issue= 3 | pages= 169-175 | pmid=19727322 | doi=10.1016/j.cpem.2008.06.006 | pmc=2598396 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19727322  }} </ref>
*[[Cyanosis]] is derived from the word '''''kuaneos''''' which is Greek for '''''dark blue'''''. This is a [[result]] of the [[bluish discoloration of the skin]] or [[mucous membranes]] depending on the [[etiology]].<ref name="pmid19727322">{{cite journal| author=Steinhorn RH| title=Evaluation and management of the cyanotic neonate. | journal=Clin Pediatr Emerg Med | year= 2008 | volume= 9 | issue= 3 | pages= 169-175 | pmid=19727322 | doi=10.1016/j.cpem.2008.06.006 | pmc=2598396 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19727322  }} </ref>


==Classification==
==Classification==
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==Pathophysiology==
==Pathophysiology==


*[[Central cyanosis]] results when there is a rise in the absolute [[concentration]] of deoxygenated [[hemoglobin]] to a 3-5g/dl. Deoxygenated hemoglobin is dusky blue or purple which causes the discoloration seen in [[skin]] and [[mucous membranes]] compared to bright red [[oxyhemoglobin]].<ref name="pmid19727322">{{cite journal| author=Steinhorn RH| title=Evaluation and management of the cyanotic neonate. | journal=Clin Pediatr Emerg Med | year= 2008 | volume= 9 | issue= 3 | pages= 169-175 | pmid=19727322 | doi=10.1016/j.cpem.2008.06.006 | pmc=2598396 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19727322  }} </ref>
*[[Central cyanosis]] occurs as a [[result]] of an increase in the absolute [[concentration]] of [[Deoxygenation|deoxygenated]] [[hemoglobin]] to 3-5 g/dl. [[Deoxygenation|Deoxygenated]] [[hemoglobin]] is dusky [[blue]] or [[Purple haze|purple]], which causes the discoloration seen in [[skin]] and [[mucous membranes]] as compared to the bright red [[oxyhemoglobin]].<ref name="pmid19727322">{{cite journal| author=Steinhorn RH| title=Evaluation and management of the cyanotic neonate. | journal=Clin Pediatr Emerg Med | year= 2008 | volume= 9 | issue= 3 | pages= 169-175 | pmid=19727322 | doi=10.1016/j.cpem.2008.06.006 | pmc=2598396 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19727322  }} </ref>
*[[Oxygen]] is transported in [[blood]] predominantly attached to [[hemoglobin]] while an insignificant amount is transported [[Dissolved oxygen|dissolved]] in [[plasma]]. Sufficient [[tissue]] [[perfusion]] relies on the concentration of [[saturated]] [[hemoglobin]].
*[[Oxygen]] is transported in [[blood]] predominantly attached to [[hemoglobin]] while an insignificant amount is transported [[Dissolved oxygen|dissolved]] in [[plasma]]. Sufficient [[tissue]] [[perfusion]] relies on the [[concentration]] of [[saturated]] [[hemoglobin]].
*With high [[hemoglobin]] concentrations (normal relative [[polycythemia]], 14-20g/dl) seen in normal [[infants]], [[cyanosis]] becomes apparent at higher [[PaO2]] (partial pressure of oxygen) compared to the setting of severe [[anemia]] where a far lower [[PaO2]] would lead to clinically recognizable [[cyanosis]] from very low [[hemoglobin]] concentration. Therefore, [[cyanosis]] depends on the concentration of deoxygenated [[hemoglobin]] and not merely [[oxygen saturation]]. As an example, a [[neonate]] with a [[hemoglobin]] concentration of 24g/dl exhibits signs of [[central cyanosis]] at 88% [[arterial]] [[saturation]] (SaO2) while [[cyanosis]] isn't clinically obvious in an [[anemic]] [[infant]] until SaO2 falls to about 62%. <ref name="pmid19727322">{{cite journal| author=Steinhorn RH| title=Evaluation and management of the cyanotic neonate. | journal=Clin Pediatr Emerg Med | year= 2008 | volume= 9 | issue= 3 | pages= 169-175 | pmid=19727322 | doi=10.1016/j.cpem.2008.06.006 | pmc=2598396 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19727322  }} </ref> <ref name="pmid3332361">{{cite journal| author=Lees MH, King DH| title=Cyanosis in the newborn. | journal=Pediatr Rev | year= 1987 | volume= 9 | issue= 2 | pages= 36-42 | pmid=3332361 | doi=10.1542/pir.9-2-36 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3332361  }} </ref>
*With high [[hemoglobin]] [[concentrations]] (normal relative [[polycythemia]],14-20 g/dl) seen in normal [[infants]], [[cyanosis]] becomes apparent at higher [[PaO2]] ([[partial pressure]] of [[oxygen]]) compared to the setting of severe [[anemia]], whereas a far lower [[PaO2]] leads to clinically recognizable [[cyanosis]] due to very low [[hemoglobin]] [[concentration]]. Therefore, [[cyanosis]] depends on the [[concentration]] of [[Deoxygenation|deoxygenated]] [[hemoglobin]] and not merely [[oxygen saturation]]. As an example, a [[neonate]] with a [[hemoglobin]] [[concentration]] of 24 g/dl exhibits [[signs]] of [[central cyanosis]] at 88% [[arterial]] [[saturation]] (SaO2) while [[cyanosis]] isn't clinically obvious in an [[anemic]] [[infant]] until SaO2 falls to about 62%.<ref name="pmid19727322">{{cite journal| author=Steinhorn RH| title=Evaluation and management of the cyanotic neonate. | journal=Clin Pediatr Emerg Med | year= 2008 | volume= 9 | issue= 3 | pages= 169-175 | pmid=19727322 | doi=10.1016/j.cpem.2008.06.006 | pmc=2598396 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19727322  }} </ref><ref name="pmid3332361">{{cite journal| author=Lees MH, King DH| title=Cyanosis in the newborn. | journal=Pediatr Rev | year= 1987 | volume= 9 | issue= 2 | pages= 36-42 | pmid=3332361 | doi=10.1542/pir.9-2-36 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3332361  }} </ref>
*[[Oxygen]] binding capabilities differ between [[fetal]] and [[adult hemoglobin]]. If a [[newborn]] has mostly adult [[hemoglobin]], [[cyanosis]] would be observed at an elevated [[PaO2]] 42-53mmHg which is comparable to an SaO2 of 75%-85% as opposed to predominantly [[fetal hemoglobin]]([[PaO2]] of 32-42mmHg); [[infants]] have varied proportions of [[adult]] and [[fetal hemoglobin]]. Therefore, a major reduction in [[PaO2]] would have set in before [[cyanosis]] becomes apparent in a [[newborn]] with elevated [[fetal hemoglobin]], a setting that shifts the [[oxygen-hemoglobin dissociation curve]] to the left. <ref name="pmid3332361">{{cite journal| author=Lees MH, King DH| title=Cyanosis in the newborn. | journal=Pediatr Rev | year= 1987 | volume= 9 | issue= 2 | pages= 36-42 | pmid=3332361 | doi=10.1542/pir.9-2-36 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3332361  }} </ref>
*[[Oxygen]] binding capacities differ between [[fetal]] and [[adult hemoglobin]]. If a [[newborn]] has mostly adult [[hemoglobin]], [[cyanosis]] would be observed at an elevated [[PaO2]] of 42-53 mmHg which is comparable to SaO2 of 75%-85% as opposed to the predominantly [[fetal hemoglobin]] ([[PaO2]] of 32-42 mmHg); [[infants]] have varied proportions of [[adult]] and [[fetal hemoglobin]]. Therefore, a major reduction in [[PaO2]] would have set in before [[cyanosis]] becomes apparent in a [[newborn]] with elevated [[fetal hemoglobin]], a setting that shifts the [[oxygen-hemoglobin dissociation curve]] to the left.<ref name="pmid3332361">{{cite journal| author=Lees MH, King DH| title=Cyanosis in the newborn. | journal=Pediatr Rev | year= 1987 | volume= 9 | issue= 2 | pages= 36-42 | pmid=3332361 | doi=10.1542/pir.9-2-36 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3332361  }} </ref>
*Several changes occur in the [[newborn]] from the first [[breath]]. Blood flow [[resistance]] decreases within the [[pulmonary vasculature]] as a result of a rise in [[oxygen]] tension; this increase in [[oxygen]] tension and [[pulmonary circulation]] causes functional closure of the [[patent ductus arteriosus (PDA)]]. Raised left [[atrial]] pressures closes the [[foramen ovale]]. The events resulting in the closures of those [[shunts]] invariably abolishes the right-to-left shunts of the precedent [[fetal circulation]]. The first breath also causes a net [[absorption]] of the [[fluid]] from the [[lungs]], causing its expansion and successfully initiates the [[gaseous]] exchange. Furthermore, removal of the low-[[pressure]] [[placental]] bed causes a rise in [[blood]] flow [[resistance]] of the [[systemic]] [[vasculature]]. These are the traditional [[physiological]] changes observed within the normal [[neonate]] after [[birth]]. <ref name="pmid19727322">{{cite journal| author=Steinhorn RH| title=Evaluation and management of the cyanotic neonate. | journal=Clin Pediatr Emerg Med | year= 2008 | volume= 9 | issue= 3 | pages= 169-175 | pmid=19727322 | doi=10.1016/j.cpem.2008.06.006 | pmc=2598396 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19727322  }} </ref>
*Several changes occur in the [[newborn]] from the first [[breath]]. [[Blood flow]] [[resistance]] decreases within the [[pulmonary vasculature]] as a result of a rise in [[oxygen]] tension; this increase in [[oxygen]] tension and [[pulmonary circulation]] causes functional closure of the [[patent ductus arteriosus (PDA)]]. Raised left [[atrial]] pressures closes the [[foramen ovale]]. The events resulting in the closures of these [[shunts]] invariably abolishes the right-to-left shunts of the precedent [[fetal circulation]]. The first breath also [[causes]] a net [[absorption]] of the [[fluid]] from the [[lungs]], causing its expansion and successfully initiates the [[gaseous]] [[Exchange interaction|exchange]]. Furthermore, removal of the low-[[pressure]] [[placental]] bed causes a rise in [[blood]] flow [[resistance]] of the [[systemic]] [[vasculature]]. These are the traditional [[physiological]] changes observed in a normal [[neonate]] after [[birth]].<ref name="pmid19727322">{{cite journal| author=Steinhorn RH| title=Evaluation and management of the cyanotic neonate. | journal=Clin Pediatr Emerg Med | year= 2008 | volume= 9 | issue= 3 | pages= 169-175 | pmid=19727322 | doi=10.1016/j.cpem.2008.06.006 | pmc=2598396 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19727322  }} </ref>
*Deviations from these may result in [[pathological]] [[conditions]] requiring immediate [[interventions]]; [[infants]], especially those born prematurely would require medical assistance for this phenomenal transition. <ref name="pmid25870083">{{cite journal| author=Hooper SB, olglase GR, Roehr CC| title=Cardiopulmonary changes with aeration of the newborn lung. | journal=Paediatr Respir Rev | year= 2015 | volume= 16 | issue= 3 | pages= 147-50 | pmid=25870083 | doi=10.1016/j.prrv.2015.03.003 | pmc=4526381 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25870083  }} </ref>
*Deviations from these may result in [[pathological]] [[conditions]] requiring immediate [[interventions]]; [[infants]], especially those born prematurely, would require medical assistance for this phenomenal transition.<ref name="pmid25870083">{{cite journal| author=Hooper SB, olglase GR, Roehr CC| title=Cardiopulmonary changes with aeration of the newborn lung. | journal=Paediatr Respir Rev | year= 2015 | volume= 16 | issue= 3 | pages= 147-50 | pmid=25870083 | doi=10.1016/j.prrv.2015.03.003 | pmc=4526381 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25870083  }} </ref>
*In [[peripheral cyanosis]], there's normal SaO2 with a rise in [[oxygen]] uptake by tissues leading to a wide arteriovenous difference within the [[venous]] aspect of the [[capillaries]]. [[Vasoconstriction]] could be a cause. This kind of [[cyanosis]] is seen majorly at the [[extremities]].
*In [[peripheral cyanosis]], there's normal SaO2 with a rise in [[oxygen]] uptake by the [[tissues]] leading to a wide arteriovenous difference within the [[venous]] aspect of the [[capillaries]]. [[Vasoconstriction]] could be a [[Causes|cause]]. This kind of [[cyanosis]] is seen majorly at the [[extremities]].


==Causes==
==Causes==


*A structured way of grouping the common causes of cyanosis in newborns is by using the '''ABC''' which stands for '''''[[Airway]]''''', '''''[[Breathing]]''''', and '''''[[Circulation]]'''''.
*A structured way of grouping the common [[causes]] of [[cyanosis in newborns]] is by using the '''ABC''' which stands for '''''[[Airway]]''''', '''''[[Breathing]]''''', and '''''[[Circulation]]'''''.


{{familytree/start}}
{{familytree/start}}
{{familytree | | | | | | A01 | | | | | | | | | | | | | | |A01=Causes of [[cyanosis]] in [[newborns]]}}
{{familytree | | | | | | A01 | | | | | | | | | | | | | | |A01=[[Causes]] of [[cyanosis]] in [[newborns]]}}
{{familytree | |,|-|-|-|-|+|-|-|-|-|.| | | | | | | | | |}}
{{familytree | |,|-|-|-|-|+|-|-|-|-|.| | | | | | | | | |}}
{{familytree | B01 | | | B02 | | | B03 | | | | | | | | | | | |B01=[[Airway]]|B02=[[Breathing]]|B03=[[Circulation]]}}
{{familytree | B01 | | | B02 | | | B03 | | | | | | | | | | | |B01=[[Airway]]|B02=[[Breathing]]|B03=[[Circulation]]}}
{{familytree | |!| | | | |!| | | | |!| | | | | | | | | |}}
{{familytree | |!| | | | |!| | | | |!| | | | | | | | | |}}
{{familytree | C01 | | | C02 | | | C03 | | | | | | | | | | | |C01=• [[Cystic hygroma]]<br>• [[Hemangioma]]<br>• [[Choanal atresia]]<br>• [[Micrognathia]]<br>• [[Laryngomalacia]]<br>• Tracheal [[stenosis]]<br>• [[Vascular rings]]<br>• [[Vocal cord]] [[paralysis]]<br>• Pierre Robin sequence|C02=• [[Phrenic nerve]] [[palsy]]<br>• [[Congenital diaphragmatic hernia]]<br>• Perinatal [[asphyxia]]<br>• Pulmonary hypoplasia<br>• Inborn errors of [[metabolism]]<br>• [[Central nervous system]] and muscle [[congenital anomalies]]<br>• [[Neonatal sepsis]]<br>• Neonatal [[botulism]]<br>• [[Congenital cystic adenomatoid malformation]]<br>• [[Pneumonia]]|C03=• [[Congenital heart diseases]]<br> [[Tetralogy of Fallot]]  
{{familytree | C01 | | | C02 | | | C03 | | | | | | | | | | | |C01=• [[Cystic hygroma]]<br>• [[Hemangioma]]<br>• [[Choanal atresia]]<br>• [[Micrognathia]]<br>• [[Laryngomalacia]]<br>• Tracheal [[stenosis]]<br>• [[Vascular rings]]<br>• [[Vocal cord]] [[paralysis]]<br>• [[Pierre Robin]] sequence|C02=• [[Phrenic nerve]] [[palsy]]<br>• [[Congenital diaphragmatic hernia]]<br>• [[Perinatal]] [[asphyxia]]<br>• [[Pulmonary]] [[hypoplasia]]<br>• [[Inborn errors of metabolism]]<br>• [[Central nervous system]] and [[muscle]] [[congenital anomalies]]<br>• [[Neonatal sepsis]]<br>• [[Neonatal]] [[botulism]]<br>• [[Congenital cystic adenomatoid malformation]]<br>• [[Pneumonia]]|C03=• [[Congenital heart diseases]]<br> [[Tetralogy of Fallot]]  
  (TOF)<br> [[Tricuspid atresia]]<br> [[Pulmonary atresia]]<br> [[Pulmonary stenosis]]<br> [[Ebstein's anomaly]]<br> [[Transposition of great arteries]] (TGA)<br> [[Hypoplastic left heart syndrome]]<br> [[Atrioventricular]] canal defect<br> Total anomalous pulmonary [[venous return]] (TAPVR)<br>• [[Anemia]]<br>• [[Methemoglobinemia]]<br>• [[Polycythemia]]<br>• Persistent [[pulmonary hypertension]]}}
  ([[TOF]])<br> [[Tricuspid atresia]]<br> [[Pulmonary atresia]]<br> [[Pulmonary stenosis]]<br> [[Ebstein's anomaly]]<br> [[Transposition of great arteries]] ([[TGA]])<br> [[Hypoplastic left heart syndrome]]<br> [[Atrioventricular]] canal defect<br> Total anomalous [[pulmonary]] [[venous return]] (TAPVR)<br>• [[Anemia]]<br>• [[Methemoglobinemia]]<br>• [[Polycythemia]]<br>• Persistent [[pulmonary hypertension]]}}
{{familytree | | | | | | | | | | | | | | | | | | | | | |}}
{{familytree | | | | | | | | | | | | | | | | | | | | | |}}
{{familytree/end}}
{{familytree/end}}
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==Epidemiology and Demographics==
==Epidemiology and Demographics==


*Persistent [[pulmonary hypertension]] of the [[newborn]] and [[Congenital heart diseases]] (CHD) are the common causes of [[newborn]] [[cyanosis]]. Common in older kids are [[respiratory]] [[diseases]]. <ref>https://pediatriccare.solutions.aap.org/chapter.aspx?sectionid=108722941&bookid=1626</ref> <ref name="pmid29763177">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=29763177 | doi= | pmc= | url= }} </ref>
*Persistent [[pulmonary hypertension]] of the [[newborn]] and [[Congenital heart diseases]] ([[CHD]]) are the common [[causes]] of [[newborn]] [[cyanosis]]. Common in older kids are [[respiratory]] [[diseases]].<ref>https://pediatriccare.solutions.aap.org/chapter.aspx?sectionid=108722941&bookid=1626</ref><ref name="pmid29763177">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=29763177 | doi= | pmc= | url= }} </ref>
*[[Tetralogy of Fallot]] (TOF) followed closely by the Transposition of Great Arteries ([[TGA]]) are the commonest causes of CHD.<ref name="pmid29763177">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=29763177 | doi= | pmc= | url= }} </ref>
*[[Tetralogy of Fallot]] ([[Tetralogy of Fallot|TOF]]) followed closely by the [[Transposition of the Great Arteries|Transposition of Great Arteries]] ([[TGA]]) are the commonest [[causes]] of [[CHD]].<ref name="pmid29763177">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=29763177 | doi= | pmc= | url= }} </ref>


===Age===
===Age===


*[[Newborns]] are more prone to cyanosis due to the peculiarities of [[birth]] and the changes that occur during the [[transition]] from [[fetal]] to neonatal life and/or due to [[congenital]] or [[acquired]] [[disorders]].
*[[Newborns]] are more prone to [[cyanosis]] due to the peculiarities of [[birth]] and the changes that occur during the [[transition]] from [[fetal]] to [[neonatal]] life and/or due to [[congenital]] or [[acquired]] [[disorders]].
 
===Gender===
 
*No documented evidence of gender predilection.
 
===Race===
 
*No particular racial tendency for [[cyanosis]] in [[newborns]].


==Risk Factors==
==Risk Factors==


*Common [[risk factors]] in the development of [[cyanosis]] in [[newborns]] are evident in the [[pregnancy]] and [[labor]] period. <ref>https://learn.pediatrics.ubc.ca/body-systems/neonate/approach-to-neonatal-cyanosis/</ref>
*Common [[risk factors]] for the [[development]] of [[cyanosis]] in [[newborns]] are evident in the [[pregnancy]] and [[labor]] period.
*[[Pregnancy]]-related [[risk factors]] are:
*[[Pregnancy]]-related [[risk factors]] include:
**Advanced age of the mother
**Advanced [[age]] of the mother
**[[Pregnancy-induced hypertension]]
**[[Pregnancy-induced hypertension]]
**[[Gestational diabetes]]
**[[Gestational diabetes]]
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**[[Oligohydramnios]]
**[[Oligohydramnios]]
**[[Polyhydramnios]]
**[[Polyhydramnios]]
*[[Labor]] and [[birth]]-related risk factors are:
*[[Labor]] and [[birth]]-related [[risk factors]] include:
**[[Cesarean section]]
**[[Cesarean section]]
**[[Preterm]]/[[prematurity]]
**[[Preterm]]/[[prematurity]]
**Use of [[Anesthetic agents|anesthetic]] drugs and/or [[sedatives]]
**Use of [[Anesthetic agents|anesthetic]] [[drugs]] and/or [[sedatives]]
**[[Premature rupture of membranes]] ([[PROM]])
**[[Premature rupture of membranes]] ([[PROM]])
**[[Meconium aspiration syndrome|Meconium aspiration]]
**[[Meconium aspiration syndrome|Meconium aspiration]]
**Difficult/assisted vaginal delivery
**Difficult/assisted [[vaginal]] [[delivery]]


==Natural History, Complications and Prognosis==
==Natural History, Complications and Prognosis==
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**[[Stroke]]
**[[Stroke]]
**[[Sudden Cardiac Arrest]]
**[[Sudden Cardiac Arrest]]
**Repeated [[respiratory tract infections]] in [[infants]] with unrepaired [[heart defects]] which can be severe.
**Repeated [[respiratory tract infections]] in [[infants]] with unrepaired [[heart defects]] which can be severe
**[[Developmental delays]] ranging from [[Motor skill|motor]] to [[cognitive]]
**[[Developmental delays]] ranging from [[Motor skill|motor]] to [[cognitive]]
**Various forms of disabilities
**Various forms of [[Disability|disabilities]]
**[[Arrhythmias]]
**[[Arrhythmias]]
**[[Heart failure]]
**[[Heart failure]]
*Prompt recognition, and administration of [[treatment]] modalities, with appropriate referral to the ideal [[hospital]] setting equipped to manage the [[diagnosis]], can improve prognosis.
*Prompt recognition, and administration of [[treatment]] modalities, with appropriate referral to the ideal [[hospital]] setting equipped to manage the [[diagnosis]], can improve the [[prognosis]].
*[[Mortality]] is high in [[newborns]] with critical CHD however, there has been an encouraging improvement in one-year survival to 75% following advances in [[treatment]]. 69% of these [[babies]] can survive to the age of 18 years. <ref name="pmid19727322">{{cite journal| author=Steinhorn RH| title=Evaluation and management of the cyanotic neonate. | journal=Clin Pediatr Emerg Med | year= 2008 | volume= 9 | issue= 3 | pages= 169-175 | pmid=19727322 | doi=10.1016/j.cpem.2008.06.006 | pmc=2598396 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19727322  }} </ref><ref name="pmid29763177">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=29763177 | doi= | pmc= | url= }} </ref>
*[[Mortality]] is high in [[newborns]] with critical [[CHD]] however, there has been an encouraging improvement in one-year survival to 75% following advances in [[treatment]]. 69% of these [[babies]] can survive to the [[age]] of 18 [[Year|years]].<ref name="pmid19727322">{{cite journal| author=Steinhorn RH| title=Evaluation and management of the cyanotic neonate. | journal=Clin Pediatr Emerg Med | year= 2008 | volume= 9 | issue= 3 | pages= 169-175 | pmid=19727322 | doi=10.1016/j.cpem.2008.06.006 | pmc=2598396 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19727322  }} </ref><ref name="pmid29763177">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=29763177 | doi= | pmc= | url= }} </ref>


==Diagnosis==
==Diagnosis==
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===Symptoms===
===Symptoms===


*Primary [[symptom]] is the bluish/dark colored lips, [[mucous membranes]], and/or hands and feet.
*Primary [[symptom]] is the [[Bluish color of the lips or skin|bluish/dark colored lips]], [[mucous membranes]], and/or [[hands]] and [[feet]]
*Other [[symptoms]] include the following:
*Other [[symptoms]] include the following:
**Breathing difficulties such as:
**[[Breathing difficulties]] evident as:
***Nasal flaring
***[[Nasal]] flaring
***Chest retractions
***[[Chest]] [[Retraction|retractions]]
***Fast [[breathing]]
***Fast [[breathing]]
***Slow breathing
***Slow [[breathing]]
***[[Irregular]] breathing
***[[Irregular]] [[breathing]]
***History of momentary cessations of breathing
***History of momentary cessations of [[breathing]]
**Pausing/excessive [[sweating]] or [[crying]] while [[feeding]]
**Pausing/excessive [[sweating]] or [[crying]] while [[feeding]]
**Small volume of feeds
**Small [[volume]] of [[Feeding|feeds]]
**Small for age/poor [[weight gain]]
**Small for [[age]]/poor [[weight gain]]
**Large for age
**Large for [[age]]
**Fixed/immobile arms suggesting [[paralysis]] from [[birth trauma]]
**[[Fixation|Fixed]]/immobile [[Arm|arms]] suggesting [[paralysis]] from [[birth trauma]]
**Increasing head cicumference with\without [[scalp]] [[injuries]] from a difficult [[delivery]]
**Increasing [[head]] circumference with\without [[scalp]] [[injuries]] resulting from a difficult [[delivery]]
**Hypo/[[hyperactive]] [[child]]
**Hypo/[[hyperactive]] [[child]]


===Physical Examination===
===Physical Examination===


*[[Patients]] usually appear [[cyanotic]]
*[[Patients]] usually [[Appearance|appear]] [[cyanotic]].
*Other [[examination]] findings relates to the etiology which can include:
*Depending on the underlying [[etiology]], other [[examination]] findings may include the following:
**[[Lethargy]]
**[[Lethargy]]
**[[Conjunctival]] injection
**[[Conjunctival]] [[injection]]
**Features of [[shock]]
**Features of [[shock]]
**[[Tachypnea]]
**[[Tachypnea]]
**Periodic breathing
**Periodic [[breathing]]
**Apneic spells
**[[Apnea|Apneic]] spells
**Use of accessory [[muscles]] of [[respiration]]
**Use of [[accessory]] [[muscles]] of [[respiration]]
**Flaring of the alar nasa
**Flaring of the [[alar]] [[Nasal|nasa]]
**Tube or [[catheter]] carefully inserted into the nasal cavity if suspicion is high for [[Choanal atresia]]
**Tube or [[catheter]] carefully [[Insert|inserted]] into the [[nasal cavity]] if suspicion is high for [[choanal atresia]]
**[[Tachycardia]]
**[[Tachycardia]]
**Abnormal [[heart sounds]]/[[murmurs]]
**[[Abnormal]] [[heart sounds]]/[[murmurs]]
**Weak peripheral [[pulses]] especially [[femoral]]
**[[Weak (thready) pulse|Weak peripheral pulses]] especially [[femoral]] [[pulse]]
**Fine [[crackles]] in lower [[lung]] fields
**Fine [[crackles]] in lower [[lung]] fields
**[[Hepatomegaly]]
**[[Hepatomegaly]]
**[[Scaphoid]] [[abdomen]](in [[diaphragmatic hernia]])
**[[Scaphoid]] [[abdomen]] (in [[diaphragmatic hernia]])
**Erb's [[paralysis]]
**[[Erb's palsy|Erb's paralysis]]
**[[Scalp]] [[injuries]]
**[[Scalp]] [[injuries]]
**[[Seizures]]
**[[Seizures]]
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===Laboratory Findings===
===Laboratory Findings===


*[[Complete blood count]] and differentials
*[[Complete blood count]] and differentials:
**↑Packed cell volume([[PCV increased|PCV]])- [[Polycythemia]]
**[[Packed cell volume increased|Increased packed cell volume]] ([[PCV increased|PCV]])- [[polycythemia]]
**[[White blood cells|White cell]] count- [[Septicemia]]
**Increased [[White blood cells|white cell]] count- [[septicemia]]
*Complete metabolic panel- [[electrolyte imbalance]] ([[metabolic acidosis]])
*Complete metabolic panel- [[electrolyte imbalance]] ([[metabolic acidosis]])
*[[Serum glucose]]- hypo or [[hyperglycemia]]
*[[Serum glucose]]- hypo or [[hyperglycemia]]
*[[Hyperoxia]] Test- differentiates [[pulmonary]] from a [[cardiovascular]] cause. An increase in [[PaO2]] to 100mmHg or more after administering 100% [[oxygen]] suggests a [[pulmonary]] [[etiology]]. Seldom used due to the availability of [[echocardiography]].
*[[Hyperoxia]] Test- differentiates [[pulmonary]] from a [[cardiovascular]] cause. An increase in [[PaO2]] to a 100 mmHg or more after administering 100% [[oxygen]] suggests a [[pulmonary]] [[etiology]]. Seldom used due to the availability of [[echocardiography]].
*[[Arterial]] [[Blood]] [[Gases]] (ABGs)
*[[Arterial]] [[Blood]] [[Gases]] ([[ABG|ABGs]])
**[[PaCO2]], ↑ suggests [[hypoventilation]] of [[CNS Disease|CNS]], [[pulmonary]] or [[cardiac]] [[etiology]].
**[[PaCO2]], ↑ suggests [[hypoventilation]] of [[CNS Disease|CNS]], [[pulmonary]] or [[cardiac]] [[etiology]].
**[[PaO2]], ↓ confirms [[cyanosis]]  
**[[PaO2]], ↓ confirms [[cyanosis]]
**PH, a ↓ suggests [[hypoxemia]], [[sepsis]]
**[[PH]], a ↓ pH suggests [[hypoxemia]],or/and [[sepsis]]
**'Chocolate-brown' color of blood with normal levels of PaO2 and reduced SaO2 [[Methemoglobinemia]]
**'[[Chocolate]]-[[brown]]' [[color]] of [[blood]] with [[normal]] levels of [[PaO2]] and reduced SaO2 [[methemoglobinemia]]


===Electrocardiogram===
===Electrocardiogram===


*It is seldom used however, may be helpful in the [[diagnosis]] of [[arrhythmias]] and [[dextrocardia]] to show a [[left axis deviation]] seen in [[Tricuspid atresia]] due to [[left ventricular hypertrophy]].  
*It is seldom used, however, may be helpful in the [[diagnosis]] of [[arrhythmias]] and [[dextrocardia]] to show a [[left axis deviation]] seen in [[tricuspid atresia]] due to [[left ventricular hypertrophy]].
*It could give a normal reading in very serious heart defects like [[TGA]]. <ref name="pmid19727322">{{cite journal| author=Steinhorn RH| title=Evaluation and management of the cyanotic neonate. | journal=Clin Pediatr Emerg Med | year= 2008 | volume= 9 | issue= 3 | pages= 169-175 | pmid=19727322 | doi=10.1016/j.cpem.2008.06.006 | pmc=2598396 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19727322  }} </ref>
*It could give a normal reading in very serious heart defects such as [[TGA]].<ref name="pmid19727322">{{cite journal| author=Steinhorn RH| title=Evaluation and management of the cyanotic neonate. | journal=Clin Pediatr Emerg Med | year= 2008 | volume= 9 | issue= 3 | pages= 169-175 | pmid=19727322 | doi=10.1016/j.cpem.2008.06.006 | pmc=2598396 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19727322  }} </ref>


===X-ray===
===X-ray===


*Can identify:
*Can identify:
**[[Pulmonary]] causes like [[pulmonary]] [[hypoplasia]]
**[[Pulmonary]] [[causes]] such as [[pulmonary]] [[hypoplasia]]
**Increased [[lung]] [[vascular]] markings in [[pulmonary edema]], [[bronchopneumonia]]
**Increased [[lung]] [[vascular]] markings in [[pulmonary edema]], [[bronchopneumonia]]
**Reduced [[pulmonary]] markings in [[pulmonary atresia]], [[Pulmonary stenosis]], and persistent [[pulmonary hypertension]] of [[newborns]]
**Reduced [[pulmonary]] markings in [[pulmonary atresia]], [[pulmonary stenosis]], and persistent [[pulmonary hypertension]] of [[newborns]]
**Location of [[abdominal]] contents in [[diaphragmatic hernia]]
**Location of [[abdominal]] contents in [[diaphragmatic hernia]]
**Elevation of the affected [[hemidiaphragm]] in [[phrenic nerve injury]]
**Elevation of the affected hemidiaphragm in [[phrenic nerve]] [[injury]]
**[[Cystic]] adenomatoid [[malformation]]
**[[Cystic]] adenomatoid [[malformation]]
*Characteristic features of some [[congenital heart diseases]] can be observed like:
*Characteristic [[Features (pattern recognition)|features]] of some [[congenital heart diseases]] may be seen such as:
**'Snowman' or 'Figure 8' in TAPVR
**'Snowman' or 'Figure 8' in TAPVR
**'Boot-shaped heart' in TOF
**'Boot-shaped [[heart]]' in [[Tetralogy of Fallot|TOF]]
**'Egg-on-string' in [[TGA]]
**'[[Egg (biology)|Egg]]-on-string' in [[TGA]]
**[[Cardiomegaly]] in [[Ebstein's anomaly]]
**[[Cardiomegaly]] in [[Ebstein's anomaly]]
[[File:Boot-shaped heart.jpg|thumb|300px|none| Boot-shaped heart in Tetralogy of Fallot. [https://medpix.nlm.nih.gov/search?allen=true&allt=true&alli=true&query=boot%20shaped%20heart]]]


===Echocardiography or Ultrasound===
===Echocardiography or Ultrasound===


*Can be used when the diagnosis is equivocal or when [[physical exam]] findings and/or failed [[hyperoxia]] test suggests the presence of [[congenital heart disease]].
*Can be used when the [[diagnosis]] is equivocal or when [[physical exam]] findings and/or failed [[hyperoxia]] test suggests the presence of [[congenital heart disease]].
*It usually used with [[doppler]] to define the direction of [[shunts]]. <ref name="pmid29763177">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=29763177 | doi= | pmc= | url= }} </ref>
*It is usually used with [[doppler]] to define the [[direction]] of [[shunts]].<ref name="pmid29763177">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=29763177 | doi= | pmc= | url= }} </ref>


===CT scan===
===CT scan===


*Used as an adjunct to further define [[cardiac]] and other [[anatomical]] anomalies in preparation for definitive management.
*[[Usage analysis|Used]] as an adjunct to further define [[cardiac]] and other [[anatomical]] anomalies in [[Preparedness|preparation]] for the definitive management.


===MRI===
===MRI===


*Used as an adjunct to further define [[cardiac]] and other [[anatomical]] anomalies in preparation for definitive management.
*Used as an adjunct to further define [[cardiac]] and other [[anatomical]] anomalies in [[Preparedness|preparation]] for the definitive management.


===Other Imaging Findings===
===Other Imaging Findings===


*[[Cardiac catheterization]] and [[angiography]]:
*[[Cardiac catheterization]] and [[angiography]]:
**Sometimes as an adjunct to further define [[cardiac]] and other [[anatomical]] anomalies in preparation for definitive management.
**Sometimes used as an adjunct to further define [[cardiac]] and other [[anatomical]] anomalies in [[Preparedness (learning)|preparation]] for the definitive management.


===Other Diagnostic Studies===
===Other Diagnostic Studies===


*Pre-ductal and post-ductal [[PaO2]] measurements
*Pre-[[Duct (anatomy)|ductal]] and post-[[Duct (anatomy)|ductal]] [[PaO2]] measurements.


==Treatment==
==Treatment==
===Medical Therapy===
===Medical Therapy===


*The immediate priority will be to optimize the [[neonate]], especially in severe [[cyanosis]]. This includes:
*The immediate priority is to [[Optimization (mathematics)|optimize]] the [[neonate]], especially in severe [[cyanosis]]. This includes:
**Establishing assisted [[ventilation]] in [[respiratory distress]]
**Establishing assisted [[ventilation]] in [[respiratory distress]].
**Keep [[infant]] in a radiant warmer
**Keep [[infant]] in a [[Radiant energy|radiant]] warmer.
**Stop all per oral feeds and give [[intravenous fluids]] through peripheral or central access like the [[umbilical vein]]
**Stop all per [[oral]] [[Feeding|feeds]] and give [[intravenous fluids]] through peripheral or [[central]] [[Accessibility|access]] such as [[umbilical vein]].
**Give [[glucose]] for [[hypoglycemic]] [[infants]] and monitor [[serum glucose]] levels
**Give [[glucose]] for [[hypoglycemic]] [[infants]] and monitor [[serum glucose]] levels.
**Consult should be sent to the [[Neonatologist]]
**[[Consultation|Consult]] should be sent to the [[neonatologist]].
**[[Oxygen]] administration should be done with caution. Care must be taken not to begin with very high [[concentrations]] of 100% due to damage to the [[lung]] tissue and [[pulmonary vessels]]
**[[Oxygen]] administration should be done with caution. Care must be taken not to begin with very high [[concentrations]] of 100% due to damage to the [[lung]] tissue and [[pulmonary vessels]].
**[[Prostaglandin]] E1([[PGE1]]) given as an infusion to keep the ductus patent for [[pulmonary]] [[blood]] flow in CHDs
**[[Prostaglandin]] E1 ([[PGE1]]) given as an [[infusion]] to keep the [[Ductus arteriosus|ductus]] [[patent]] for [[pulmonary]] [[blood]] flow in [[CHD|CHDs]].
**Definitive [[treatment]] can be planned in stages once [[infant]] is optimized and a [[diagnosis]] has been made.
**Definitive [[treatment]] can be planned in stages once [[infant]] is optimized and a [[diagnosis]] has been made.
**[[Antibiotics]] coverage for [[sepsis]] if suspected. Give after [[blood]] samples are taken for [[Culture collection|culture]] and [[Sensitivity (tests)|sensitivity]], [[urine]] samples have been collected.
**[[Antibiotics]] coverage for [[sepsis]] if suspected, after [[blood]] samples are taken for [[Culture collection|culture]] and [[Sensitivity (tests)|sensitivity]], and [[urine]] samples have been collected.


===Surgery===
===Surgery===


*This a [[treatment]] modality for diagnoses associated with [[anatomic]] [[deformities]] in CHDs or [[airway]] obstructions.
*This a [[treatment]] modality for [[Diagnosis|diagnoses]] [[Association (statistics)|associated]] with [[anatomic]] [[deformities]] in [[CHD|CHDs]] or [[airway]] [[Obstruction|obstructions]].
*[[Surgical]] [[treatment]] is tailored to the cause of the [[cyanosis]] that requires [[surgical]] intervention. An example is a Balloon Atrial Septostomy for acute [[TGA]] allowing for [[blood]] mixing. <ref name="pmid19727322">{{cite journal| author=Steinhorn RH| title=Evaluation and management of the cyanotic neonate. | journal=Clin Pediatr Emerg Med | year= 2008 | volume= 9 | issue= 3 | pages= 169-175 | pmid=19727322 | doi=10.1016/j.cpem.2008.06.006 | pmc=2598396 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19727322  }} </ref>
*[[Surgical]] [[treatment]] is tailored to the underlying [[Causes|cause]] of [[cyanosis]] that requires [[surgical]] [[Intervention (counseling)|intervention]]. An example is a [[Balloon septostomy|Balloon Atrial Septostomy]] for [[acute]] [[TGA]] allowing for [[blood]] mixing.<ref name="pmid19727322">{{cite journal| author=Steinhorn RH| title=Evaluation and management of the cyanotic neonate. | journal=Clin Pediatr Emerg Med | year= 2008 | volume= 9 | issue= 3 | pages= 169-175 | pmid=19727322 | doi=10.1016/j.cpem.2008.06.006 | pmc=2598396 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19727322  }} </ref>
   
   
===Prevention===
===Prevention===


*[[Prevention]] can be challenging as some of its [[causes]] would have been prevalent in-utero before the [[birth]] of the child while others occur during the actual [[labor]] and birthing process.
*[[Prevention]] can be challenging as some of its [[causes]] are prevalent in-[[Uterus|utero]] before the [[birth]] of [[child]] while others occur during the actual [[labor]] and [[Birth|birthing]] [[Process (anatomy)|process]].
*The preventive measures that can be adopted are:
*The [[Preventive care|preventive measures]] that can be adopted include:
*[[Counsel]] [[expectant mothers]] especially women who are above the age of 35 years.
*[[Counsel]] [[expectant mothers]] especially [[women]] who are above the [[age]] of 35 [[Year|years]].
*Routine [[prenatal]] and [[postnatal]] care for early detection of [[congenital anomalies]] and adequate preparedness for its management during [[pregnancy]], [[labor]], and [[delivery]].
*Routine [[prenatal]] and [[postnatal]] [[Care centers|care]] for early [[Detection theory|detection]] of [[congenital anomalies]] and adequate [[preparedness]] for its management during [[pregnancy]], [[labor]], and [[delivery]].
*Early detection and management of [[gestational diabetes]] and [[pregnancy-induced hypertension]].
*Early [[Detection theory|detection]] and management of [[gestational diabetes]] and [[pregnancy-induced hypertension]].
*Parents of a child with [[congenital malformations]] should be counseled on the risk of having another child with the same or similar [[deformities]].
*[[Parenting|Parents]] of a [[child]] with [[congenital malformations]] should be counseled on the [[RiskMetrics|risk]] of having another [[child]] with the same or similar [[deformities]].
*[[Prophylaxis]] against [[Respiratory syncytial virus]]([[Human respiratory syncytial virus|RSV]]).
*[[Prophylaxis]] against [[respiratory syncytial virus]] ([[Human respiratory syncytial virus|RSV]]).
*Follow up for [[polycythemia]], excessive [[dehydration]], and [[iron-deficiency anemia]].<ref name="pmid29763177">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=29763177 | doi= | pmc= | url= }} </ref>
*Follow up for [[polycythemia]], excessive [[dehydration]], and [[iron-deficiency anemia]].<ref name="pmid29763177">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=29763177 | doi= | pmc= | url= }} </ref>


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[[Category:Pediatrics]]
[[Category:Pediatrics]]
[[Category:Primary care]]
[[Category:Up-To-Date]]

Latest revision as of 21:06, 24 February 2021

Cyanosis in newborns Microchapters

Overview

Historical Perspective

Classification

Pathophysiology

Causes

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Natural History, Complications, and Prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ifeoma Anaya, M.D.[2]

Synonyms and keywords: Acrocyanosis; central cyanosis

Overview

Cyanosis is derived from the word kuaneos which is Greek for dark blue. It is categorized into two major types: peripheral and central cyanosis. Cyanosis is observed with an increase in the absolute concentration of deoxygenated hemoglobin to a level of 3-5g/dl. A structured way of grouping the common causes of cyanosis in newborns is by using the ABC which stands for Airway, Breathing, and Circulation. Persistent pulmonary hypertension of the newborn and congenital heart diseases (CHD) are the common causes of newborn cyanosis. Common risk factors in the development of cyanosis in newborns are evident in the pregnancy and labor period. Prompt recognition, and administration of treatment modalities, with appropriate referral to the ideal hospital setting equipped to manage the diagnosis, can improve the prognosis. The primary symptom is the bluish/dark colored lips, mucous membrane, and/or hands and feet. Patients can have breathing difficulties which can be seen as nasal flaring and chest retractions. Findings from exam include lethargy, conjunctival injection, features of shock, and tachypnea. Laboratory findings include a complete blood count, and differentials showing packed cell volume (PCV) suggesting polycythemia, and white cell count (septicemia). ECG is used seldomly, however, it may aid in the diagnosis of arrhythmias and dextrocardia. X-rays can show pulmonary causes such as pulmonary hypoplasia and increased lung vascular markings in pulmonary edema, and bronchopneumonia. Echocardiography can be used when the diagnosis is equivocal or when physical exam findings and/or failed hyperoxia test suggests the presence of congenital heart disease. There are other imaging techniques used as adjuncts to making diagnoses. The immediate priority is to optimize the neonate, especially in severe cyanosis. Surgery is employed for more definitive treatment. The preventive measures that can be adopted include pre-conceptual counseling for expectant mothers especially women who are above the age of 35 years, routine prenatal and postnatal care for early detection of congenital anomalies, and adequate preparedness for its management during pregnancy, labor, and delivery.

Historical Perspective

Classification

Pathophysiology

Causes

 
 
 
 
 
Causes of cyanosis in newborns
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Airway
 
 
Breathing
 
 
Circulation
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Cystic hygroma
Hemangioma
Choanal atresia
Micrognathia
Laryngomalacia
• Tracheal stenosis
Vascular rings
Vocal cord paralysis
Pierre Robin sequence
 
 
Phrenic nerve palsy
Congenital diaphragmatic hernia
Perinatal asphyxia
Pulmonary hypoplasia
Inborn errors of metabolism
Central nervous system and muscle congenital anomalies
Neonatal sepsis
Neonatal botulism
Congenital cystic adenomatoid malformation
Pneumonia
 
 
Congenital heart diseases
Tetralogy of Fallot (TOF)
Tricuspid atresia
Pulmonary atresia
Pulmonary stenosis
Ebstein's anomaly
Transposition of great arteries (TGA)
Hypoplastic left heart syndrome
Atrioventricular canal defect
Total anomalous pulmonary venous return (TAPVR)
Anemia
Methemoglobinemia
Polycythemia
• Persistent pulmonary hypertension
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Epidemiology and Demographics

Age

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography or Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Prevention

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Steinhorn RH (2008). "Evaluation and management of the cyanotic neonate". Clin Pediatr Emerg Med. 9 (3): 169–175. doi:10.1016/j.cpem.2008.06.006. PMC 2598396. PMID 19727322.
  2. Izraelit A, Ten V, Krishnamurthy G, Ratner V (2011). "Neonatal cyanosis: diagnostic and management challenges". ISRN Pediatr. 2011: 175931. doi:10.5402/2011/175931. PMC 3317242. PMID 22482063.
  3. 3.0 3.1 Lees MH, King DH (1987). "Cyanosis in the newborn". Pediatr Rev. 9 (2): 36–42. doi:10.1542/pir.9-2-36. PMID 3332361.
  4. Hooper SB, olglase GR, Roehr CC (2015). "Cardiopulmonary changes with aeration of the newborn lung". Paediatr Respir Rev. 16 (3): 147–50. doi:10.1016/j.prrv.2015.03.003. PMC 4526381. PMID 25870083.
  5. https://pediatriccare.solutions.aap.org/chapter.aspx?sectionid=108722941&bookid=1626
  6. 6.0 6.1 6.2 6.3 6.4 "StatPearls". 2020. PMID 29763177.