Cyanosis in newborns

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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


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




Causes of cyanosis in newborns
Cystic hygroma
Choanal atresia
• 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
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)
• Persistent pulmonary hypertension

Epidemiology and Demographics


Risk Factors

Natural History, Complications and Prognosis



Physical Examination

Laboratory Findings



Echocardiography or Ultrasound

CT scan


Other Imaging Findings

Other Diagnostic Studies


Medical Therapy




  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.
  6. 6.0 6.1 6.2 6.3 6.4 "StatPearls". 2020. PMID 29763177.