Cyanosis in newborns

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Cyanosis in newborns Microchapters

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Epidemiology and Demographics

Risk factors

Natural History, Complications, and Prognosis

Diagnosis

Treatment

Prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2] Associate Editor(s)-in-Chief: Ifeoma Anaya, M.D.[3]

Synonyms and Keywords: Acrocyanosis; central cyanosis

Overview

Cyanosis is coined from the word kuaneos which is greek for dark blue. It is classified into two major types: peripheral and central cyanosis. Cyanosis results when there is an increase in the absolute concentration of deoxygenated hemoglobin to a level of 3-5g/dl. A systematic way of classifying the common causes of cyanosis in newborns is by using the ABC which stands for Airway, Breathing, and Circulation. Congenital heart diseases (CHD) affecting 8-9 per 1000 live births and Persistent pulmonary hypertension of the newborn are the common causes of newborn cyanosis. In older kids, respiratory diseases tend to be more common. Common risk factors in the development of cyanosis in newborns are evident in the pregnancy and labor period. Complications and prognosis are dependent on the actual cause of the cyanosis, prompt recognition, and administration of treatment modalities with appropriate referral to the ideal hospital setting equipped to manage the diagnosis. The primary symptom is the bluish/dark colored lips, mucous membrane, and/or hands and feet. Breathing difficulties such as nasal flaring, chest retractions. Exam findings include lethargy, conjunctival injection, features of shock, tachypnea. Laboratory findings include a Complete blood count and differentials showing ↑Packed cell volume(PCV) suggesting polycythemia, ↑White cell count (Septicemia). Although seldom helpful, 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 is employed when physical exam findings and/or failed hyperoxia test suggests the presence of congenital heart disease or when the diagnosis is uncertain. Other imaging modalities are used as adjuncts in making diagnoses. The priority in the immediate term will be to optimize the neonate, especially in severe cyanosis. Surgery is employed for more definitive treatment. The following preventive measures can be adopted; 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

  • Cyanosis is coined 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. [1]

Classification

  • Cyanosis is classified into two major types:[2]
    • Peripheral Cyanosis (acrocyanosis) which is located on the hands and feet. It is mostly physiological and relatively common.
    • Central cyanosis which is considered to be pathological and requiring immediate evaluation until proven otherwise.

Pathophysiology

Causes

  • A systematic way of classifying the common causes of cyanosis in newborns is by using the ABC which stands for Airway, Breathing, and Circulation.
 
 
 
 
 
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

Gender

  • No documented evidence of gender predilection.

Race

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Boot-shaped heart in Tetralogy of Fallot. [1]

Echocardiography or Ultrasound

CT scan

  • Used as an adjunct to further define cardiac and other anatomical anomalies in preparation for definitive management.

MRI

  • Used as an adjunct to further define cardiac and other anatomical anomalies in preparation for definitive management.

Other Imaging Findings

Other Diagnostic Studies

  • Pre-ductal and post-ductal PaO2 measurements

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, Polglase 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.
  7. https://learn.pediatrics.ubc.ca/body-systems/neonate/approach-to-neonatal-cyanosis/