Cyanosis in Infants

Aka: Cyanosis in Infants, Neonatal Cyanosis

1. See Also
   1. Newborn Cardiopulmonary Exam
   2. Newborn Resuscitation
   3. Pediatric Murmur
   4. Congenital Heart Disease
2. Causes: Transient Cyanosis after Delivery
   1. Central Cyanosis
      1. Should clear in minutes of birth
      2. Tongue and Mucus membranes are pink
   2. Acrocyanosis (Peripheral cyanosis)
      1. Bluish distal extremities
      2. Clears within 1-2 days
3. Causes: Cyanotic Cardiac Defect
   1. See Congenital Heart Disease
   2. Transposition of the Great Vessels
   3. Total Anomalous Pulmonary Venous Return
   4. Ebstein's Anomaly
   5. Tricuspid Atresia
   6. Pulmonary Atresia with Intact Ventricular Septum
   7. Severe Pulmonary Stenosis
   8. Severe Tetralogy of Fallot
   9. Associated Congestive Heart Failure Causes
      1. Hypoplastic Left Heart Syndrome
      2. Truncus Arteriosus
4. Causes: Lung Disorders
   1. Transient Tachypnea of the Newborn
   2. Respiratory Distress Syndrome
   3. Aspiration
      1. Meconium aspiration
      2. Blood or amniotic fluid aspiration
   4. Pneumonia
   5. Pneumothorax
   6. Pleural Effusion
   7. Congenital Diaphragmatic Hernia
   8. Persistent Pulmonary Hypertension
5. Causes: Airway Disorders
   1. Choanal Atresia
   2. Pierre-Robin Syndrome
   3. Macroglossia
   4. Vascular Ring or Pulmonary Sling
   5. Neck mass (e.g. Cystic Hygroma)
6. Causes: Miscellaneous
   1. Apnea or asphyxia
   2. Hemorrhage
   3. Seizure
   4. Hypothermia
   5. Electrolyte abnormality
      1. Hypoglycemia
      2. Hypocalcemia
      3. Hypermagnesemia
7. Causes: Cyanosis with normal pO2
   1. Methemoglobinemia
   2. Polycythemia
   3. Vasoconstriction (e.g. Cold environment)
8. Diagnostics
   1. Chest XRay
   2. Electrocardiogram
   3. Hematocrit
   4. Arterial Blood Gas on 100% oxygen
      1. Arterial pO2>200 rules out Congenital Heart Disease
   5. Simultaneous Pre-Ductal, Post-Ductal Arterial Blood Gas
      1. Indications
         1. No obvious pulmonary cause
         2. Persistent pO2 <100 mmHg
      2. Interpretation: No difference in pre and post pO2
         1. Suggests right to left shunt via ductus arteriosus
         2. Causes
            1. Persistent Pulmonary Hypertension
            2. Critical Aortic Coarctation
            3. Interrupted Aortic Arch
9. Management
   1. Follow initial protocol per Neonatal Resuscitation
   2. Congenital Heart Disease Management
      1. Consider Prostaglandin E1
      2. Manage associated CHF
10. References
    1. Cloherty (1991) Neonatal Care, Little Brown, p. 261-70
    2. Fuloria (2002) Am Fam Physician 65(1):61-8