Neonatal Cyanosis

Neonatal Cyanosis
Pediatric
Department
Prepared by:
1. Chateen
said
Objectives
Definition of
cyanosis
Types of cyanosis
Causes of
cyanosis
Complications
Management
2
Introduction
Cyanosis is Bluish discoloration of skin and mucous

membrane caused by increase concentration of
reduced hemoglobin > 5g/dI
so its not less pronounced if the child is
anemic while in polycythemia more
pronounced.
Types of cyanosis
1.Peripheral cyanosis
Arterial blood is normally saturated but there is oxygen
unsaturation at the venous end of capillary. may be due
to sluggish peripheral circulation
Excessive extraction of oxygen by the peripheral
tissues from the
arterial blood .
Where can be seen
Ear
lobules
F
e
et
To Tip of
es nose
sol Pal Fing
es er
ms Nail
bed
Causes:
1-Vasoconstriction ( exposure to
cold) 2-Polycythemia
3-Low cardiac output
5
2. Central Cyanosis
Pathologic condition caused by reduced arterial oxygen saturation.

Due oxygenation defect in lung or admixture of venous and arterial
blood Involves highly vascularized tissues, through which blood flow is
brisk.
Cardiac output typically is normal. It is evident when O2 saturation falls
below 90% From 90_95% (desaturated)
Where can be seen
Mucous membranes of gums ,soft palate

,cheeks
Inner aspect Tong

of lips ue
Causes of central cyanosis
A. Congenital heart disease :

1. Tetralogy of Fallot (TOF)
2. Transposition of great vessels (TGA)
3. %Total anomalous pulmonary venous
return
4. Truncus arteriosus
5. Tricuspid atresia.
B. Respiratory disorders :
1. Respiratory Distress syndrome
RDS
2. Lung collapse
3. Apnea prematurity
4. Meconium aspiration
5. Congenital diaphragmatic
hernia
6. Sever asthma
7. Bronchopulmonary dysplasia
8. Pneumonia (sepsis)
C. CNS disorders:
1. Birth asphyxia
2. Over sedation (direct or through maternal
route )
3. Choanal atresia
4. Seizure
D. Poisoning
1- carbon monoxide
poison 2- cyanide
poisoning
3- methamglobinemia
Management
Aim:
Differentiate physiologic from pathologic cyanosis
Differentiate cardiac from non- cardiac cause of
cyanosis
Find causes which needs urgent treatment or
referral
Management
1. History
2. Physical
Examination
3. Investigations
4. Treatment
Management
1.
Drug History
Histor
Causing neonatal depression
y
Lithium-Ebstein anomaly
Phenytoin- PS and AS Fetal Hydantoin syndrome
Fetal Alcohol –VSD and ASD
Maternal Diabetes
TGA, VSD, and hypertrophic cardiomyopathy
Congenital intrauterine infections (TORCH) can lead to
cardiac structural
abnormalities or functional impairment
Antenatal fetal echocardography
Management
2. Physical Examination
A. Respiratory
assessment:
Respiratory rate, chest wall movement,
noisy breathing, grunting, stridor, use
accessory muscles, flaring of alae nasi
B. Cardiac
assessment:
Pulse rate, auscultation for heart murmur
or 2nd heart sound abnormality
Management
2. Physical
Examination
Vital signs
(1) Hypothermia or hyperthermia = infection
(2) Tachycardia = hypovolemia
(3) Weak pulses = Hypoplastic left heart
syndrome or hypovolemia
(4) Pulses or blood pressure stronger in the
upper extremities more than lower
extremities = Coarctation of aorta
Management
3.
Investigat
CBC and differentials
(1)
(2)
ions
Increase or decrease WBC = Sepsis
Hematocrit > 65% = Polycythemia
Serum glucose to detect
hypoglycemia Arterial blood gas
analysis (ABG):
(3) Arterial PO2 to confirm central cyanosis: SaO2 is not as good an indicator due to
increase fetal
HB affinity for O2
(4) Increases PaCO2: may indicate pulmonary or CNS disorder, heart failure
(5) Decrease pH: Sepsis, circulatory shock, severe hypoxemia
(6) Methoglobinemia: Decrease SaO2, normal PaO2, chocolate-brown blood

Management
3.
Investigat
Chest X ray
ions causes of cyanosis:
To identify pulmonary
Pnemothorax, pulmonary hypoplasia,
diaphragmatic hernia, pulmonary edema, pleural
effusion, etc.
Useful in evaluating congenital heart disease:
e.g. cardiomegaly, and vascular congestion:
heart failure.
Aberrancy of the cardiothoracic silhouette:
(1) Suggest the presence of structural heart disease
(2) Abnormalities of the lung fields may be helpful
in distinguishing a primary pulmonary

problem such as meconium aspiration
Management
3.
Investigat
Tetralogy of Fallot –
Chest X ray ions
Boot Shaped
Management
3.
Investigat
Transposition of great arteries
– Chest X rayions
Egg on string
Management
3.
Investigat
Total Anomalous Pulmonary Venous Return
ions
TAPVR – Chest X ray
Snowman
Treatment
Goals
- Provide adequate tissue oxygen
and CO2 removal
Principles
(1) Establish airway
(2) Ensure oxygenation
(3) Ensure adequate ventilation
(4) Correct metabolic abnormalities
(5) Alleviate the causes of respiratory
distress
Monitor Airway, Breathing, circulation (ABCs) with
respiratory compromise, establish an airway and
provide supportive therapy (e.g. oxygen, mechanical
ventilation)
Monitor Vital signs
Establish vascular access for sampling blood and
administrating meds (if needed): Umbilical vessels
convienint for placement of intravenous and intraarterial
catheters.
If sepsis is suppected or another specific cause is not
identified, start on broad spectrum antibiotics (e.g.
amipicillin and gentamycin) after obtaining a CBC,
urinalysis, blood and urine cultures (if possible). Left
untreated, sepsis may lead to pulmonary disease and left
ventricular dysfunction
Treatment
Warming of the affected area: in peripheral
cyanosis Oxygenation & adequate
ventilation
(Pa02 normalizes completely during artificial
ventilation in infant with CNS disorder)
* IV fluids
Children who have difficulty in feeding due to
cyanosis need fluids to be administrated.
*If sepsis is suspected or another specific cause
is not identified, start on broad spectrum
antibiotics then obtain a full septic screening
Drugs: Prostaglandin E1
For ductal dependent CHD / reduced pulmonary blood flow –
fail hyperoxia test (An arterial PO2 of less than 100 torr in the
absence of clear-cut lung disease
IV Infusion of PGE1 at a dose of (0.05-to maintain patency
0.1mcg/kg/min)
S/E- hypoventilation, apnea, edema and low grade feverv
Complication of CCHD
Cyanotic spells (in TOF)
brain abscess
Cerebral thrombosis
(CVA)
pulmonary TB (oligemic
lung)
§HF "rare"
Death
Tx of cyanotic spells:
Hold the baby in knee chest position

02
Morphine (subcut.) : to relieve pain &
anexietv
NaHco3 : for metabolic acidosis
Inderal (Beta blocker) : prevent recurrent
attack
8/7
/23
u
ThankYou

Neonatal Cyanosis

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Neonatal Cyanosis

Cyanosis is Bluish discoloration of skin and mucous

Pathologic condition caused by reduced arterial oxygen saturation.

Mucous membranes of gums ,soft palate

Inner aspect Tong

A. Congenital heart disease :

2. Over sedation (direct or through maternal

(5) Decrease pH: Sepsis, circulatory shock, severe hypoxemia

(6) Methoglobinemia: Decrease SaO2, normal PaO2, chocolate-brown blood

(2) Abnormalities of the lung fields may be helpful

in distinguishing a primary pulmonary

Hold the baby in knee chest position

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