Cyanosis in the neonatal period

Question 1

what is very common in the first 24 hours of life and may occur when the child is crying or unwell from any cause?

Answer 1

peripheral cyanosis

Question 2

when can central cyanosis be recognised?

Answer 2

when the concentration of reduced haemoglobin in the blood exceeds 5g/dl

Question 3

what are nitrogen washout tests?

Answer 3

(also known as the hyperoxia test) may be used to differentiate cardiac from non-cardiac causes. The infant is given 100% oxygen for ten minutes after which arterial blood gases are taken. A pO2 of less than 15 kPa indicates cyanotic congenital heart disease

Question 4

what are the causes of cyanotic congenital heart disease? (3 T’s)

Answer 4

tetralogy of Fallot (TOF)
transposition of the great arteries (TGA)
tricuspid atresia

Question 5

management of suspected cyanotic congenital heart disease?

Answer 5

supportive care
prostaglandin E1 e.g. alprostadil

used to maintain a patent ductus arteriosus in ductal-dependent congenital heart defect

this can act as a holding measure until a definite diagnosis is made and surgical correction performed

Question 6

what is acrocyanosis?

Answer 6

Acrocyanosis is often seen in healthy newborns and refers to the peripheral cyanosis around the mouth and the extremities (hands and feet)

Question 7

what causes acrocyanosis?

Answer 7

benign vasomotor changes that result in peripheral vasoconstriction and increased tissue oxygen extraction and is a benign condition

Question 8

what differentiates acrocyanosis from other sinister pathologies causing peripheral cyanosis?

Answer 8

as it occurs immediately after birth in healthy infants. It is a common finding and may persist for 24 to 48 hours.