This document provides an overview of cyanosis in newborns. It describes central versus peripheral cyanosis, with central cyanosis caused by reduced arterial oxygen saturation and peripheral cyanosis caused by increased tissue oxygen extraction. The document outlines various causes of cyanosis, including conditions that affect ventilation and gas exchange as well as cardiac and hematologic disorders. It provides guidance on evaluating and initially managing newborns with cyanosis through history, physical exam, testing, and supportive care measures while determining the underlying condition.

1. Overview of
cyanosis in the
newborn
Dr: Mh Radi
Senior Registrar of Pediatrics

2. INTRODUCTION
– Cyanosis is a bluish discoloration of the tissues that
results when the absolute level of reduced hemoglobin
in the capillary bed exceeds 3 g/dL

3. CENTRAL VERSUS
PERIPHERAL CYANOSIS
– Peripheral cyanosis
Patients with peripheral cyanosis have normal systemic arterial oxygen
saturation and increased tissue oxygen extraction that leads to a widened
systemic arteriovenous oxygen difference of 60 percent (from the normal 40
percent) resulting in an increased concentration of reduced hemoglobin on the
venous side of the capillary bed.
– Acrocyanosis
Acrocyanosis is often seen in healthy newborns and refers to the peripheral
cyanosis around the mouth and the extremities (hands and feet)
It is a common finding and may persist for 24 to 48 hours.

4. – Central cyanosis
Central cyanosis is caused by reduced arterial oxygen saturation. Newborn
infants normally have central cyanosis until up to 5 to 10 minutes after birth,
as the oxygen saturation rises to 85 to 95 percent by 10 minutes of age

5. Pathogenesis
1- Alveolar hypoventilation
eg central nervous system depression (eg, perinatal asphyxia), airway
obstruction (choanal atresia), or neuromuscular disorders (eg, spinal
muscular atrophy
2- Ventilation-perfusion mismatch
(eg, neonatal pneumonia,RDS,MAS, pneumothorax )
3- Right-to-left shunt
(eg, cyanotic congenital heart disease [CCHD],PPH)
4- Diffusion impairment
(eg, pulmonary edema, shock )

6. FACTORS THAT AFFECT
CYANOSIS
– ●Hemoglobin concentration
– ●Fetal hemoglobin
– ●Skin pigmentation
– ●Physiological conditions that affect oxygen dissociation curve
Shift to left (alkalosis, hyperventilation (low PCO2), cold temperature)
Shift to right ( acidosis, fever )

7. CAUSES OF PERIPHERAL
CYANOSIS
●Shock
●Sepsis
●Elevated venous pressure or venous obstruction (eg, venous thrombosis)
●Polycythemia
●Cold exposure and benign acrocyanosis

8. CAUSES OF CENTRAL
CYANOSIS
Disease category Primary underlying mechanism
Airway obstruction
Choanal atresia
Hypoventilation
Laryngotracheomalacia
Macroglossia
Micrognathia or retrognathia (eg, Pierre-
Robin syndrome)

9. Cardiac
Congenital cyanotic heart disease Right-to-left shunting
Heart failure/pulmonary edema
Impaired alveolar-arterial diffusion and
V/Q mismatch
Hematologic
Hemoglobinopathies (eg,
methemoglobinemia)
Impaired oxygen saturation
Polycythemia
Elevated hemoglobin resulting in low
oxygen saturation
Metabolic
Severe hypoglycemia
Hypoventilation due to decreased or
absent respiratory effort secondary to
lethargy, seizures, and/or apneaInborn errors of metabolism

10. Central nervous system depression
Apnea of prematurity
Hypoventilation
Infection (eg, meningitis, encephalitis)
Intraventricular hemorrhage
Maternal sedation
Seizure
Neuromuscular disorder
Neonatal myasthenia gravis
HypoventilationPhrenic nerve injury
Spinal muscular atrophy type 1 (Wernig-
Hoffman disease)

11. Pulmonary
Parenchymal disease
Atelectasis
V/Q mismatch
Alveolar capillary dysplasia
Lobar emphysema
Pneumonia
Pulmonary hypoplasia
Pulmonary hemorrhage
Respiratory distress syndrome (Hyaline
membrane disease)
Transient tachypnea of the newborn
Pulmonary fibrosis Impaired alveolar-arterial diffusion
Pulmonary edema
Impaired alveolar-arterial diffusion and V/Q
mismatch
Nonparenchymal disease
Pleural effusion
V/Q mismatch
Pneumothorax
Other
Persistent pulmonary hypertension of the
newborn
Right-to-left shunting

12. EVALUATION
– identify critically or potentially critically ill infant,
– provide supportive care
– and determine the underlying cause of neonatal cyanosis

13. History
– Polyhydramnios
– Oligohydramnios
– Prolonged rupture of the fetal membranes
– Maternal diabetes
– Meconium staining
– Family risk history of cyanotic heart disease

14. Physical examination
– Peripheral vs central
– respiratory distress
– cardiac findings
– shock

15. Initial tests
– Pulse oximetry measurement
– preductal (right hand) and post-ductal (foot)
– Hyperoxia test
– Arterial blood gas
– complete blood count, blood glucose, blood culture
– Chest radiograph
– echocardiography

16. INITIAL MANAGEMENT
general care that includes cardiorespiratory support and monitoring to ensure
sufficient organ/tissue perfusion and oxygenation
- A, B, C, D,
- For infants with respiratory distress and carbon dioxide retention, continuous
positive airway pressure (CPAP) or intubation for positive pressure ventilation
should be considered.
- Patients with hypotension or poor perfusion require cardiopulmonary
resuscitation.
- Cyanosis may be an initial finding of sepsis. As a result,, broad spectrum
antibiotics should be initiated

17. – If cyanotic heart disease is suspected, a pediatric cardiology consultation
and echocardiogram should be promptly performed. Until a definitive
diagnosis is made, prostaglandin E1 (alprostadil) should be initiated as a
continuous intravenous infusion at 0.01 to 0.05 mcg/kg per min, which is
increased as needed to a maximum dose of 0.1 mcg/kg per min.

18. –THANK YOU