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The Indian Journal of Pediatrics

, Volume 82, Issue 11, pp 1050–1060 | Cite as

Clinical Approach to a Neonate with Cyanosis

  • Saurabh Kumar Gupta
Review Article

Abstract

Cyanosis is always pathological and demands detailed evaluation. Combined use of clinical findings, electrocardiogram and chest radiograph permits determination of underlying cause in vast majority. Stepwise approach allows hemodynamic classification of the cardiac lesion and directs immediate management. Accurate anatomic diagnosis of the cardiac malformation is seldom essential for preliminary management and therefore, emphasis must be on clinical classification rather than on obtaining echocardiographic diagnosis.

Keywords

Cyanosis Neonate Congenital heart disease 

Notes

Acknowledgments

The author is grateful to Dr. Sandeep Singh, Professor of Cardiology, All India Institute Medical Sciences, New Delhi for critical review of the manuscript.

Contributions

SKG prepared and finalised the manuscript. Anita Saxena, Professor of Cardiology, Department of Cardiology, AIIMS, New Delhi, India, will act as guarantor for this paper.

Conflict of Interest

None.

Source of Funding

None.

References

  1. 1.
    Lundsgaard C. Studies on cyanosis. I and II. J Exp Med. 1919;30:259–93.PubMedCentralCrossRefPubMedGoogle Scholar
  2. 2.
    Lundsgaard C, Van Slyke DD. Cyanosis. Medicine. 1923;2:1–76.CrossRefGoogle Scholar
  3. 3.
    Lees MH. Cyanosis of the newborn infant. Recognition and clinical evaluation. J Pediatr. 1970;77:484–98.CrossRefPubMedGoogle Scholar
  4. 4.
    Jennis MS, Peabody JL. Pulse oximetry: an alternative method for the assessment of oxygenation in newborn infants. Pediatrics. 1987;79:524–8.PubMedGoogle Scholar
  5. 5.
    Ewer AK, Middletonn LJ, Furmston AT, et al; PulseOx study group. Pulse oximetry screening for congenital heart defects in newborn infants (PulseOx): a test accuracy study. Lancet. 2011;378:785–94.CrossRefPubMedGoogle Scholar
  6. 6.
    Ewer AK. Pulse oximetry screening for critical congenital heart defects in newbron infants: should it be routine? Arch Dis Child Fetal Neonatal Ed. 2014;99:F93–5.PubMedGoogle Scholar
  7. 7.
    Koppel RI, Druschel CM, Carter T, et al. Effectiveness of pulse oximetry screening for congenital heart disease in asymptomatic newborns. Pediatrics. 2003;111:451–5.CrossRefPubMedGoogle Scholar
  8. 8.
    Thangaratinam S, Brown K, Zamora J, Khan KS, Ewer AK. Pulse oximetry screening for critical congenital heart defects in asymptomatic newborn babies: a systemic review and meta-analysis. Lancet. 2012;379:2459–64.CrossRefPubMedGoogle Scholar
  9. 9.
    Sasidharan P. An approach to diagnosis and management of cyanosis and tachypnea in term infants. Pediatr Clin North Am. 2004;51:999–1021.CrossRefPubMedGoogle Scholar
  10. 10.
    Tingelstad J. Nonrespiratory cyanosis. Pediatr Rev. 1999;20:350–2.CrossRefPubMedGoogle Scholar
  11. 11.
    Kopelman AE, Mathew OP. Common respiratory disorders of the newborn. Pediatr Rev. 1995;16:209–17.CrossRefPubMedGoogle Scholar
  12. 12.
    Fuloria M, Kreiter S. The newborn examination. Part I. Am Fam Physician. 2002;65:61–8.PubMedGoogle Scholar
  13. 13.
    Schwartz R, Teramo KA. Effects of diabetic pregnancy on the fetus and newborn. Semin Perinatol. 2000;24:120–35.CrossRefPubMedGoogle Scholar
  14. 14.
    Kjos SL, Walther FJ, Montoro M, Paul RH, Diaz F, Stabler M. Prevalence and etiology of respiratory distress in infants of diabetic mothers: predictive value of fetal lung maturation tests. Am J Obstet Gynecol. 1990;163:898–903.CrossRefPubMedGoogle Scholar
  15. 15.
    Hook B, Kiwi R, Amini SB, Fanaroff A, Hack M. Neonatal morbidity after elective repeat cesarian section and trial of labor. Pediatrics. 1997;100:348–53.CrossRefPubMedGoogle Scholar
  16. 16.
    Levine EM, Ghai V, Barton J, Strom CM. Mode of delivery and risk of respiratory diseases in newborns. Obstet Gynecol. 2001;97:439–42.CrossRefPubMedGoogle Scholar
  17. 17.
    Rusakow LS, Khare S. Radiographically occult congenital lobar emphysema presenting as unexplained neonatal tachypnea. Pediatr Pulmonol. 2001;32:246–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Nadroo AM, Levshina R, Tugertimur A, Gudavalli M, Raziuddin K. Congenital diaphragmatic hernia: atypical presentation. J Perinat Med. 1999;27:276–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Grifka RG. Cyanotic congenital heart disease with increased pulmonary blood flow. Pediatr Clin North Am. 1999;46:405–25.CrossRefPubMedGoogle Scholar
  20. 20.
    Marino BS, Bird GL, Wernovsky G. Diagnosis and management of the newborn with suspected congenital heart disease. Clin Perinatol. 2001;28:91–136.CrossRefPubMedGoogle Scholar
  21. 21.
    Wren C, Reinhardt Z, Khawaja K. Twenty-year trends in diagnosis of life- threatening neonatal cardiovascular malformations. Arch Dis Child Fetal Neonatal. 2008;93:F33–5.CrossRefGoogle Scholar
  22. 22.
    Cloherty JP, Eichenwald EC, Stark AR. Manual of neonatal care. 6th ed, South Asian edition, 4th Indian reprint edition. New Delhi: Wolters Kluwer Company; 2009.Google Scholar
  23. 23.
    Cleveland RH. A radiologic update on medical diseases of the newborn chest. Pediatr Radiol. 1995;25:631–7.CrossRefPubMedGoogle Scholar
  24. 24.
    Tandon R. Bedside approach. In: Tandon R, editor. The diagnosis of congenital heart disease. 2nd ed. New Delhi: Sitaram Bhartia Institute of Science and Research Publishers; 2011.Google Scholar
  25. 25.
    Allen HD, Driscoll DJ, Shaddy RE, Timothy FF. Moss and Adam’s Heart disease in infants, children and adolescents: including the fetus and young adults. 8th ed. Philadelphia: Lippincott Willaims and Wilkins; 2012.Google Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2015

Authors and Affiliations

  1. 1.Department of CardiologyRoom No. 23, 7th Floor, Cardiothoracic Sciences Center, All India Institute of Medical SciencesNew DelhiIndia

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