Assessment of cyanosis in the newborn

incidence is higher in male infants and infants of diabetic mothers; cyanosis appears within the first 24 hours, sometimes with no respiratory distress; if transposition of great arteries is present with an intact ventricular septum, the infant will be very cyanotic, requiring immediate intervention

prominent right ventricular heave and a single second heart sound (a loud A2) are usually present; a systolic murmur due to increased pulmonary blood flow may be heard in a few cases

cyanosis depends on the degree of right ventricular outflow tract obstruction, which ranges from very mild to severe; the age of symptom onset is variable; VACTERL (vertebral anomalies, imperforate anus, cardiac lesions, tracheo-oesophageal fistula, renal and limb anomalies) are seen in approximately 15% of infants who have tetralogy of Fallot; infants may be referred for mild cyanosis or presence of a murmur at birth

prominent right ventricular heave and systolic ejection murmur at left sternal border are usually present

variable presentation depends on the presence of ventricular septal defect and atrial septal defect for adequate mixing of blood at the atrial or ventricular level; mild to moderate cyanosis becomes worse when ductus arteriosus closes

murmur of patent ductus arteriosus is the only common finding

generally occurs in preterm infants due to surfactant deficiency; antenatal history may reveal immature lung profile in the amniotic fluid; higher incidence has been noted in infants of diabetic mothers; full-term infants with RDS have been reported to have surfactant protein B deficiency or adenosine triphosphate-binding cassette, sub-family A (ABCA3) mutations; majority of preterm infants with RDS are born to mothers who did not receive antenatal corticosteroids; delivery of previous sibling with RDS

tachypnoea, nasal flaring, grunting, and retractions with cyanosis; in severe cases, diminished air entry is present on chest auscultation

higher incidence among full-term newborns born by elective caesarean section; tachypnoea is the presenting symptom with increased FiO₂ requirement; self-limiting problem; generally resolves within the first 3 days; cyanosis may occur in severe cases

tachypnoeic infant with reasonable air entry bilaterally upon auscultation

occurs in full-term, post-term, or preterm infants commonly; aetiology is variable; risk factors include history of asphyxia, meconium aspiration syndrome, sepsis, congenital diaphragmatic hernia (CDH), pulmonary hypoplasia

loud S2 and right ventricular heave

can occur spontaneously at birth in full-term newborns or following resuscitation with positive pressure ventilation; occurs frequently in preterm infants with respiratory distress syndrome; assisted ventilation and continuous positive airway pressure contribute to the development of pneumothorax; higher incidence in meconium aspiration syndrome, pulmonary hypoplasia, and congenital diaphragmatic hernia

tachypnoea and cyanosis are usually present; depending on severity (proportionate to the amount of free air in the pleural space), breath sounds and heart sounds may be faint/distant; mediastinal shift to the contralateral side may occur; transillumination of the chest will be positive in most cases

may be due to meconium aspiration syndrome, blood, milk aspiration, or amniotic fluid; meconium aspiration is commonly seen in post-term infants and those who develop fetal distress; a history of thick meconium-stained amniotic fluid at the time of rupture of membranes is characteristic; most infants become symptomatic with respiratory distress at birth; in the case of blood aspiration, there may be a history of antepartum haemorrhage; in the case of milk aspiration, emesis following feeding and subsequent development of respiratory distress is usually present

tachypnoea, grunting, retractions, and cyanosis are present; on auscultation diminished air entry, rales, and rhonchi may be evident

risk factors include a history of prolonged rupture of membranes, chorioamnionitis, or positive maternal group B beta streptococcus (GBS) screen; congenital pneumonia due to viruses or bacteria is rare; early-onset GBS sepsis may present as GBS pneumonia with apnoea and circulatory collapse within the first week of life

respiratory distress with tachypnoea, retractions, and grunting may be present; auscultation often reveals rales, rhonchi, and diminished air entry in a few cases; apnoea may be the only presenting symptom in some cases

generally due to congestive cardiac failure; underlying cardiac disease, arteriovenous (AV) malformation, or severe anaemia may be present

tachypnoea, tachycardia, and hepatomegaly are usually present; severe pallor or signs of AV malformation present (bruit)

most cases are diagnosed by antenatal ultrasound; more common on the left side; most cases are symptomatic at birth with severe cyanosis; some have minimal symptoms and are diagnosed later in the neonatal period or infancy; history of polyhydramnios

scaphoid abdomen at birth, diminished air entry on the left side of chest, with cyanosis at birth are typical features; heart sounds may not be heard on the left side of chest due to mediastinal shift

most of these cases are diagnosed by antenatal ultrasound; the severe forms may lead to hydrops in the fetus; milder forms may have mild respiratory distress or no symptoms at birth; many infants are diagnosed in childhood when they present with recurrent infections

tachypnoea and mild cyanosis are present in many infants; diminished air entry on the affected side will be present

most become symptomatic shortly after birth with no significant cyanosis; symptoms worsen during feeding, with stridulous breathing; those with vocal cord paralysis will have a weak or non-existent cry; cyanosis may develop; risk of aspiration during feeding; infants with vocal cord paralysis may have central nervous system conditions

submandibular, suprasternal, and supraclavicular retractions are characteristic of upper airway obstruction; infants with choanal atresia or stenosis may have mild to moderate symptoms depending on whether unilateral or bilateral; inability to pass nasogastric tube is diagnostic

polycythaemia is common in insulin-dependent diabetes mellitus, small for gestational age infants, and twin-to-twin transfusion; maternal history of diabetes and hypertension during pregnancy are frequent; slightly higher incidence of transient tachypnoea of the newborn may be present

either large for gestational age or small for gestational age infants who may appear cyanotic but have normal ABGs; some infants may have transient tachypnoea of the newborn or mild persistent pulmonary hypertension of newborn; infants appear ruddy and plethoric, and have a higher incidence of acrocyanosis; clinical examination may be normal or findings of transient tachypnoea of the newborn may be present

history of fetal distress with perinatal asphyxia and low Apgar scores requiring vigorous resuscitation; history of seizures or apnoea may be the presenting symptom; may lead to hypoxic ischaemic encephalopathy

neurologically depressed, hypotonia, subtle seizure activity, with good aeration to both lung fields; apnoea or hypoventilation (bradypnoea) is the cause for cyanosis

usually well in spite of characteristic skin discoloration, termed pseudocyanosis; condition may worsen with shortness of breath and central nervous system features including seizures; may be congenital or acquired; acquired form may result from exposure to drugs/toxins known to cause met-Hb

characteristic blue colour, dyspnoea, mental state changes; arterial blood with elevated methaemoglobin levels has a characteristic chocolate-brown colour; pulse oximetry is unreliable

either a small for gestational age or large for gestational age infant born to a diabetic or hypertensive woman

may be jittery or may have seizures; clinical examination may be normal or may reveal hypo- or hypertonia; cyanosis is usually due to apnoea or transient persistent pulmonary hypertension of newborn

history of premature rupture of membranes, chorioamnionitis, or intrapartum maternal fever may be present; may present with non-specific, non-localised symptoms; fever, low body temperature or temperature instability; lethargy, irritability or non-responsiveness; poor feeding, or emesis; may present with apnoea and cyanosis or with circulatory shock

tachycardia, tachypnoea, fever (>38℃ [>100.4°F]) or hypothermia (<36℃ [<96.8°F]); infants and young children may be hypotonic with normal or poor peripheral perfusion and hypotension; prolonged capillary refill, mottled or ashen skin, cyanosis, low oxygen saturation, reduced urine output; may be absence of bowel sounds; hypo- or hyperglycaemia may be present

clinical condition depends on the presence of pulmonary venous obstruction; pulmonary congestion (pulmonary oedema) with respiratory distress and cyanosis can be mistaken for interstitial pneumonitis

prominent right ventricular heave; widely split S2; systolic ejection murmur at the left upper sternal border may occur; hepatomegaly is common; response to alprostadil (prostaglandin E1) infusion is generally ineffective to minimal

most cases are diagnosed prenatally; more common in boys; if unrecognised at birth, infants become symptomatic at the time of the closure of the ductus arteriosus; when the ductus arteriosus closes, respiratory distress develops, shock and cyanosis with poor peripheral perfusion generally occur within the first 3 days of life; severe cyanosis can occur at birth when the foramen ovale is closed or restrictive

right ventricular heave and single S2 are present

most cases are diagnosed antenatally by fetal echo; symptoms depend on the presence of ventricular septal defect (VSD); if there is a large shunt through the VSD, many infants may have mild cyanosis or none in the neonatal period; many infants present with congestive heart failure later; if the VSD is very restrictive, severe cyanosis may develop when the ductus arteriosus closes

systolic ejection murmur at the left upper sternal border and prominent left ventricular impulse

mild to moderate cyanosis with or without respiratory distress may present in first week of life; velocardiofacial syndrome (22q deletion) is present in 30% to 50% of truncus arteriosus cases

hyperdynamic precordium with loud single S2; loud systolic and diastolic murmur with wide pulse pressure and bounding pulses; respiratory distress depends on the degree of pulmonary congestion and worsens when pulmonary vascular resistance drops after the first 2 to 3 days; congestive heart failure may develop as a result

most cases occurring in full-term infants will give a history of severe asphyxia or coagulopathy; in preterm infants who have haemodynamically significant patent ductus arteriosus (PDA) with left-to-right shunt, pulmonary haemorrhage may develop; most of these infants are ventilated post-surfactant instillation

sudden appearance of cyanosis or increased requirement of oxygen when infant is being ventilated is the earliest sign; bloody secretions from the trachea may be suctioned from the endotracheal tube; rales or diminished air entry found on the affected side, but condition is generally bilateral

history of oligohydramnios and respiratory distress soon after birth are present; higher incidence of pneumothorax in these cases

tachypnoea, cyanosis, and fair to poor aeration of lungs present; S2 is loud with associated pulmonary hypertension

generally asymptomatic at birth; respiratory distress becomes progressively worse over the next few days

tachypnoea and cyanosis are present; diminished air entry over the affected side (commonly over left upper chest)

respiratory distress and cyanosis in the newborn

tachypnoea and cyanosis in a full-term newborn; air entry will not be diminished; occasionally rales may be heard

history of polyhydramnios and large amount of pharyngeal secretions present after birth; inability to pass an orogastric or nasogastric tube is diagnostic; OA associated with VACTERL (vertebral anomalies, imperforate anus, cardiac lesions, TOF, renal and limb anomalies)

respiratory distress with frothy secretions at the mouth following birth is usually present; conducted upper airway sounds will be heard on auscultation; presentation at birth is typically the result of OA with/without tracheo-oesophageal fistula; respiratory distress is due to secretions in the upper airway and aspiration

most pleural effusions present at birth are seen in infants with hydrops fetalis and are diagnosed by antenatal ultrasound; in severe cases it will be difficult to ventilate unless needle aspiration or chest tube insertion occurs to remove the fluid; minor degrees of pleural effusion are seen in pneumonitis, meconium aspiration syndrome, and persistent pulmonary hypertension of newborn

in severe cases, diminished air entry will be present on the affected side; in bilateral effusions, as seen in hydrops fetalis, it will be difficult to ventilate the lungs unless the pleural fluid is evacuated

congestive heart failure, large head due to hydrocephalus, seizures

bruit may be heard over the cranium on auscultation