Neonatal Cyanosis
Etiologies of Cyanosis
Peripheral
Central
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Respiratory
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Apnea
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RDS
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TTN
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Aspiration
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Pneumonia
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PPHN
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Congenital Anomalies/Malformations
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Diaphragmatic hernia
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Tracheal atresia, web, stenosis
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Cardiac
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Transposition of the Great Arteries
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Truncus Arteriosus
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Tricuspid Atresia
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Tetralogy of Fallot
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Total Anomalous Venous Pulmonary Return
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Neurologic
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Meningitis
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Intraventricular or other intracranial hemorrhage
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Drugs: respiratory depression, seizures
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Metabolic
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Decreased glucose
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Decreased temperature
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Hematologic
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Polycythemia
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Methemoglobinemia
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Infectious Disease
Evaluation
Needs to be tailored to the individual case.
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History
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Physical Exam
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Vital Signs
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Glucose
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Give 100% oxygen for central cyanosis
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Make sure baby is breathing (otherwise oxygen will not be very helpful)
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Arterial blood gas is the only way to determine if correct oxygenation
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Chest X-ray
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CBC with differential
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Cardiac Evaluation
Treatment
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Oxygen, with or without mechanical ventilatory support as required
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Infusion of glucose for hypoglycemia
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Improve cardiac output
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Prostin (PGE1) if you believe it is congenital heart disease
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If shock state or hypovolemia exists, treat.
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Increased heart rate is associated with hypovolemia and distributive shock
(septic or neurogenic)
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Decreased or normal heart rate may be associated with cardiogenic shock
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Consider inotropic drugs by continuous infusion
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Dopamine affects alpha, beta and delta receptors at different doses
Low dose |
Delta "C" receptors |
Middle dose |
Beta receptors |
High dose |
Alpha receptors |
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Dobutamine primarily affects B1, with minimal B2 and no alpha or delta
effects.
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Last modification: July 8, 1997