Diagnostic Considerations in Infants and Children with Cyanosis

Hiremath, Gurumurthy; Kamat, Deepak

doi:10.3928/00904481-20150203-12

Cited by 12 publications

(21 citation statements)

References 11 publications

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“…When a patient has oxygen saturation less than 85% in room air, this test is performed by administering 100% FiO 2 for up to ten minutes and evaluating the change in oxygen saturation. It is performed on the right upper extremity to eliminate possible alterations from shunting [ 11 ]. With supplemental oxygen provided, a ventilation/perfusion mismatch would be improved, resulting in oxygen saturations greater than 97%, thus indicating likely pulmonary pathology.…”

Section: Discussionmentioning

confidence: 99%

Delayed Presentation of Tetralogy of Fallot with Isolated Cyanosis

Zemore

Sharma

Carter

et al. 2018

Case Reports in Pediatrics

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A pediatric patient with hypoxia or cyanosis can frighten even the most seasoned emergency providers. Patients with these symptoms require immediate evaluation and intervention to stabilize their condition. While the differential can be broad, specific attention must be paid to cardiopulmonary etiologies. Tetralogy of Fallot is the most common cyanotic congenital heart abnormality, and routine screening surprisingly misses a significant amount of these cases. This case serves as an example of a missed diagnosis by screening efforts and reaffirms the resuscitation algorithm of a hypoxic pediatric patient that all emergency providers should be familiar with.

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Section: Discussionmentioning

confidence: 99%

Delayed Presentation of Tetralogy of Fallot with Isolated Cyanosis

Zemore

Sharma

Carter

et al. 2018

Case Reports in Pediatrics

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“…Cyanosis, i.e., a bluish discoloration of the skin and mucosa, results from the presence of at least 5 g/dL of deoxygenated hemoglobin in the circulation. This pathologic condition can be due to four different mechanisms: pulmonary venous desaturation, extrapulmonary right to left shunting, transposition physiology, and hemoglobin disorders affecting the affinity to oxygen [1]. Diagnostic differentiation among potential pathogenetic mechanisms is based on clinical history and a detailed clinical examination [2].…”

Section: Introductionmentioning

confidence: 99%

The Dose Makes the Poison: A Case Report of Acquired Methemoglobinemia

Cannata

Abate

Scarabello

et al. 2020

IJERPH

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Background: Methemoglobinemia (MET) should be suspected in cases where cyanosis is not associated with signs and symptoms of lung and/or heart disease, or in a cyanotic child exhibiting discrepancies in the partial pressure of oxygen in the arterial blood, the blood oxygen saturation, and the clinical assessment. Case presentation: A 10-month-old girl was taken to the Pediatric Emergency Department for the acute, sudden development of significant peroral cyanosis associated with gray pigmentation of the skin. The problem was evidenced approximately one hour after she ingested a homemade puree of mixed vegetables, mainly composed of potatoes and chards that had been prepared three days before and had been kept in the refrigerator since then. Physical examination revealed that the child was very pale, conscious, and without respiratory distress. Oxygen saturation of hemoglobin in the arterial blood (SpO2) was 94%. Respiratory, cardiovascular, and abdominal evaluations did not reveal any signs of disease. A venous blood sample showed chocolate-colored blood with a pH of 7.404, a partial pressure of CO2 (pCO2) of 40.6 mmHg, a partial pressure of oxygen (pO2) of 21.3 mmHg, a bicarbonate level of 24 mmol/L, and an oxygen saturation (SO2%) of 47.7%. CO-oximetry carried out simultaneously identified a methemoglobin level of 22%. MET was suspected, and oxygen via nasal cannula at a rate of 4 L/min was given with only a slight increase in oxygen saturation (96%). Slow intravenous injection of methylene blue 1 mg/kg over a period of 5 min was initiated. The peripheral oxygen saturation (SpO2) gradually improved to 100% over the next 20 min. Forty minutes later, venous blood gas analysis showed a methemoglobin level of 0.9% with a complete resolution of cyanosis; supplemental oxygen via nasal cannula was therefore discontinued. During the next 36 h, the patient remained hemodynamically stable with good oxygenation on room air. Conclusions: This case report shows that recognition of acquired MET in a child with sudden cyanosis onset requires a high index of suspicion. In daily activities, there is a need to pay particular attention when homemade vegetable soups for child alimentation are prepared. The consumption of vegetable soups must occur immediately after preparation. Storage in a refrigerator must last no more than 24 h and if longer storage is needed, vegetable soups should be frozen.

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“…It is sometimes difficult to detect cyanosis in the newborn due to factors such as skin colour, exposure to light, or presence of jaundice [2]. Since the relationship between cyanosis and pulse oximetry (SpO 2 ) is directly related to the hemoglobin concentration, the percent desaturation required to produce the same grade of cyanosis is higher in anemic than in polycythemic infant [2]. …”

Section: Introductionmentioning

confidence: 99%

“…Cyanosis can appear early after birth or later as an acute episode, often during crying or feeding when tissue oxygenation can decrease further [2]. The detection of cyanosis in infants is very important because it generally suggests inadequate peripheral tissue oxygenation and is one of the most accurate clinical signs of severe illness in infants during the first months of life [3].…”

Section: Introductionmentioning

confidence: 99%

Unexpected episodes of cyanosis in late preterm and term neonates prompted admission to a neonatal care unit

et al. 2017

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BackgroundWe studied late preterm and term infants who were admitted to our neonatal care unit in a tertiary hospital for unexpected episodes of cyanosis that occurred during rooming-in for evaluation of their frequency, most frequent associated diseases, and documentation of the diagnostic clinical approach.MethodsWe carried out a retrospective study of infants with a gestational age ≥35 weeks who were admitted from the nursery with the diagnosis of cyanosis from January 2009 to December 2016. Exclusion criteria were the occurrence of acrocyanosis and the diagnosis of sudden unexpected postnatal collapse (SUPC).ResultsWe studied 49 infants with a mean gestational age of 38 ± 2 weeks. The frequency of admission for cyanosis was 1.8/1000 live births and was similar (p = 0.167) in late preterm and term infants. The majority of episodes occurred during the first 24 h of life (57%). Only 16 infants (33%) were discharged with a diagnosis, that was mostly (n = 5;10%) gastro-esophageal reflux.ConclusionsUnexpected episodes of cyanosis caused admission of 1.8/1000 live births to the neonatal care unit without differences between late preterm and term infants. These episodes occurred mainly during the first day of life and infants were mostly discharged without a known diagnosis.

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Diagnostic Considerations in Infants and Children with Cyanosis

Cited by 12 publications

References 11 publications

Delayed Presentation of Tetralogy of Fallot with Isolated Cyanosis

Delayed Presentation of Tetralogy of Fallot with Isolated Cyanosis

The Dose Makes the Poison: A Case Report of Acquired Methemoglobinemia

Unexpected episodes of cyanosis in late preterm and term neonates prompted admission to a neonatal care unit

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