Cyanosis is a very common issue in the newborn period. This term refers to the bluish coloring of skin that occurs when the blood oxygen level decreases. Cyanosis can be peripheral or central, and both types can be caused by different pathologies.
There are two main types of cyanosis based on where the bluish hint is noted. These include peripheral and central cyanosis.
The main symptom of cyanosis is color change in the skin. Depending on if the cyanosis is central or peripheral can be determined by where the color change occurs. Central cyanosis leads to blueness in the central portions of the body and around the lips. Peripheral cyanosis leads to limb cyanosis. Central cyanosis can also lead to sleepiness, lethargy, excessive fussiness, and poor respiratory effort. These symptoms are typically a result of poor oxygenation in the blood, leading to overall decreased alertness. Peripheral cyanosis often has no other symptoms besides color changes in the limbs.
Cyanosis is most commonly caused by issues with the baby’s heart or lungs, however it can also be caused by infection or metabolic issues. Normally, newborns pump blood through their hearts and into the lungs in order to be oxygenated. If any part of this heart lung circuit is abnormal, then cyanosis can occur.
Congenital heart disease can lead to cyanosis depending on where the lesion is located. There are cyanotic congenital heart diseases and congenital heart diseases that have normal oxygen saturations. To test for cyanotic heart disease, most babies have their oxygen checked in their hands and their feet before leaving the hospital. If there is a large difference in the oxygen saturation in their limbs, then there is concern for a cyanotic heart lesion.
Infections such as sepsis can lead to cyanosis due to overwhelming infection in the newborn’s body. If a newborn becomes cyanotic and heart and lung abnormalities have been ruled out, then infection is the next most common cause of cyanosis. Metabolic diseases in the newborn period can also lead to cyanosis due to decreased respiratory drive. These diseases tend to show up after 1 to 2 weeks of age.
The main treatment of cyanosis is oxygen therapy. However, it is vital to determine the cause of cyanosis in a newborn because central cyanosis is never normal. While undergoing a full workup, the infant may need to be transferred to a higher level of care such as an intensive care unit for close monitoring.