Logo

Log In Sign Up |  An official publication of: American College of Emergency Physicians
Navigation
  • Home
  • Multimedia
    • Podcasts
    • Videos
  • Clinical
    • Airway Managment
    • Case Reports
    • Critical Care
    • Guidelines
    • Imaging & Ultrasound
    • Pain & Palliative Care
    • Pediatrics
    • Resuscitation
    • Trauma & Injury
  • Resource Centers
    • mTBI Resource Center
  • Career
    • Practice Management
      • Benchmarking
      • Reimbursement & Coding
      • Care Team
      • Legal
      • Operations
      • Quality & Safety
    • Awards
    • Certification
    • Compensation
    • Early Career
    • Education
    • Leadership
    • Profiles
    • Retirement
    • Work-Life Balance
  • Columns
    • ACEP4U
    • Airway
    • Benchmarking
    • Brief19
    • By the Numbers
    • Coding Wizard
    • EM Cases
    • End of the Rainbow
    • Equity Equation
    • FACEPs in the Crowd
    • Forensic Facts
    • From the College
    • Images in EM
    • Kids Korner
    • Medicolegal Mind
    • Opinion
      • Break Room
      • New Spin
      • Pro-Con
    • Pearls From EM Literature
    • Policy Rx
    • Practice Changers
    • Problem Solvers
    • Residency Spotlight
    • Resident Voice
    • Skeptics’ Guide to Emergency Medicine
    • Sound Advice
    • Special OPs
    • Toxicology Q&A
    • WorldTravelERs
  • Resources
    • ACEP.org
    • ACEP Knowledge Quiz
    • Issue Archives
    • CME Now
    • Annual Scientific Assembly
      • ACEP14
      • ACEP15
      • ACEP16
      • ACEP17
      • ACEP18
      • ACEP19
    • Annals of Emergency Medicine
    • JACEP Open
    • Emergency Medicine Foundation
  • About
    • Our Mission
    • Medical Editor in Chief
    • Editorial Advisory Board
    • Awards
    • Authors
    • Article Submission
    • Contact Us
    • Advertise
    • Subscribe
    • Privacy Policy
    • Copyright Information

The Cyanotic Neonate

By ACEP Now | on August 1, 2011 | 0 Comment
CME CME Now
  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
Print-Friendly Version

Learning Objectives

After reading this article, the physician should be able to:

You Might Also Like
  • Oxyhemoglobin Saturation Better Assesses Oxygenation in Cyanotic Patients
  • A 3-Step Approach for Infants with Congenital Heart Disease
  • Trauma in the Obstetric Patient: A Bedside Tool
Explore This Issue
ACEP News: Vol 30 – No 08 – August 2011
  • Discuss the presentation, evaluation, differential diagnosis and treatment of the cyanotic neonate.
  • Discuss the pathophysiology of the transition from fetal to newborn circulation.
  • Explain the significance of the hyperoxia test.
  • Discuss the management of a neonate with methemoglobinemia.

Neonatal cyanosis may be a signal of serious underlying pathology, and these patients require prompt and comprehensive evaluation when they present to the emergency department. This article will review the differential diagnosis, evaluation, and management of these infants in the ED setting.

Definition

Cyanosis is categorized as either central or peripheral. Peripheral cyanosis, also known as acrocyanosis, is a bluish discoloration of hands and feet caused by peripheral vasoconstriction. It is a common benign condition in the newborn.
By contrast, central cyanosis, a bluish discoloration of mucous membranes, lips, skin, and nailbeds, should be considered pathological until proven otherwise. It takes 3-5 g/dL of desaturated hemoglobin to manifest clinically as cyanosis, so it is important to keep in mind that an anemic patient may not look cyanotic despite a low pulse oximetry reading. Put another way, equal amounts of desaturated hemoglobin (producing comparable degrees of overt cyanosis) correspond to lesser oxygen saturation in the anemic patient. For example, a patient with a hemoglobin level of 18 and 3 g/dL of desaturated hemoglobin would have an oxygen saturation of 83%, whereas a patient with a hemoglobin level of 9 who has 3 g/dL of desaturated hemoglobin would have an oxygen saturation of 67%.

Epidemiology

When a cyanotic neonate presents to the emergency department, the differential diagnosis must include congenital heart disease (CHD), respiratory disorders, hematologic disorders, and infectious processes.

Table 1. Etiologies of Cyanotic CHD

  • Tetrology of Fallot.
  • Total anomalous pulmonary venous return.
  • Transposition of the great arteries.
  • Tricuspid atresia.
  • Truncus arteriosus.
  • Pulmonary atresia or stenosis.
  • Ebstein’s anomaly.

Cyanotic Congenital Heart Disease

Congenital heart disease that presents with cyanosis is associated with lesions causing blood to shunt from the pulmonary to the systemic circulation. The most common etiologies of cyanotic CHD are listed in Table 1.

In order to understand the pathophysiology and presentation of neonatal congenital heart disease, it is essential to recall the transitional circulatory changes of the newborn. In utero, the placenta oxygenates fetal blood. The deoxygenated fetal blood bypasses the lungs due to high pulmonary vascular resistance (PVR) and travels via the umbilical artery to the placenta, where it is oxygenated and returns to the fetus via the umbilical vein.

Pages: 1 2 3 4 5 6 7 | Single Page

Topics: CardiovascularClinical ExamClinical GuidelineCMEConsultationCritical CareEducationEmergency MedicineEmergency PhysicianHematologyImaging and UltrasoundOB/GYNPediatricsPregnancyProcedures and Skills

Related

  • Dr. Joe Sachs and “The Pitt” Redefine Public Health Education Through Storytelling

    July 3, 2025 - 0 Comment
  • Push-Dose Pressors in the Emergency Department

    June 29, 2025 - 1 Comment
  • ACEP Clinical Policy on Outpatient Mgmt. of Adults with Asymptomatic Elevated Blood Pressure

    June 25, 2025 - 0 Comment

Current Issue

ACEP Now: July 2025

Download PDF

Read More

About the Author

ACEP Now

View this author's posts »

No Responses to “The Cyanotic Neonate”

Leave a Reply Cancel Reply

Your email address will not be published. Required fields are marked *


*
*

Wiley
  • Home
  • About Us
  • Contact Us
  • Privacy
  • Terms of Use
  • Advertise
  • Cookie Preferences
Copyright © 2025 by John Wiley & Sons, Inc. All rights reserved, including rights for text and data mining and training of artificial technologies or similar technologies. ISSN 2333-2603