The general appearance and mental status are evaluated. Tachypnea (>60 breaths/min) in a newborn is nonspecific but may indicate a pulmonary disorder, congenital heart disease, infection, metabolic disorder, or gastrointestinal or central nervous system pathology. Infants with cyanosis, increased respiratory depth, periodic apnea episodes, or diaphoresis with feeding may have congenital heart disease. Intermittent apnea in infants suggests central nervous system immaturity or a central lesion. Upper airway obstruction and other signs of respiratory insufficiency should be sought. Blood pressure and heart rate vary, depending on the cause and acuity of cyanosis. Vital signs should be obtained from all patients. This form of cyanosis is usually seen in patients with cyanotic heart disease with multiple anomalies.
Differential cyanosis may occur in the upper or lower (or the right or left) half of the body, with the remainder of the body appearing well oxygenated. Peripheral cyanosis affects capillary beds and typically is seen in the extremities and nail beds. Peripheral cyanosis is secondary to vasoconstriction and slow flow of normally oxygenated hemoglobin in arterial blood, allowing for greater oxygen extraction by the tissues. Central cyanosis is best seen on perioral skin, oral mucosa, or conjunctivae.
SLIGHT BLUE TINGE TO LIPS SKIN
A patient's natural skin tone, thickness, and pigmentation also may alter findings.Ĭentral cyanosis is often secondary to the shunting of venous unsaturated hemoglobin into the arterial circulation or the presence of abnormal hemoglobin. Room lighting and temperature may affect examination of the skin and mucous membranes. There is significant interobserver variability in detecting cyanosis on physical examination. Walls MD, in Rosen's Emergency Medicine: Concepts and Clinical Practice, 2018 Signs Arterial oxygen tension and response to oxygen breathing in differential diagnosis of heart disease in infancy. 1982 4:13 and Jones RW, Baumer JH, Joseph MC, et al. Cyanosis of the newborn infant: recognition and clinical evaluation. c Truncus arteriosus, total anomalous pulmonary venous return, single ventricle, hypoplastic left heart syndrome, D-TGA with ventricular septal defect, tricuspid atresia without pulmonary stenosis or atresia.įrom Lees MH. b Tricuspid atresia with pulmonary stenosis or atresia, pulmonary atresia or critical pulmonary stenosis with intact ventricular septum, or tetralogy of Fallot.
a D-Transposition of the great arteries (D-TGA) with intact ventricular septum. FiO 2, Fraction of inspired oxygen PBF, pulmonary blood flow PFO, patent foramen ovale.
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