Child with cyanosis

Child with cyanosis

Presented by :

Group C4

5th year medical students

Tripoli university

Pediatric

Objectives

Definition of cyanosis

Types of cyanosis

Causes of cyanosis

Complications

Management

Cyanosis is derived from the colour ‘cyan’, which comes from ‘kyanous’, the Greek word for blue .

Definition:It is Bluish discoloration of skin and mucous membrane caused by increase concentration of reduced

hemoglobin > 5g/dl

so its not less pronounced if the child is anemic.

Types of cyanosis

CentralPeripheral

Peripheral cyanosis (blueness of hands &feet)

Normal systemic arterial oxygen saturation.

The increased extraction of oxygen results from sluggish movement of blood through the capillary circulation

Sites

Tip of nose

Ear lobules

Outer aspect of lips,chin,cheek

Tips and nailbeds of fingers,toes

Palms,soles Tongue is spared

Causes:

vasoconstriction ( exposure to cold)

polycythemia

low cardiac output

Central cyanosisPathologic condition caused by reduced arterial oxygen saturation.

due oxygenation defect in lung or admixture of venous and arterial blood

Involves highly vascularized tissues, through which blood flow is brisk .

Cardiac output typically is normal, and patients have warm extremities.

It is evident when O2 saturation falls below 90%

From 90_95% (desaturated)

Sites:

Tongue (margins & undersurface)

Inner aspect of lips

Mucous membranes of gums ,soft palate ,cheeks

Causes of central cyanosis 1_Respiratory disorders :

upper airway obstruction

Respiratory distress syndrome (RDS)

Meconium aspiration(MAS)

Pneumonia (sepsis)

PPHN_Failure of pulm.vascular resistance to fall after birth

Pulmonary hypoplasia

Bronchopulmonary dysplasia(mechanical ventilation)

Congenital diaphragmatic hernia

Asthma

2_CNS disorders:

ICH

Birth asphyxia

Seizures

Oversedation (direct or through maternal route)

3_Cardiac disorders:

Cyanotic congenital heart diseases (right to left shunt)

5Ts

Tetralogy of Fallot (TOF)

Transposition of great vessels(TGA)

Total anomalous pulmonary venous return

Truncus arteriosus

Tricuspid atresia

Note: persistant cyanosis in otherwise well infant is nearly always a sign of CHD

Ebstein malformation of the tricuspid valve

Left hypoplastic heart

Single ventricle

Critical pulmonary atresia

Heart failure/Cardiogenic Shock

othersPolycythemia

Methemoglobinemia

Metabolic diseases

Infection _septicemia

(physiological) : High altitude – Acrocyanosis “newborn”

examplecause

Cardiovascular disorders congenital cyanotic heart disease

Respiratory disorders - Pneumonia- Bronchiolitis

- RDS & meconium aspiration- Pneumothorax & pleural effusion

0CNS disorders - intra cranial hemorrhage0- Tonic clonic seizure

hematological disorders - Methemoglobinemia- Polycythemia

- Congenital cyanosis

other disorders - High Altitude- hypothermia - obstructive sleep apnea

Differential CyanosisHands red (less blue) and feet blue seen in PDA with reversal of shunt (Differential Cyanosis) Requires pulmonary vascular resistance elevated to a systemic level and a patent ductus arteriosus

Left to right sunt pulmonary HT reversed shunt (Rt Lt shunt)

Desaturated blood from the ductus enters the aorta distal to the left subclavian artery, sparing the brachiocephalic circulation.

ManagementAim:

* Differentiate physiologic from pathologic cyanosis

* Differentiate cardiac from non- cardiac cause of cyanosis

* Find causes which needs urgent treatment or referral

Do :

1_complete maternal and newborn history

2_perform a full physical examination

3_ Investigation

Investigation* Pulse oximetry: (normal O2 sat. ≥ 95%)

* ABGs :

PaO2: to confirm central cyanosis

↑ PaCO2: may indicate pulmonary or CNS disorders.

↓ pH: sepsis, circulatory shock, severe hypoxemia

* Hyperoxia test (Is it due cardiac or pulmonary cause?)

placing the infant in 100% oxygen for 10 minutes. If he remains cyanotic after this period, the cyanosis is said to be secondary to cyanotic heart diseases(SaO2 not reach the normal value).

* CBC :

↑ or ↓ WBC : sepsis

Hematocrit > 65% : polycythemia

* Methemoglobinemia : ↓ SaO2, normal PaO2, chocolate-brown blood , HB-M

* Sepsis screening

* ECG: Dx for Tricusped atresia (Lt axis deviation only is seen)

* Echo: Dx for CHD

* Chest x-ray

Treatment* Warming of the affected area: in peripheral cyanosis

* Oxygenation & adequate ventilation

(PaO2 normalizes completely during artificial ventilation in infant with CNS disorder)

* IV fluidsChildren who have difficulty in feeding due to cyanosis

need fluids to be administrated.

* If sepsis is suspected or another specific cause is not identified, start on broad spectrum antibiotics then obtain a full septic screening

* Drugs: Prostaglandin E1

For ductal dependent CHD

IV Infusion of PGE1 at a dose of (0.05-0.1mcg/kg/min) to maintain patency

S/E- hypoventilation, apnea, edema and low grade fever

* Surgery

CCHD

Tetralogy of Fallot

Boot shape

Total Anomalous Pulmonary Venous Return(TAPVR)

Snowman

Transposition of Great Arteries

Egg on a string

Truncus arteriosus

Tricusped atresia

Complication of CCHD

Stunt of growth

Cyanotic spells (in TOF)

brain abscess

Cerebral thrombosis (CVA)

pulmonary TB (oligemic lung)

HF “rare”

Death

Tx of cyanotic spells:

Hold the baby in knee chest position

O2

Morphine (subcut.) : to relieve pain & anexiety

NaHco3 : for metabolic acidosis

Inderal (Beta blocker) : prevent recurrent attack

Thank you