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CYANOSIS By P.Padma Priyanka
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Cyanosis in newborn

Jan 22, 2018

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  1. 1. CYANOSIS By P.Padma Priyanka
  2. 2. Contents Introduction Factors affecting detection of cyanosis Etiology Types Cardiac vs pulmonary Approach Conclusion
  3. 3. Introduction Cyanosis is the bluish discoloration of the skin and mucous membranes due to increased concentration of reduced hemoglobin to about >5g/100 mL in the cutaneous veins Desaturation of arterial blood Increased extraction of oxygen by peripheral tissue in the presence of normal arterial saturation Detected lips,fingernails,oral mucous membranes,conjuctiva and tip of tongue
  4. 4. Factors affecting detection of cyanosis in newborn Hemoglobin concentration Fetal hemoglobin Skin pigmentation
  5. 5. Hemoglobin concentration The arterial oxygen saturation level at which cyanosis is detectable at different total hemoglobin concentrations is illustrated above. The solid red portion of each bar represents 3 gm/dL reduced hemoglobin.
  6. 6. Fetal hemoglobin The oxygen-dissociation curve of human blood and the effects of changes in the H+ ion concentration, Pco2 temperature and level of 2, 3-diposphoglycerate (2,3-DPG) are depicted above. For fetal hemoglobin, the normal curve (a) is shifted to the left (b).
  7. 7. Skin pigmentation Less apparent in the skin of babies with darker pigmentation. Examination should include the nail beds, tongue, and mucous membranes, which are less affected by pigmentation.
  8. 8. Cyanosis Pulmonary Central CNS depression Local Ventilation- perfusion mismatch Alveolar hypoventilation Diffuse impairment Cardiac Increased pulmonary vascularity Decreased pulmonary vascularity Hemoglobi- nopathies
  9. 9. Ventilation/perfusion mismatch Airway disease: transient tachypnea of the newborn (TTN), respiratory distress syndrome (RDS), pneumonia, aspiration (meconium, blood, amniotic fluid), atelectasis, diaphragmatic hernia, pulmonary hypoplasia, pulmonary hemorrhage, CCAM Extrinsic compression of the lungs: pneumothorax, pleural effusion, hemothorax,
  10. 10. Alveolar hypoventilation CNS depression: asphyxia, maternal sedation, intraventricular hemorrhage, seizure, meningitis, encephalitis Airway obstruction: choanal atresia, laryngomalacia, Pierre Robin syndrome Neuromuscular disease: phrenic nerve inury, neonatal myasthenia gravis
  11. 11. Diffusion impairment Pulmonary edema: left-sided obstructive cardiac disease, cardiomyopathy Pulmonary fibrosis Congenital lymphangiectasia
  12. 12. Cardiac causes Decreased pulmonary blood flow- Tetralogy of Fallot Tricuspid valve anomaly Pulmonary valve atresia Critical valvular pulmonary steanosis Increased pulmonary blood flow- Transposition of great arteries Truncus arteriosus Total anomalous pulmonary venous connection
  13. 13. Cardiac causes- "five Ts" of cyanotic CHD: Transposition of the great arteries Tetralogy of Fallot Truncus arteriosus Total anomalous pulmonary venous connection Tricuspid valve abnormalities. A sixth "T" is often added for "tons" of other diseases, such as double outlet right ventricle, pulmonary atresia, multiple variations of single ventricle, hypoplastic left heart syndrome, or anomalous systemic venous connection (left superior vena cava connected to the left atrium).
  14. 14. Hemoglobinopathies Hereditary < exposure to toxic substances >15%- cyanosis >70% -lethal Remain chocolate brown-even with full oxygenation or long exposure to room air
  15. 15. Central cyanosis Inadequate alveolar ventilation CNS depression Inadequate ventilatory drive Obstruction Structural changes Muscle weakness Desaturated blood bypassing alveolar units Intracardiac R-L Intrapulmonary shunt Pulmonary hypertension with R-L shunt
  16. 16. Peripheral cyanosis Peripheral cyanosis, involves a bluish discoloration of the skin but sparing of the mucus membranes & tongue. In this type, a normal PaO2 value is detected Increased oxygen extraction due to sluggish movement through the capillaries leads to increased deoxygenated blood on the venous side Vasomotor instability,vasoconstriction caused by cold, low cardiac output, venous obstruction, elevated venous pressure and polycythemia
  17. 17. Acrocyanosis Bluish discoloration of fingers seen in neonates and infants due to vasoconstriction as a result of transient hypothermia No clinical significance unless associated with circulatory shock Circum-oral cyanosis Healthy child with fair skin due to sluggish blood flow with vasoconstriction No clinical significance unless associated with low cardiac output
  18. 18. Cardiac vs Pulmonary Hyperoxiatest- Response of arterial PaO2 to 100%oxygen inhalation Result in PaO2 Disease >100mm Hg Lung disease Large pulmonary blood flow (TAPVR)
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