The key to the diagnosis of central cyanosis in the neonate is to always careful examine the newborn’s tongue and mouth (mucous membranes) and to gently pull down the lower lip to look at the mucous membrane there.
This podcast presents an approach to cyanosis in neonates. In this episode, listeners will learn how to assess and recognize a cyanotic infant, as well as develop a differential diagnosis and identify immediate investigations and management for the cyanotic infant. This podcast was developed by Michelle Fric, a medical student at the University of Alberta, in collaboration with Dr. Georgeta Apostol, a general pediatrician at the Royal Alexandra Hospital in Edmonton.
And here is the summary from the transcript:
Now that we have developed an approach to a cyanotic newborn, I want to leave you with some key take home points.
1. Checking for cyanosis should always be part of your newborn exam. Central cyanosis persisting after the first 10 minutes of life must always be investigated. Keep in mind, cyanosis is not always obvious, especially in dark-skinned babies. Make sure to look closely in the mouth with a good light. [Gently pull down the lower lip and examine the mucosal color there also.]
2. During the assessment of cyanotic the newborn, it is important to identify the cause of cyanosis on a physiologic basis. It will be helpful to consider if the cyanosis is caused by: cardiac or pulmonary conditions, because these are the most common causes for cyanosis in the newborn and could potentially be lifethreating requiring immediate interventions. 2a. Other causes to consider are sepsis, hemoglobin abnormalities, hypoglycemia or metabolic diseases.
3. Remember to check the babies response to supplemental oxygen for the Hyperoxia test.
4. Don’t be afraid to ask for help from your team or consulting services. Cyanosis can indicate a life-threatening pathology. Ensure that the baby is stable before continuing on with the rest of your exam or investigations.