Give supplemental oxygen ± provide assisted ventilation as you consider the causes of cyanosis in the neonate:
Pulmonary
- Respiratory Distress Syndrome
- sepsis, pneumonia (incl. meconium aspiration)
- persistent foetal circulation
- transient tachypnoea
Cardiovascular
- cyanotic heart disease
- congestive cardiac failure
CNS
- maternal sedative drugs
- asphyxia
- intracranial haemorrhage
- neuromuscular disease
Haematologic
- acute blood loss (shock)
- chronic blood loss (CCF)
- polycythaemia
- methemoglobinemia
Metabolic
- hypoglycaemia
- congenital adrenal hyperplasia (shock) – i.e. salt losing type
In neonates, several causes of HF can present with acute circulatory collapse or progress to shock if not recognized early. Many of these conditions require maintenance of duct patency with prostaglandin infusion or emergency procedures such as ductal stenting and balloon atrial septostomy. Indiscriminate administration of intravenous fluid resuscitation is contra-indicated and will worsen the condition of children with HF.¹
Reference
- Jayaprasad N. Heart Failure in Children. Heart Views. 2016 Jul-Sep;17(3):92-99. doi: 10.4103/1995-705X.192556. PMID: 27867456; PMCID: PMC5105230.
Further
Adeyinka A, Kondamudi NP. Cyanosis. [Updated 2020 Sep 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482247/.
Goldman HI, Maralit A, Sun S, Lanzkowsy P. Neonatal cyanosis and arterial oxygen saturation. J Pediatr. 1973 Feb;82(2):319-24. doi: 10.1016/s0022-3476(73)80181-7. PMID: 4684379.
Steinhorn RH. Evaluation and management of the cyanotic neonate. Clin Pediatr Emerg Med. 2008 Sep;9(3):169-175. doi: 10.1016/j.cpem.2008.06.006. PMID: 19727322; PMCID: PMC2598396.
