Blue baby syndrome: Difference between revisions
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'''Blue baby syndrome''' can refer to a number of conditions that affect oxygen transportation in the blood, resulting in [[cyanosis|blueness of the skin]] in babies. Historically, the term "blue baby syndrome" has referred to babies |
'''Blue baby syndrome''' can refer to a number of conditions that affect oxygen transportation in the blood, resulting in [[cyanosis|blueness of the skin]] in babies. Historically, the term "blue baby syndrome" has referred to babies with one of two conditions: |
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#[[Cyanotic heart disease]], which is a category of [[congenital heart defect]] that results in low levels of oxygen in the blood. This can be caused by either reduced blood flow to the lungs or mixing of oxygenated and deoxygenated blood.<ref name=":0">{{Cite web|url=https://medlineplus.gov/ency/article/001104.htm|title=Cyanotic heart disease: MedlinePlus Medical Encyclopedia|website=medlineplus.gov|language=en|access-date=2019-11-01}}</ref> |
#[[Cyanotic heart disease]], which is a category of [[congenital heart defect]] that results in low levels of oxygen in the blood. This can be caused by either reduced blood flow to the lungs or mixing of oxygenated and deoxygenated blood.<ref name=":0">{{Cite web|url=https://medlineplus.gov/ency/article/001104.htm|title=Cyanotic heart disease: MedlinePlus Medical Encyclopedia|website=medlineplus.gov|language=en|access-date=2019-11-01}}</ref> |
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#[[Methemoglobinemia]], which is a disease defined by |
#[[Methemoglobinemia]], which is a disease defined by high levels of methemoglobin in the blood. Increased levels of [[methemoglobin]] cause oxygen to tightly bind to [[hemoglobin]] in red blood cells, preventing oxygen from being released into the tissues.<ref>{{Cite web|url=https://medlineplus.gov/ency/article/000562.htm|title=Methemoglobinemia: MedlinePlus Medical Encyclopedia|website=medlineplus.gov|language=en|access-date=2019-11-01}}</ref> |
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Both of these conditions cause [[cyanosis]], or a bluish discoloration of skin or mucous membranes.<ref>{{Citation|last=Snider|first=H. L.|title=Cyanosis|date=1990|url=http://www.ncbi.nlm.nih.gov/books/NBK367/|work=Clinical Methods: The History, Physical, and Laboratory Examinations|editor-last=Walker|editor-first=H. Kenneth|edition=3rd|publisher=Butterworths|isbn=9780409900774|pmid=21250208|access-date=2019-11-01|editor2-last=Hall|editor2-first=W. Dallas|editor3-last=Hurst|editor3-first=J. Willis}}</ref> |
Both of these conditions cause [[cyanosis]], or a bluish discoloration of skin or mucous membranes.<ref>{{Citation|last=Snider|first=H. L.|title=Cyanosis|date=1990|url=http://www.ncbi.nlm.nih.gov/books/NBK367/|work=Clinical Methods: The History, Physical, and Laboratory Examinations|editor-last=Walker|editor-first=H. Kenneth|edition=3rd|publisher=Butterworths|isbn=9780409900774|pmid=21250208|access-date=2019-11-01|editor2-last=Hall|editor2-first=W. Dallas|editor3-last=Hurst|editor3-first=J. Willis}}</ref> Cyanosis can be detected using [[pulse oximetry]], which measures oxygen saturation in the blood. While severe cyanosis can be easily noticed, an oxygen saturation as low as 80% causes only mild clinical cyanosis that is more subtle.<ref>{{Cite journal|last=Silove|first=E. D.|date=1994|title=Assessment and management of congenital heart disease in the newborn by the district paediatrician|url=https://www.ncbi.nlm.nih.gov/pubmed/8117134|journal=Archives of Disease in Childhood. Fetal and Neonatal Edition|volume=70|issue=1|pages=F71–74|doi=10.1136/fn.70.1.f71|issn=1359-2998|pmc=1060995|pmid=8117134|via=}}</ref> |
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==Causes== |
==Causes== |
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{{anchor|Cause}} |
{{anchor|Cause}} |
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===Cyanotic heart disease=== |
===Cyanotic heart disease=== |
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Specific types of congenital heart defects that cause blood to pass directly from the right side of the heart to the left side result in cyanosis.<ref>{{Cite journal|last=Lin|first=Pei-Yi|last2=Hagan|first2=Katherine|last3=Fenoglio|first3=Angela|last4=Grant|first4=P. Ellen|last5=Franceschini|first5=Maria Angela|date=2016-05-16|title=Reduced cerebral blood flow and oxygen metabolism in extremely preterm neonates with low-grade germinal matrix- intraventricular hemorrhage|url=https://www.ncbi.nlm.nih.gov/pubmed/27181339|journal=Scientific Reports|volume=6|pages=25903|doi=10.1038/srep25903|issn=2045-2322|pmc=4867629|pmid=27181339|via=}}</ref> In these defects, some of the blood that is pumped to the body has not been oxygenated by the lungs and therefore will appear more blue. Infants with these types of heart defects may have a constant bluish tint to their skin, or they may have temporary episodes of cyanosis. The degree of cyanosis is dependent on how much deoxygenated blood is mixed with oxygenated blood before being pumped to the body. |
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A number of cardiovascular defects may lead to blue baby syndrome. The most common cyanotic heart defects include [[tetralogy of Fallot]], [[Persistent truncus arteriosus|persistent (or patent) truncus arteriosus]], [[tricuspid atresia]], [[transposition of the great vessels]], and [[anomalous pulmonary venous connection]]. |
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The five most common cyanotic heart defects that may result in Blue Baby Syndrome include: |
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# [[Persistent truncus arteriosus|Persistent (or patent) truncus arteriosus]] |
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# [[Transposition of the great vessels]] |
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# [[Tricuspid atresia]] |
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# [[Tetralogy of Fallot]] |
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# [[Anomalous pulmonary venous connection]] |
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File:Truncus arteriosus.jpg|[[Persistent truncus arteriosus|Persistent (or patent) truncus arteriosus]] |
File:Truncus arteriosus.jpg|[[Persistent truncus arteriosus|Persistent (or patent) truncus arteriosus]] |
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File:D-tga-575px.jpg|[[Transposition of the great vessels]] |
File:D-tga-575px.jpg|[[Transposition of the great vessels]] |
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Revision as of 19:37, 7 November 2019
| Blue baby syndrome | |
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| Other names | Blue baby, cyanotic infant, cyanotic baby, cyanotic newborn |
 | |
| A cyanotic newborn, or "blue baby". Note the blue coloration of the fingertips. | |
| Specialty | Pediatrics, cardiac surgery |
Blue baby syndrome can refer to a number of conditions that affect oxygen transportation in the blood, resulting in blueness of the skin in babies. Historically, the term "blue baby syndrome" has referred to babies with one of two conditions:
- Cyanotic heart disease, which is a category of congenital heart defect that results in low levels of oxygen in the blood. This can be caused by either reduced blood flow to the lungs or mixing of oxygenated and deoxygenated blood.[1]
- Methemoglobinemia, which is a disease defined by high levels of methemoglobin in the blood. Increased levels of methemoglobin cause oxygen to tightly bind to hemoglobin in red blood cells, preventing oxygen from being released into the tissues.[2]
Both of these conditions cause cyanosis, or a bluish discoloration of skin or mucous membranes.[3] Cyanosis can be detected using pulse oximetry, which measures oxygen saturation in the blood. While severe cyanosis can be easily noticed, an oxygen saturation as low as 80% causes only mild clinical cyanosis that is more subtle.[4]
Causes
Cyanotic heart disease
Specific types of congenital heart defects that cause blood to pass directly from the right side of the heart to the left side result in cyanosis.[5] In these defects, some of the blood that is pumped to the body has not been oxygenated by the lungs and therefore will appear more blue. Infants with these types of heart defects may have a constant bluish tint to their skin, or they may have temporary episodes of cyanosis. The degree of cyanosis is dependent on how much deoxygenated blood is mixed with oxygenated blood before being pumped to the body.
The five most common cyanotic heart defects that may result in Blue Baby Syndrome include:
- Persistent (or patent) truncus arteriosus
- Transposition of the great vessels
- Tricuspid atresia
- Tetralogy of Fallot
- Anomalous pulmonary venous connection
Methemoglobinemia
Blue baby syndrome can also be caused by nitrates in drinking water leading to methemoglobinemia. Nitrates from polluted drinking water form compounds in the body that change haemoglobin to methemoglobin, decreasing the ability of blood to carry oxygen. In infants, the condition can be fatal.[6] The sources of nitrate can include fertilizers used in agricultural lands, waste dumps or pit latrines.[7] For example, cases of blue baby syndrome have been reported in villages in Romania and Bulgaria, and were thought to be caused by groundwater polluted by nitrate leaching from pit latrines.[8] Nitrate levels are subject to monitoring to comply with drinking water quality standards in the United States and other countries.[9][10] The link between blue baby syndrome and nitrates in drinking water is widely accepted, but some studies indicate that other contaminants, or dietary nitrate sources, may also play a role in the syndrome.[8][11][12]
Other causes
Other insults in neonates, such as respiratory distress syndrome, can also produce a "blue baby syndrome". Like methemoglobinemia, these are not structural lesions and are not regarded by most doctors as true "cyanotic lesions."
References
- ^ "Cyanotic heart disease: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 1 November 2019.
- ^ "Methemoglobinemia: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 1 November 2019.
- ^ Snider, H. L. (1990), Walker, H. Kenneth; Hall, W. Dallas; Hurst, J. Willis (eds.), "Cyanosis", Clinical Methods: The History, Physical, and Laboratory Examinations (3rd ed.), Butterworths, ISBN 9780409900774, PMID 21250208, retrieved 1 November 2019
- ^ Silove, E. D. (1994). "Assessment and management of congenital heart disease in the newborn by the district paediatrician". Archives of Disease in Childhood. Fetal and Neonatal Edition. 70 (1): F71–74. doi:10.1136/fn.70.1.f71. ISSN 1359-2998. PMC 1060995. PMID 8117134.
- ^ Lin, Pei-Yi; Hagan, Katherine; Fenoglio, Angela; Grant, P. Ellen; Franceschini, Maria Angela (16 May 2016). "Reduced cerebral blood flow and oxygen metabolism in extremely preterm neonates with low-grade germinal matrix- intraventricular hemorrhage". Scientific Reports. 6: 25903. doi:10.1038/srep25903. ISSN 2045-2322. PMC 4867629. PMID 27181339.
- ^ Manassaram, Deana M.; Backer, Lorraine C.; Moll, Deborah M. (2006). "A review of nitrates in drinking water: maternal exposure and adverse reproductive and developmental outcomes". Environmental Health Perspectives. 114 (3): 320–327. doi:10.1289/ehp.8407. ISSN 0091-6765. PMC 1392223. PMID 16507452.
- ^ Majumdar Deepanjan. "The Blue Baby Syndrome". Resonance. 8: 20–30. doi:10.1007/BF02840703.
- ^ a b Fewtrell, Lorna (22 July 2004). "Drinking-Water Nitrate, Methemoglobinemia, and Global Burden of Disease: A Discussion". Environmental Health Perspectives. 112 (14): 1371–1374. doi:10.1289/ehp.7216. PMC 1247562. PMID 15471727.
- ^ "National Primary Drinking Water Regulations". EPA: United States Environmental Protection Agency. Retrieved 14 July 2018.
- ^ "Water-related diseases". World Health Organization. Retrieved 14 July 2018.
- ^ van Grinsven, Hans JM; Ward, Mary H = 2006 (2006). "Does the evidence about health risks associated with nitrate ingestion warrant an increase of the nitrate standard for drinking water?". Environ Health. 5 (1): 26. doi:10.1186/1476-069X-5-26. PMC 1586190. PMID 16989661.
{{cite journal}}: CS1 maint: numeric names: authors list (link) CS1 maint: unflagged free DOI (link) - ^ Ward, Mary H.; deKok, Theo M.; Levallois, Patrick; Brender, Jean; Gulis, Gabriel; Nolan, Bernard T.; VanDerslice, James (23 June 2005). "Workgroup Report: Drinking-Water Nitrate and Health—Recent Findings and Research Needs". Environmental Health Perspectives. 113 (11): 1607–1614. doi:10.1289/ehp.8043. PMC 1310926. PMID 16263519.