Paeds Vivas · fetal-neonatal-and-perinatal
Neonatal cyanosis and collapsed neonate — branching viva
Branching viva from the recognition of central cyanosis, through the duct-dependent day-3 collapse and the oxygen-refractory blue infant, to the prostaglandin rule and the apnoea management.
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Study tools
Target exams
RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
You are the paediatric registrar in the emergency department. The triage nurse asks you to assess three newborns presenting with cyanosis of differing cause: a day-3 term infant with sudden collapse, a blue infant unresponsive to oxygen, and a shocky infant with weak femoral pulses. The examiner releases information in stages.
Station opening
Examiner: "Define neonatal cyanosis and tell me the first bedside decision in a blue newborn." [3]
Strong candidate (must-hit)
- Defines cyanosis as the blue discolouration that appears when deoxyhaemoglobin exceeds about 3 g/dL; notes it is a late and unreliable sign of hypoxaemia and that an anaemic infant may never look blue. States that the first decision is to distinguish central cyanosis (blue tongue and mucous membranes — pathological, arterial desaturation) from benign peripheral acrocyanosis (blue hands and feet, pink tongue) — and that the tongue is the single site that settles it. [3]
Weak candidate
- "Cyanosis is being blue, usually from a lung problem." [3]
References5ShowHide
- [1]Wyckoff MH; Wyllie J; Aziz K; de Almeida MF; et al Neonatal Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation, 2020.PMID 33084392
- [2]Singh Y; Lakshminrusimha S Perinatal Cardiovascular Physiology and Recognition of Critical Congenital Heart Defects. Clin Perinatol, 2021.PMID 34353581
- [3]Strobel AM; Lu le N The Critically Ill Infant with Congenital Heart Disease. Emerg Med Clin North Am, 2015.PMID 26226862
- [6]Browning Carmo KA; Barr P; West M; Nicholl M; et al Transporting newborn infants with suspected duct dependent congenital heart disease on low-dose prostaglandin E1 without routine mechanical ventilation. Arch Dis Child Fetal Neonatal Ed, 2007.PMID 16905574
- [10]Lyle ANJ; Spurr R; Kirkey D; Maglinte D; et al Case report of congenital methemoglobinemia: an uncommon cause of neonatal cyanosis. Matern Health Neonatol Perinatol, 2022.PMID 36114590