What Is Cyanotic Heart Disease?

Cyan is one of the common symptoms during the neonatal period. It is caused by an increase in the reduction of hemoglobin in the capillary blood of the newborn. It is generally believed that when the hemoglobin content of the arterial blood in the newborn is greater than 50 g / L, the blue can be detected by the naked eye. The lips and mucous membrane bruises first appeared. It can be caused by a variety of causes, it can occur in lung disease, heart disease, hematological disease and central nervous system disease, and it can also occur in a small number of normal newborns. The primary disease that causes bruising can be mild or severe enough to be life threatening.

Basic Information

English name

cyanosis in newborn

Visiting department

Neonatal

Multiple groups

Newborn

Common causes

The lungs have not fully expanded, the peripheral skin blood flow is poorly perfused, the environment is too cold, and the hemoglobin content is too high, etc.

Common symptoms

Bruising skin

Causes of neonatal bruising

Physiological bruising

Normal newborns may have bruises due to incomplete lung expansion, inadequate lung ventilation, and poor perfusion of the surrounding skin bloodstream; increased pulmonary artery pressure during neonatal crying may cause arterial ducts and / or oval holes Right to left shunts cause transient bruising. All belong to physiology.

2. Pathological bruising

(1) Peripheral bruising is due to the environment being too cold, high hemoglobin content, and local venous occlusion, due to increased tissue oxygen consumption and local hypoxia, but the partial pressure of oxygen and saturation of arterial blood are normal. Seen in systemic diseases such as heart failure, shock, local blood flow disorders caused by local compression or cold during delivery due to local blood pressure.

(2) Central bruising due to systemic diseases caused by arterial oxygen saturation and reduced oxygen partial pressure leading to bruising, seen in various respiratory diseases such as asphyxia, pneumonia, congenital malformations of the respiratory tract, etc., various bruising congenital heart diseases such as left Cardiac dysplasia syndrome, permanent arterial trunk, ectopic drainage of pulmonary veins, etc.

(3) Children with methemoglobinemia for other reasons . For example, when methemoglobin levels exceed 10% of the total hemoglobin, skin bruising and blood brown may occur; certain drugs such as nitrite, sulfa, phenacetin And drinking nitrite or nitrate-containing water, inhaling nitric oxide, etc. can cause methemoglobinemia. Polycythemia and central nervous system diseases can also cause bruising.

Neonatal bruising diagnosis

The first thing to determine is the type of bruise, whether it is physiological or pathological, peripheral or central. Physiological bruising is temporary, disappearing over time, and there is no manifestation of organic lesions. If bruising is limited to the lower body temperature such as the extremities, ear wheels, nose tip, etc., the bruising disappears into peripheral bruising after keeping warm and improving the microcirculation. If the whole body skin, eye conjunctiva, oral mucosa and tongue are widely bruising, the central bruising is not resolved after keeping warm and improving local circulation.

If it has been clinically identified as central bruising, the etiology should be further searched through medical history inquiry, physical examination and auxiliary examination.

Respiratory disease

Pay attention to the presence and degree of dyspnea such as the number of breaths, the depth, the rhythm, and the symptoms of tri-concavity. The bruising caused by respiratory diseases can be relieved by inhaling 100% oxygen. Further examination of lung signs and chest X A line check can confirm the diagnosis.

2. Persistent pulmonary hypertension in newborns

If there is no pulmonary disease at the same time, there is no obvious breathing difficulties, and atmospheric pressure oxygen cyanosis cannot be alleviated. A high oxygen-hyperventilation test can be performed for 10 minutes. If the arterial blood oxygen pressure increases and the PH value increases, consider the disease .

3. Congenital heart disease

Cyan-type congenital heart disease is often accompanied by heart murmurs, but it is not absolute. Therefore, a color Doppler ultrasound examination should be performed when the disease is suspected.

4. Other reasons

(1) Methemoglobinemia Children with this disease have bruising, but arterial oxygen partial pressure is normal.

(2) Except for erythrocytosis , the child's skin color is red, which may be accompanied by symptoms such as irritation, drowsiness, and apnea. The blood oxygen saturation may decrease and the partial oxygen pressure may be normal.

(3) Central nervous system diseases: neonatal intracranial hemorrhage, hypoxic-ischemic encephalopathy, etc. due to respiratory depression.

Neonatal bruising treatment principles

1. Physiological bruising does not require treatment.

2. Peripheral bruising should strengthen local insulation, and children with heart failure or shock should improve heart function and correct shock and microcirculation disorders.

3. The central bruise should be searched for the cause, and the treatment should be based on the cause, such as high-frequency ventilation or nitric oxide inhalation for those with persistent pulmonary hypertension, active treatment of lung diseases, and surgery for congenital heart disease.