APROACH to child with cyanosis types management CCHD

1. Child with cyanosis

2. Presented by :
Group C4
5th year medical students
Tripoli university
Pediatric

3. Objectives
 Definition of cyanosis
 Types of cyanosis
 Causes of cyanosis
Complications
Management

4. Cyanosis is derived from the colour ‘cyan’, which comes
from ‘kyanous’, the Greek word for blue .
Definition:
It is Bluish discoloration of skin and mucous membrane
caused by increase concentration of reduced
hemoglobin > 5g/dl
so its not less pronounced if the child is anemic.

5. Types of cyanosis
Peripheral Central

6. Peripheral cyanosis (blueness of hands &feet)
Normal systemic arterial oxygen saturation.
The increased extraction of oxygen
results from sluggish movement of blood
through the capillary circulation
Sites
Tip of nose
Ear lobules
Outer aspect of lips,chin,cheek
Tips and nailbeds of fingers,toes
Palms,soles Tongue is spared

7. Causes:
 vasoconstriction ( exposure to cold)
 polycythemia
 low cardiac output

8. Central cyanosis
Pathologic condition caused by
reduced arterial oxygen saturation.
due oxygenation defect in lung or admixture of
venous and arterial blood
Involves highly vascularized tissues, through which
blood flow is brisk .
Cardiac output typically is normal, and patients have
warm extremities.
It is evident when O2 saturation falls below 90%
From 90_95% (desaturated)

9. Sites:
Tongue (margins & undersurface)
Inner aspect of lips
Mucous membranes of gums ,soft palate
,cheeks

11. Causes of central cyanosis
1_Respiratory disorders :
upper airway obstruction
Respiratory distress syndrome (RDS)
Meconium aspiration(MAS)
Pneumonia (sepsis)
PPHN_Failure of pulm.vascular resistance to fall after
birth
Pulmonary hypoplasia
Bronchopulmonary dysplasia(mechanical ventilation)
Congenital diaphragmatic hernia
Asthma

12. 2_CNS disorders:
ICH
Birth asphyxia
Seizures
Oversedation (direct or through maternal route)

13. 3_Cardiac disorders:
Cyanotic congenital heart diseases (right to left shunt)
5Ts
Tetralogy of Fallot (TOF)
Transposition of great vessels(TGA)
Total anomalous pulmonary venous return
Truncus arteriosus
Tricuspid atresia
Note: persistant cyanosis in otherwise well infant is nearly
always a sign of CHD

14. Ebstein malformation of the tricuspid valve
Left hypoplastic heart
Single ventricle
Critical pulmonary atresia
Heart failure/Cardiogenic Shock
others
Polycythemia
Methemoglobinemia
Metabolic diseases
Infection _septicemia
(physiological) : High altitude – Acrocyanosis “newborn”

15. cause example
Cardiovascular disorders congenital cyanotic heart disease
Respiratory disorders - Pneumonia
- Bronchiolitis
- RDS & meconium aspiration
- Pneumothorax & pleural effusion
0CNS disorders - intra cranial hemorrhage0
- Tonic clonic seizure
hematological disorders - Methemoglobinemia
- Polycythemia
- Congenital cyanosis
other disorders - High Altitude
- hypothermia
- obstructive sleep apnea

16. Differential Cyanosis
Hands red (less blue) and feet blue seen in PDA with
reversal of shunt (Differential Cyanosis) Requires
pulmonary vascular resistance elevated to a systemic level
and a patent ductus arteriosus
Left to right sunt pulmonary HT reversed shunt
(Rt Lt shunt)
Desaturated blood from the ductus enters the aorta distal
to the left subclavian artery, sparing the brachiocephalic
circulation.

17. Management
Aim:
* Differentiate physiologic from pathologic
cyanosis
* Differentiate cardiac from non- cardiac cause
of cyanosis
* Find causes which needs urgent treatment or
referral

18. Do :
1_complete maternal and newborn history
2_perform a full physical examination
3_ Investigation

19. Investigation
* Pulse oximetry: (normal O2 sat. ≥ 95%)
* ABGs :
PaO2: to confirm central cyanosis
↑ PaCO2: may indicate pulmonary or CNS disorders.
↓ pH: sepsis, circulatory shock, severe hypoxemia
* Hyperoxia test (Is it due cardiac or pulmonary cause?)
placing the infant in 100% oxygen for 10 minutes. If he
remains cyanotic after this period, the cyanosis is said to
be secondary to cyanotic heart diseases(SaO2 not reach
the normal value).

20. * CBC :
↑ or ↓ WBC : sepsis
Hematocrit > 65% : polycythemia
* Methemoglobinemia : ↓ SaO2, normal PaO2, chocolate-brown
blood , HB-M
* Sepsis screening
* ECG: Dx for Tricusped atresia (Lt axis deviation only is seen)
* Echo: Dx for CHD
* Chest x-ray

21. Treatment
* Warming of the affected area: in peripheral cyanosis
* Oxygenation & adequate ventilation
(PaO2 normalizes completely during artificial ventilation
in infant with CNS disorder)
* IV fluids
Children who have difficulty in feeding due to cyanosis
need fluids to be administrated.
* If sepsis is suspected or another specific cause is not
identified, start on broad spectrum antibiotics then obtain
a full septic screening

22. * Drugs: Prostaglandin E1
For ductal dependent CHD
IV Infusion of PGE1 at a dose of (0.05-
to maintain patency 0.1mcg/kg/min)
S/E- hypoventilation, apnea, edema and low grade fever
* Surgery

23. CCHD

25. Tetralogy of Fallot
Boot shape

26. Total Anomalous Pulmonary
Venous Return(TAPVR)
Snowman

27. Transposition of Great Arteries
Egg on a string

28. Truncus arteriosus

29. Tricusped atresia

30. Complication of CCHD
Stunt of growth
Cyanotic spells (in TOF)
brain abscess
Cerebral thrombosis (CVA)
pulmonary TB (oligemic lung)
HF “rare”
Death

31. Tx of cyanotic spells:
Hold the baby in knee chest position
O2
Morphine (subcut.) : to relieve pain &
anexiety
NaHco3 : for metabolic acidosis
Inderal (Beta blocker) : prevent recurrent
attack

32. Thank you