2. Approach to diagnosis1 CYANOSIS in Pediatrics Approach to Diagnosis For 5 th year Medical Students Norah A.A. Khathlan M.D. Consultant Pediatric Intensivist 11/2006

3. Approach to diagnosis2 Introduction  Outline  Age  General condition  History  Physical examination  Associated findings  Investigations

4. Approach to diagnosis3 Definitio n: bluish discoloration of tissues caused by increased concentration of reduced hemoglobin > 3 g/dl

5. Approach to diagnosis4 Problems:  - Skin Color - Temperature - Lighting - Anemia Look At: Lips, Nail Beds, Tongue and Mucous Membranes  Causes: Classify According to Age

6. Approach to diagnosis5 Cyanosis in a Neonate  Respiratory  Cardiac  CNS  Hematological  Metabolic

7. Approach to diagnosis6 I – Respiratory:  Apnea Apnea  RDS RDS  TTN  Aspiration  Pneumonia  PPHN  Cogenital anomalies/malformations  Diaphragmatic hernia  Tracheal atresia, web, stenosis

8. Approach to diagnosis7 II- Cardiac  Transposition of the great arteries  Truncus Arteriosus  Tricuspid Atresia  Tetralogy of Fallot  Total anomalous venous pulmonary return

9. Approach to diagnosis8 III- CNS:  Meningitis  Intra-ventricular or other intracranial hemorrhage  Drugs: respiratory depression, seizures

10. Approach to diagnosis9 IV- Metabolic  Acidosis  Hypoglycemia  Hypothermia  Sepsis

11. Approach to diagnosis10 V- Hematological:  Polycythemia  Methemoglobinemia

12. Approach to diagnosis11 Evaluation: Needs to be tailored to the individuals case.  History  Physical Exam  Vital Signs  Glucose  Give 100% oxygen for central cyanosis.  Hyperoxia test.  Make sure baby is breathing (otherwise oxygen will not be very helpful)  Arterial blood gas is the only way to determine if correct oxygenation  Chest X-ray  CBC with differential  Cardiac Evaluation

13. Approach to diagnosis12 Cyanosis Beyond Infancy:  Cardiac  Respiratory  CNS  Metabolic To be continued…..