Cyanosis and tachypnea are frequently encountered in the neonatal period. The prevalence of respiratory distress in newborns ranges from 2.9% to 7.6%. Cyanosis can result from a range of disorders, including cardiac, metabolic, neurologic, and pulmonary disorders. In all, 4.3% of newborns may require supplemental oxygen therapy because of cyanosis.[1] [2] [3] Cyanosis is dependent on the absolute concentration of the reduced hemoglobin and not on the ratio of reduced hemoglobin to oxyhemoglobin. It is visually perceptible when reduced hemoglobin exceeds 3-5 g/dL. Cyanosis is classified into central and peripheral cyanosis. When present throughout the body, including the mucous membranes and tongue, the condition is termed central cyanosis. When limited to the extremities, it is termed peripheral cyanosis or acrocyanosis.
Summary
Library
Hyaline membrane disease (respiratory distress syndrome type 1): air bronchograms and a reticular granular pattern
Transient tachypnea of the newborn (respiratory distress syndrome type 2): perihilar streakiness and horizontal fissural fluid on the right
Meconium aspiration syndrome
Congenital diaphragmatic hernia
Congenital pulmonary airway malformation (CPAM; formerly known as congenital cystic adenomatoid malformation [CCAM])
Tracheoesophageal fistula: orogastric tube curled in the esophagus
Pneumothorax (right side)
Pleural effusion (right side) with mediastinal shift to the left
Pneumomediastinum without pneumothorax
Pneumomediastinum with pneumothorax (left side)
Citations
Sasidharan P. An approach to diagnosis and management of cyanosis and tachypnea in term infants. Pediatr Clin N Am. 2004 Aug;51(4):999-1021.[Abstract]
Marino BS, Tabbutt S, MacLaren G, et al. Cardiopulmonary resuscitation in infants and children with cardiac disease: a scientific statement from the American Heart Association. Circulation. 2018 May 29;137(22):e691-782.[Abstract][Full Text]
National Institute for Health and Care Excellence. Specialist neonatal respiratory care for babies born preterm. Apr 2019 [internet publication].[Full Text]
Yamada NK, Szyld E, Strand ML, et al. 2023 American Heart Association and American Academy of Pediatrics focused update on neonatal resuscitation: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2024 Jan 2;149(1):e157-66.[Abstract][Full Text]
Sweet DG, Carnielli VP, Greisen G, et al. European consensus guidelines on the management of respiratory distress syndrome: 2022 update. Neonatology. 2023;120(1):3-23.[Abstract][Full Text]
1. Hjalmarson O. Epidemiology and classification of acute neonatal respiratory disorders: a prospective study. Acta Paediatr Scand. 1981 Nov;70(6):773-83.[Abstract]
2. Hjalmarson O. Epidemiology of neonatal disorders of respiration. Int J Technol Assess Health Care. 1991;7 Suppl 1:9-15.[Abstract]
3. Kumar A, Bhat BV. Epidemiology of respiratory distress of newborns. Indian J Pediatr. 1996 Jan-Feb;63(1):93-8.[Abstract]
4. Sasidharan P. An approach to diagnosis and management of cyanosis and tachypnea in term infants. Pediatr Clin N Am. 2004 Aug;51(4):999-1021.[Abstract]
5. Dawson JA, Kamlin CO, Vento M, et al. Defining the reference range for oxygen saturation for infants after birth. Pediatrics. 2010 Jun;125(6):e1340-7.[Abstract]
6. Marino BS, Tabbutt S, MacLaren G, et al. Cardiopulmonary resuscitation in infants and children with cardiac disease: a scientific statement from the American Heart Association. Circulation. 2018 May 29;137(22):e691-782.[Abstract][Full Text]
7. The Royal Children's Hospital Melbourne. Nursing guidelines: oxygen saturation SpO2 level targeting in neonates. Jun 2023 [internet publication].[Full Text]
8. Khalil M, Jux C, Rueblinger L, et al. Acute therapy of newborns with critical congenital heart disease. Transl Pediatr. 2019 Apr;8(2):114-26.[Abstract][Full Text]
9. National Institute for Health and Care Excellence. Specialist neonatal respiratory care for babies born preterm. Apr 2019 [internet publication].[Full Text]
10. Yamada NK, Szyld E, Strand ML, et al. 2023 American Heart Association and American Academy of Pediatrics focused update on neonatal resuscitation: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2024 Jan 2;149(1):e157-66.[Abstract][Full Text]
11. Berg KM, Bray JE, Ng KC, et al. 2023 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations: summary from the basic life support; advanced life support; pediatric life support; neonatal life support; education, implementation, and teams; and first aid task forces. Resuscitation. 2023 Nov 9:109992 [Epub ahead of print].[Abstract][Full Text]
12. Sweet DG, Carnielli VP, Greisen G, et al. European consensus guidelines on the management of respiratory distress syndrome: 2022 update. Neonatology. 2023;120(1):3-23.[Abstract][Full Text]
13. Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016 Feb 23;315(8):801-10.[Abstract][Full Text]
14. National Institute for Health and Care Excellence. Suspected sepsis: recognition, diagnosis and early management. Mar 2024 [internet publication].[Full Text]
15. Weiss SL, Peters MJ, Alhazzani W, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Intensive Care Med. 2020 Feb;46(suppl 1):10-67.[Abstract][Full Text]
16. Schlapbach LJ, Watson RS, Sorce LR, et al. International consensus criteria for pediatric sepsis and septic shock. JAMA. 2024 Feb 27;331(8):665-74.[Abstract][Full Text]
17. Royal College of Physicians. National Early Warning Score (NEWS) 2. Dec 2017 [internet publication].[Full Text]
18. American College of Emergency Physicians (ACEP) Expert Panel on Sepsis. DART: an evidence-driven tool to guide the early recognition and treatment of sepsis and septic shock [internet publication].[Full Text]
19. Academy of Medical Royal Colleges. Statement on the initial antimicrobial treatment of sepsis. Oct 2022 [internet publication].[Full Text]
20. Kurl S, Heinon KM, Kiekara O. The first chest radiograph in neonates exhibiting respiratory distress at birth. Clin Pediatr (Phila). 1997 May;36(5):285-9.[Abstract]
21. Cleveland RH. A radiologic update on medical diseases of the newborn chest. Pediatr Radiol. 1995;25(8):631-7.[Abstract]
22. O'Donnell CP, Kamlin CO, Davis PG, et al. Clinical assessment of infant colour at delivery. Arch Dis Child Fetal Neonatal Ed. 2007 Nov;92(6):F465-7.[Abstract]
23. Levesque BM, Pollack P, Griffin BE, et al. Pulse oximetry: what's normal in the newborn nursery? Pediatr Pulmonol. 2000 Nov;30(5):406-12.[Abstract]
24. Jennis MS, Peabody JL. Pulse oximetry: an alternative method for the assessment of oxygenation in newborn infants. Pediatrics. 1987 Apr;79(4):524-8.[Abstract]
25. Hay WW, Brockway JM, Eyzaguirre M. Neonatal pulse oximetry: accuracy and reliability. Pediatrics. 1989 May;83(5):717-22.[Abstract]
26. Fanconi S. Reliability of pulse oximetry in hypoxic infants. J Pediatr. 1988 Mar;112(3):424-7.[Abstract]
27. Plana MN, Zamora J, Suresh G, et al. Pulse oximetry screening for critical congenital heart defects. Cochrane Database Syst Rev. 2018 Mar 1;3(3):CD011912.[Abstract][Full Text]
28. Kemper AR, Mahle WT, Martin GR, et al. Strategies for implementing screening for critical congenital heart disease. Pediatrics. 2011 Nov;128(5):e1259-67.[Abstract]
29. Thangaratinam S, Brown K, Zamora J, et al. Pulse oximetry screening for critical congenital heart defects in asymptomatic newborn babies: a systematic review and meta-analysis. Lancet. 2012 Jun 30;379(9835):2459-64.[Abstract]
30. Narayen IC, Blom NA, Ewer AK, et al. Aspects of pulse oximetry screening for critical congenital heart defects: when, how and why? Arch Dis Child Fetal Neonatal Ed. 2016 Mar;101(2):F162-7.[Abstract]
31. British Association of Perinatal Medicine. Identification and management of neonatal hypoglycaemia in the full term infant - a framework for practice. Apr 2017 [internet publication].[Full Text]
32. Moss AJ. Clues in diagnosing congenital heart disease. West J Med. 1992 Apr;156(4):392-8.[Abstract][Full Text]
33. Yip WC, Tay JS. A practical diagnostic approach to cyanotic congenital heart disease. Singapore Med J. 1983 Aug;24(4):189-201.[Abstract]
