Chapter 92 Clinical Manifestations of Diseases in the Newborn Period
Central cyanosis has respiratory, cardiac, central nervous system (CNS), hematologic, and metabolic causes (Table 92-1). Respiratory insufficiency may be due to pulmonary conditions or may be secondary to CNS depression from drugs, intracranial hemorrhage, or anoxia. If respiratory insufficiency is caused by pulmonary conditions, respirations tend to be rapid and may be accompanied by retraction of the thoracic cage. If it is due to the CNS depression, respirations tend to be irregular and weak and are often slow. Cyanosis unaccompanied by obvious signs of respiratory difficulty suggests cyanotic congenital heart disease or methemoglobinemia. Cyanosis resulting from congenital heart disease may, however, be difficult to distinguish clinically from cyanosis caused by respiratory disease. Episodes of cyanosis may also be the initial sign of hypoglycemia, bacteremia, meningitis, shock, or pulmonary hypertension. Peripheral acrocyanosis is common in neonates and does not usually warrant concern unless poor perfusion is suspected.
Table 92-1 DIFFERENTIAL DIAGNOSIS OF CYANOSIS IN THE NEWBORN
From Smith F: Cyanosis. In Kliegman RM: Practical strategies in pediatric diagnosis and therapy, Philadelphia, 1996, WB Saunders.
