RT Book, Section
A1 Leone, Tina A.
A2 Siassi, Bijan
A2 Noori, Shahab
A2 Acherman, Ruben J.
A2 Wong, Pierre C.
SR Print(0)
ID 1161424770
T1 Desaturation and Cyanosis in the Newborn Infant without Congenital Heart Disease*
T2 Practical Neonatal Echocardiography
YR 2018
FD 2018
PB McGraw-Hill Education
PP New York, NY
SN 9781260123135
LK accesspediatrics.mhmedical.com/content.aspx?aid=1161424770
RD 2024/04/20
AB The  physical  signs  of  cyanosis  and  decreased  oxygen  saturation  are  usually  the  result  of  hypoxemia,  and  can  be  found  in  newborn  infants  with  a  variety  of  pathologies.  Hypoxemia  can  be  the  result  of  shunting  of  deoxygenated  blood  from  the  venous  to  the  arterial  circulation.  This  can  occur  at  many  levels  including  intracardiac,  extracardiac,  and  intrapulmonary  locations.  The  primary  causes  of  hypoxemia  in  infants  without  congenital  heart  disease  vary  and  include  pulmonary  problems  such  as  pneumonia,  respiratory  distress  syndrome  (RDS),  congenital  anomalies,  pneumothorax,  and  meconium  aspiration  syndrome  (MAS).  Additionally,  the  primary  cause  of  hypoxemia  could  be  persistent  pulmonary  hypertension  of  the  newborn  (PPHN),  a  failure  or  delay  in  making  the  circulatory  transition  from  fetal  to  newborn  life  leading  to  persistently  elevated  pulmonary  vascular  resistance,  and  continued  shunting  through  the  fetal  channels.  In  most  cases,  PPHN  is  secondary  to  another  respiratory  disease,  and  therefore  these  findings  do  not  usually  occur  in  isolation.  Certain  conditions  predispose  infants  to  having  a  more  prolonged  circulatory  transition.  Infants  at  higher  risk  include  infants  of  diabetic  mothers,  infants  with  trisomy  21,  and  fetal  exposure  to  nonsteroidal  anti-inflammatory  agents  or  selective  serotonin  reuptake  inhibitors.  Preterm  infants  may  have  a  variety  of  transitional  problems  after  birth  leading  to  hypoxemia.  Both  RDS  and  prolonged  premature  rupture  of  membranes  (PPROM)  are  associated  with  PPHN.  Additionally,  a  significant  patent  ductus  arteriosus  (PDA)  is  often  associated  with  increasing  oxygen  and  ventilator  requirements.  Echocardiography  can  be  helpful  in  the  diagnosis  and  management  of  many  of  these  problems.