Evaluation of cyanosis in the newborn

Last reviewed: 7 Apr 2025
Last updated: 23 Oct 2024

Summary

Differentials

Common

  • Transposition of great arteries
  • Tetralogy of Fallot
  • Pulmonary atresia
  • Respiratory distress syndrome (RDS)
  • Transient tachypnea of the newborn
  • Persistent pulmonary hypertension of the newborn
  • Pneumothorax
  • Aspiration pneumonia
  • Pneumonia
  • Pulmonary edema
  • Congenital diaphragmatic hernia
  • Congenital pulmonary airway malformation (CPAM; formerly known as congenital cystic adenomatoid malformation [CCAM])
  • Upper airway obstruction
  • Polycythemia
  • Asphyxia
  • Methemoglobinemia (met-Hb)
  • Hypoglycemia
  • Neonatal sepsis
Full details

Uncommon

  • Total anomalous pulmonary venous return
  • Hypoplastic left heart syndrome or single ventricle physiology states
  • Tricuspid atresia
  • Truncus arteriosus
  • Pulmonary hemorrhage
  • Pulmonary hypoplasia
  • Congenital lobar emphysema
  • Pulmonary lymphangiectasia
  • Tracheoesophageal fistula (TEF)/esophageal atresia (EA)
  • Pleural effusion
  • Arteriovenous malformation
Full details

Contributors

Authors

Associate Professor

Section of Neonatology and Department of Pediatrics

Baylor College of Medicine

Houston

TX

Disclosures

MP received payment for a talk on neonatal COVID-19 in the NICU for Goldline Learning in 2021.

Dr Mohan Pammi would like to gratefully acknowledge Dr AnnaMarie Arias-Shah, Dr Robin H. Steinhorn and Dr Ponthenkandath Sasidharan, the previous contributors to this topic.

Disclosures

AA-S and PS declare that they have no competing interests. RHS is Associate Editor for Journal of Pediatrics. The University of California has received honoraria for Dr Steinhorn from Scientific Therapeutics Information Inc, through Mallinckrodt.

Peer reviewers

Professor of Pediatrics

Department of Pediatrics

Medical Center

University of Illinois

Chicago

IL

Disclosures

RB declares that he has no competing interests.

Assistant Professor Pediatrics/Neonatology

Medical College of Wisconsin

Milwaukee

WI

Disclosures

UGD declares that she has no competing interests.

Consultant Paediatrician

Neonatal Unit

Gloucestershire Royal Hospital

Gloucester

UK

Disclosures

RP declares that he has no competing interests.

References

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Key articles

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.Full text  Abstract

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.Full text  Abstract

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.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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