Table Of Contents

Neonatal Cyanosis

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Hyperoxia test (Helps to distinguish cardiac from pulmonary causes of cyanosis)

• In this test, PaO2 is measured during the administration of 100% oxygen.
• When cyanosis results from a right-to-left-shunt, the continued mixing of oxygenated with low-oxygenated blood results in continued hypoxemia and low PaO2 → Cardiac pathology
• SpO2 increased → Pulmonary pathology </aside>

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What is the next step in management for a newborn with cyanosis that does not improve with 100% O2 and a continuous machine-like murmur on auscultation?

• Answer </aside>

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Acrocyanosis

• ****Often seen in healthy newborns immediately after birth in healthy infants. It is a common finding and may persist for 24 to 48 hours.
• Refers to the peripheral cyanosis around the mouth and the extremities (hands and feet) </aside>

Acrocyanosis

Approach to Pediatric Murmurs

Watch ▶Approach to a murmur (pediatrics): Clinical sciences

Innocent Murmurs

<aside> <img src="/icons/flag_red.svg" alt="/icons/flag_red.svg" width="40px" /> "Red Flags" Indicating Need for Workup

• Murmurs > 3/6 in intensity and harsh in quality
• Diastolic or continuous murmurs
• Holosystolic murmurs
• Presence of S3 or S4 gallop </aside>

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In Peds World

• Musical qualities almost always indicate benign murmurs ⇒ no further investigation. </aside>

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Rules

• Ejection Systolic murmurs are likely to be physiological
• Holosystolic murmurs are nearly always pathological.
• Diastolic and continuous murmurs are usually due to an underlying pathologic cause and their presence should prompt further evaluation with TTE. </aside>