Table Of Contents

Neonatal Cyanosis

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

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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?

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Acrocyanosis

Acrocyanosis

Acrocyanosis

Approach to Pediatric Murmurs

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

Innocent Murmurs

Type Description Clinical Presentation
Vibratory Still's 🔹 Low pitched vibratory crescendo-decrescendo systolic murmur
🔹 Best heard at left lower sternal border
🔹 ↑ While supine 🔹 Most common innocent murmur
Cervical Venous Hum 🔹 Low pitched crescendo-plateau-decrescendo, continuous
🔹 Caused by turbulence in the internal jugular vein
🔹 Best heard over the supra- or infraclavicular area
🔹 **Disappear with neck flexion
🔹 loudest in diastole** 🔹 Common in children
Pulmonary or Aortic Flow 🔹 Systolic ejection murmurs
🔹 Best heard over left upper sternal border 🔹 Typically benign

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

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In Peds World

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Rules

Feature Benign Murmurs Pathologic Murmurs
History 🔹 Asymptomatic
🔹 Normal growth
🔹 No significant family history 🔹 Infants → poor weight gain respiratory distress difficulty feeding
🔹 Older children → exertional fatigue chest pain syncope
🔹 Family history of SCD or CHD
Murmur Characteristics 🔹 Early or midsystolic
🔹 Musical or vibratory
🔹 Grade 1-2 intensity
🔹 Decreases or disappears with standing and Valsalva maneuver 🔹 Holosystolic or diastolic
🔹 Harsh
🔹 Grade ≥3 intensity
🔹 Intensity persists with standing and Valsalva maneuver
Other Findings 🔹 Normal vital signs
🔹 Normal S1 & S2
🔹 Symmetric pulses 🔹 Central cyanosis
🔹 Loud fixed or single S2
🔹 Weak femoral pulses
🔹 Hepatomegaly
Management 🔹 Reassurance 🔹 ECG and echocardiography