Blue Baby
Quick Reference
Reviewed by Stanley Forwand, MD
A blue baby is an infant born with a type of congenital heart disease that induces a bluish tinge to the skin. Cyanosis, or the condition of having a bluish or purplish complexion, lips, and tongue, occurs when there is a depleted supply of oxygen in the blood. There are many kinds of heart defects that can result in a blue baby. While once life threatening, many advanced treatments are now available that allow blue babies to live normal, healthy lives.
Detailed Description
Cyanosis, or the condition of having a bluish coloration of the skin, is often caused by structural defect of the infant’s heart or blockage of the valves or major arteries. Blue babies often have a right-to-left shunt, a condition where blood is diverted or shunted from the right side of the heart to the left through a hole in the ventricular septum (the wall between the two lower chambers of the heart). Normally, blood flows from the right side of the heart to the lungs to be oxygenated, returns to the left side of the heart, and is pumped through the aorta, providing oxygen to cells throughout the body. However, babies with a right-to-left shunt divert oxygen-poor or "blue" blood from the right side to the left side of the heart, and onwards to the whole body before being oxygenated. A mixture of oxygen-rich and oxygen-poor blood may then circulate throughout the body, resulting in the bluish coloration of a blue baby’s skin. Another common heart defect is pulmonary stenosis, where there is a narrowing or stenosis of the pulmonic valve. This reduces the amount of blood that can squeeze through the opening from the right ventricle, or lower chamber, and travel through the pulmonary artery to the lungs for oxygenation. Other types of heart defects that can cause a baby’s bluish complexion include: Tetralogy of Fallot, a condition that has four elements:
- ventricular septal defect, a hole in the wall between the heart’s two lower chambers
- pulmonary stenosis, a narrowing of the pulmonic valve
- hypertrophy, enlargement of the muscle tissue of the right ventricle due to pulmonary stenosis
- displaced or deviated aorta, when oxygen-poor and oxygen-rich blood from both chambers is forced up through a displaced aorta that lies over a ventricular septal defect
Transposition of the great arteries, where the aorta and the pulmonary artery are “switched”
Total anomalous pulmonary venous return, when the pulmonary veins drain into the right atrium instead of the left atrium
Tricuspid atresia, a condition where the tricuspid valve is entirely closed, obstructing blood flow between the right atrium and right ventricle
Hypoplastic left heart syndrome, poor development of the left side of the heart leading to inadequate pumping of oxygen-rich blood to the body
Critical pulmonary stenosis or pulmonary atresia, where the pulmonary valve is severely narrowed or completely closed, interfering with blood flow to the lungs to be oxygenatedAll of these heart defects can result in inefficient circulation of oxygen-rich blood to the body, leading to a blue baby condition. A blue baby will have blue-tinged skin, nails, lips, tongue, tips of the fingers and toes or other parts of the body. The infant may also present the following symptoms: Fatigue, especially during crying spells or feeding times
Lack of energy
Shortness of breath or rapid breathing
Difficulty eating, breathing or sucking
Poor weight gain
Fainting or collapsing
Slow growth or other physical retardation
Heart murmurDiagnosis tools for blue baby may include:
Chest X-Ray
Electrocardiogram
Echocardiogram
Cardiac catheterization
Blood tests
Treatment
Long-term prognosis of blue baby depends on the severity of the specific heart defect and the chosen treatment. Inotropic medications such as digoxin, which affects the contraction of heart muscle, may reduce the workload of heart muscles, vessels or chambers and relieve a blue baby’s symptoms.Cardiac catheterization is another procedure that is more invasive and requires a thin tube, or catheter, to be inserted through a large blood vessel near the groin and guided to the heart. Through this tube, cardiologists can enlarge vessels and valves that have been narrowed, close holes in the wall between the chambers of the heart, or repair vessels. A blue baby may also undergo surgery to restore normal function to the heart and treat underlying congenital heart disease. Blue babies may require supplements to their diet to help them grow, such as high calorie formulas. Consumption of iron drops and iron-rich formula may also be necessary to aid oxygen binding to red blood cells, so oxygen can be carried more efficiently in the bloodstream. Because children with cyanosis may not have the same level of energy as other children do, they require more rest. You should know your child’s usual coloring and daily behavior and note persistent changes, such as a bluish complexion, increased sleeping, poor feeding, decreased energy, or squatting. Children can also turn blue because of lung or other respiratory problems, being cold, or having seizures. Keep in contact with your physician and notify him or her of significant changes. Although the extent of cyanosis due to congenital heart disease varies in nature and severity from blue baby to blue baby, advanced treatments can restore the flush in a baby’s cheeks and enable him or her to grow up and live a healthy life.
Last updated: 26-Jul-04
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