**4. Cardiac disease**

234 Congenital Heart Disease – Selected Aspects

with esophageal atresia and severe esophageal reflux. Cyanosis that disappears with crying

3. Congenital defects ( eg. Diaphragmatic hernia, hypoplastic lungs, lobar emphysema, cystic adenomatoid malformation, diaphragmal abnormality )

1. All cyanotic heart diseases includin transposition of great arteries, total anomalous pulmonary venous return, Ebstein's anomaly, tricuspid atresia, pulmonary atresia, pulmonary stenosis, tetralogy of Fallot, patent ductus

Periventricular-intraventricular hemorrhage, meningitis and primary seizure disorder can all cause cyanosis. Neuromuscular disorders such as Werdnong-

7. Respiratory depression secondary to maternal medications ( eg. magnesium

9. Upper airway obstruction. Choanal atresia is nasal passage obstruction caused most commonly by a bony abnormality. Other causes are laryngeal web,

If there is cyanosis of upper or lower part of the body only, this usually signifies serious heart disease. The more common pattern is cyanosis restricted to the lower part of the body, which is seen in patients with patent ductus arteriosus with left-to right shunt. Cyanosis restricted to the upper half of the body is seen occasionally in patients with pulmonary hypertension,

Hoffmanndisease and congenital myotonic dystrophy can cause cyanosis.

may signify choanal atresia.

**a. Respiratory diseases**  1. Lung diseases

c. Pneumonia

2. Air leak syndrome

**b. Cardiac diseases** 

**c. CNS diseases** 

**d. Other disorders** 

5. Sepsis

8. Shock

1. Methemoglobinemia

sulfate and narcotics )

**3.4 Is there differential cyanosis?** 

3. Hypothermia 4. Hypoglycemia

a. Hyaline membrane disease

d. Meconium aspiration

b. Transiet tachypnea of the newborn

arteriosus and ventricular septal defect

2. Polycythemia/hyperviscostiy syndrome

Table 1. Differential diagnosis of cyanosis in the newborn

6. Pseudocyanosis caused by fluorescent lighting

tracheal stenosis, goiter and Pierre Robin syndrome.

patent ductus arteriosus, coarctation of aorta and D-transposition of great arteries.

2. Persistent pulmonary hypertension 3. Severe congestive heart failure

Congenital heart disease produces cyanosis when obstruction to right ventricular outflow causes intracardiac right-to-left shunting or when complex anatomic defects, unassociated with pulmonary stenosis, cause an admixture of pulmonary and systemic venous return in the heart. Cynosis from pulmonary edema may also develop in patients with heart failure caused by left-to-right shunts, although the degree is usually less severe. Cyanosis may be caused by persistence of fetal pathways, for example, right-to-left shunting across the foramen ovale and ductus arterious in the presence of persistent pulmonary hypertension of the newborn (PPHN).
