502:. Central cyanosis is typically visible as a blueish discoloration over the entire body and mucous membranes. In contrast, peripheral cyanosis typically has a blueish discoloration over the extremities. Cyanosis can be noted in babies around the lips, tongue, and sublingual area, where the skin is thinnest. In addition, it is important to observe the infant for signs of respiratory distress, visualized as nasal flaring, subcostal retractions, etc. Examination should include a respiratory and cardiac assessment.
332:
608:). This gives the oxygenation level the heart and brain receive. Traditionally, supplemental oxygen is given in an escalating manner beginning with free-flowing oxygen, progressing to positive pressure ventilation or continuous positive airway pressure, and ending with mechanical intubation. The goal oxygen saturation is between 85 and 95 %. If an infant requires supplemental oxygen for a prolonged time it should be heated and humidified to avoid heat loss.
276:
234:
42:
488:
297:
255:
318:
1151:
1280:
1217:
719:(PDA) typically lived longer, so the trio tried to create the same effect as a PDA by joining the subclavian artery to the pulmonary artery, relieving the child's cyanosis. The operation was published in the Journal of the American Medical Association in 1945 and impacted management of blue babies around the world.
198:
increase in blood flow to the lungs but with limited flow of the oxygenated blood to the rest of the body. Conditions in which there is poor blood flow to the systemic circulation, such as coarctation of the aorta suggests that the body does not receive the oxygenated blood it requires with resultant cyanosis.
722:
Anna was the name of the dog who was the first survivor of the surgery, considered an experimental procedure at the time. Anna survived the first pulmonary bypass after having been operated on twice. The second operation was required to replace the original stitches with flexible ones. After their
569:
A screening tool has been developed to screen for critical cardiac defects, which refers to cardiac lesions that require surgery or intervention in the 1st year of life. Screening for critical congenital heart defects should be done on all newborns after 24hours or shortly before discharge. Oxygen
197:
Cardiac conditions in which there is decreased blood flow to the lungs such as, tetralogy of Fallot or pulmonary valve atresia, result in less blood becoming oxygenated. There are also cardiac conditions such as transposition of the great arteries or truncus arteriosus, that results in an overall
193:
Specific types of congenital heart defects that cause blood to pass directly from the right side of the heart to the left side result in cyanosis. In these defects, some of the blood that is pumped to the body has not been oxygenated by the lungs and therefore will appear more blue. Infants with
120:, or a bluish discoloration of skin or mucous membranes. Normally, oxygenated blood appears red and deoxygenated blood has more of a blue appearance. In babies with low levels of oxygen or mixing of oxygenated and deoxygenated blood, the blood can have a blue or purple color, causing cyanosis.
108:
Although these are the most common causes of cyanosis, there are other potential factors that can cause a blue tint to a baby's skin or mucous membranes. These factors include hypoventilation, perfusion or ventilation differences in the lungs, and poor cardiac output of oxygenated blood, among
595:
When evaluating a patient for cyanosis or respiratory distress, vital signs should be monitored, especially the patient's heart rate and oxygen saturation. It is beneficial to have vascular access established. In newborns, the pulse oximeter is typically placed on the right hand to determine
548:, episodes in which infants become cyanotic are called tet spells, typically occurring during feeding or crying. When older, children may squat to feel relief since this increases the systemic vascular resistance causing more blood to go towards the lungs, resulting in increased oxygenation.
483:
When diagnosing blue baby syndrome, it is important to perform a thorough history and physical exam. When obtaining the history, it is important to determine the timing of symptoms and to ask about risk factors/exposures, such as prenatal history or access to well-water.
474:
standards in the United States and other countries. The link between blue baby syndrome and nitrates in drinking water is widely accepted, but as of 2006 some studies indicated that other contaminants or dietary nitrate sources, might also play a role in the syndrome.
556:
can be used to detect levels of methemoglobin in the blood if methemoglobinemia is suspected, by seeing the difference between oxygen saturation on an arterial blood gas and the measurement on a co-oximeter. Additionally, a direct methemoglobin level can be obtained.
194:
these types of heart defects may have a constant bluish tint to their skin, or they may have temporary episodes of cyanosis. The degree of cyanosis is dependent on how much deoxygenated blood is mixed with oxygenated blood before being pumped to the body.
682:
In the case of cyanotic causing heart defects, about 75 % of infants survive to 1 year of age and 69 % survive to 18 years of age. These individuals have an increased risk of developmental delay, heart failure, or heart rhythm disorders.
513:. While severe cyanosis can be easily noticed, an oxygen saturation as low as 80 % causes only mild clinical cyanosis that is difficult to see. Additionally an arterial blood gas is useful, for example in the case of methemoglobinemia the PO
565:
As of 22 May 2007, the United States
Environmental Protection Agency has established a maximum contaminant level of 10 mg/L for nitrate and 1 mg/L for nitrite in drinking water due to the potential harmful effects in infants.
1893:
551:
Babies with cyanosis due to methemoglobinemia also usually present with cyanosis in the neonatal period, but pulse oximetry may be falsely elevated and does not always reveal low blood oxygen saturation. A
686:
Methemoglobinemia responds well to treatment, its prognosis is associated with the level of methemoglobinemia and the degree of end organ damage it can cause. Death can occur when levels reach 70 %.
532:(fast breathing), a heart murmur, and decreased peripheral pulses. If congenital heart disease is suspected in a newborn, doctors will likely perform several tests to evaluate the heart, including a
83:
can refer to conditions that cause cyanosis, or blueness of the skin, in babies as a result of low oxygen levels in the blood. This term has traditionally been applied to cyanosis as a result of:.
358:. Additionally, the oxygen that is already bound is held more tightly to the hemoglobin due to a higher affinity, resulting in less oxygen delivery. A methemoglobin level > 1.5 g/dL causes
161:
Blue baby syndrome has been attributed to cyanotic congenital heart diseases and methemoglobinemia, however there are additional causes that could result in a baby becoming cyanotic, such as:
289:
A heart defect with 4 features including a narrow pulmonary artery, a thick right ventricle, an aorta that connects to both the right and left ventricles, and a hole in the ventricular wall.
247:
The positions of the pulmonary artery and the aorta are switched, with the aorta connecting to the right ventricle and the pulmonary artery connecting to the left ventricle.
1459:
528:
Babies with cyanosis due to congenital heart disease usually present with symptoms hours to days after birth. In addition to cyanosis, they often show signs of
94:
that results in low levels of oxygen in the blood. This can be caused by either reduced blood flow to the lungs or mixing of oxygenated and deoxygenated blood.
2107:
636:
to increase the percentage of oxygen in the blood. Most of these babies will require surgery during infancy to correct their structural heart defect.
109:
others. The blue baby syndrome or cyanosis occurs when absolute amount of deoxygenated hemoglobin > 3g/dL which is typically reflected with an O
1788:
335:
Hemoglobin oxygenation dissociation curve. In the case of methemoglobinemia the curve is shifted to the left given the higher affinity for oxygen.
1597:
1305:
1242:
1176:
1110:
1868:
996:"Reduced cerebral blood flow and oxygen metabolism in extremely preterm neonates with low-grade germinal matrix- intraventricular hemorrhage"
2460:
2063:
656:
1611:
Ward, Mary H.; deKok, Theo M.; Levallois, Patrick; Brender, Jean; Gulis, Gabriel; Nolan, Bernard T.; VanDerslice, James (23 June 2005).
1540:"Does the evidence about health risks associated with nitrate ingestion warrant an increase of the nitrate standard for drinking water?"
2158:
1901:
2163:
1433:
128:
The main sign of blue baby syndrome is cyanosis. Depending on the underlying cause of the cyanosis, additional symptoms may be:
2491:
2100:
2032:
268:
The heart valve connecting the right atrium to the right ventricle does not form properly, disrupting blood flow in the heart.
2016:
1362:
961:
936:
828:
305:
498:
On physical exam it is important to visualize where the cyanosis is present to differentiate between peripheral and central
177:
438:. Infants younger than 4 months are at greater risk given that they drink more water per body weight, they have a lower
2236:
2195:
2153:
1467:
731:
in 1944. In 1950, Anna's story was made into a movie, and the film has been shown to various schools and other groups.
674:
Methemoglobinemia is considered to be rare, with acquired methemoglobinemia encountered more than the congenital form.
242:
2093:
1737:
Khalil, Markus; Jux, Christian; Rueblinger, Lucie; Behrje, Johanna; Esmaeili, Anoosh; Schranz, Dietmar (April 2019).
439:
517:
can be expected to be normal even with a low oxygen saturation. Additional work up includes a complete blood count,
2413:
2418:
2308:
583:
Oxygen saturation difference > 3 % between both extremities on 3 measurements separated by an hour each.
2228:
454:. Additionally, infants are at an increased risk after an episode of gastroenteritis due to the production of
2303:
2170:
2141:
221:
994:
Lin, Pei-Yi; Hagan, Katherine; Fenoglio, Angela; Grant, P. Ellen; Franceschini, Maria Angela (16 May 2016).
2133:
510:
419:(directly in the drinkwater, or after ingestion by the infant, in his digestive system) are more powerful
1085:
201:
The five most common cyanotic heart defects that may result in Blue Baby
Syndrome include the following:
952:
Stack, Anne M (2006). "Cyanosis". In
Fleisher, Gary Robert; Ludwig, Stephen; Henretig, Fred M (eds.).
2210:
2200:
2146:
1857:
712:
699:
occurred at Johns
Hopkins University in 1944. Through a collaboration between pediatric cardiologist
667:
Out of all the babies born with congenital heart defects, about 25 % have cyanosis as a result.
1666:
876:"Assessment and management of congenital heart disease in the newborn by the district paediatrician"
715:
shunt was created. Dr. Taussig had recognized that children with
Tetralogy of Fallot who also had a
379:
However, in infants the most common cause of methemoglobinemia is acquired through the ingestion of
310:
The pulmonary veins returning oxygenated blood from the lungs do not connect properly to the heart.
226:
Instead of two separate major blood vessels leaving the heart, there is one common outgoing vessel.
2330:
2298:
716:
2455:
2325:
2116:
1261:
1191:
1066:
443:
366:
91:
2067:
2278:
2257:
580:
Oxygen saturation 90-94 % in both extremities on 3 measurements separated by an hour each,
100:, which is a disease defined by high levels of methemoglobin in the blood. Increased levels of
87:
924:
2465:
2368:
2358:
2177:
1917:
1591:
617:
2486:
2385:
2363:
2335:
2264:
2187:
1551:
1007:
8:
2218:
2124:
1990:
696:
668:
545:
541:
284:
1613:"Workgroup Report: Drinking-Water Nitrate and Health—Recent Findings and Research Needs"
1555:
1011:
1936:
Ossa Galvis, Maria M.; Bhakta, Rupal T.; Tarmahomed, Abdulla; Mendez, Magda D. (2024).
1765:
1738:
1716:
1637:
1612:
1574:
1539:
1515:
1491:"Drinking-Water Nitrate, Methemoglobinemia, and Global Burden of Disease: A Discussion"
1490:
1415:
1028:
995:
900:
875:
724:
2320:
2012:
1972:
1945:
1839:
1818:"Congenital Methemoglobinemia: A Rare Cause of Cyanosis in the Newborn—A Case Report"
1770:
1720:
1708:
1642:
1579:
1520:
1419:
1358:
1320:
1299:
1236:
1170:
1125:
1104:
1033:
957:
932:
905:
834:
824:
760:
625:
597:
518:
339:
263:
97:
63:
2040:
331:
2450:
2445:
1829:
1760:
1750:
1700:
1632:
1624:
1569:
1559:
1510:
1502:
1407:
1350:
1023:
1015:
895:
887:
700:
629:
621:
605:
533:
522:
447:
982:
857:
803:
786:
2440:
2380:
2315:
2293:
1704:
420:
416:
72:
776:
774:
723:
success with Anna, Blalock and Thomas had the courage to perform the very first
1964:
1937:
1354:
752:
704:
645:
633:
537:
506:
491:
171:
Disordered control of breathing (ex: cyanotic breath-holding spells, seizures)
2480:
2408:
2252:
1665:
Bearl, David W.; Hill, Kevin (2019), Jain, Lucky; Suresh, Gautham K. (eds.),
771:
708:
471:
451:
373:
101:
1834:
1817:
816:
104:
prevent oxygen from being released into the tissues and result in hypoxemia.
2430:
2375:
2353:
2085:
1976:
1949:
1843:
1816:
Da-Silva, Shonola S.; Sajan, Imran S.; Underwood, Joseph P. (August 2003).
1774:
1755:
1712:
1646:
1583:
1564:
1524:
1037:
838:
764:
728:
428:
909:
2423:
977:
852:
798:
781:
553:
467:
891:
2435:
1411:
1126:"Congenital Heart Defects – dextro-Transposition of the Great Arteries"
470:. For example, nitrate levels are subject to monitoring to comply with
463:
435:
396:
347:
68:
1918:
American
Academy of Pediatrics and American Heart Association (2016).
1256:
1254:
1252:
1019:
592:
Treatment for blue baby syndrome will depend on the underlying cause.
174:
Pulmonary/lung disorders (ex: pulmonary hypertension, cystic fibrosis)
2009:
Partners of the Heart: Vivien Thomas and His Work with Alfred
Blalock
1995:
1628:
1506:
695:
The first successful operation to treat blue baby syndrome caused by
529:
233:
821:
Clinical
Methods: The History, Physical, and Laboratory Examinations
652:
methemoglobin in the blood. This is possible because methylene blue
275:
1249:
499:
459:
423:
than nitrates and are the chemical agent really responsible of the
359:
117:
50:
41:
1739:"Acute therapy of newborns with critical congenital heart disease"
1963:
Ludlow, John T.; Wilkerson, Richard G.; Nappe, Thomas M. (2024).
1935:
487:
455:
400:
380:
53:
1811:
1809:
1192:"Congenital Heart Defects – Facts about Tricuspid Atresia | CDC"
1073:. Centers for Disease Control and Prevention. 22 November 2019.
363:
355:
296:
1268:. Centers for Disease Control and Prevention. 3 February 2023.
659:, which in turn can convert methemoglobin back to hemoglobin.
254:
1806:
880:
Archives of
Disease in Childhood - Fetal and Neonatal Edition
653:
649:
601:
424:
370:
351:
317:
1691:
McMullen, Sarah M.; Patrick, Ward (March 2013). "Cyanosis".
596:
pre-ductal oxygenation, referring to oxygenation before the
925:"Clinical Manifestations of Diseases in the Newborn Period"
431:
343:
35:
Blue baby, cyanotic infant, cyanotic baby, cyanotic newborn
570:
saturation is measured in the right hand and either foot.
362:. The most common congenital cause is a deficiency in the
1736:
1610:
644:
The first-line treatment for severe methemoglobinemia is
1815:
1391:
1382:
1398:
Majumdar
Deepanjan (2003). "The Blue Baby Syndrome".
993:
927:. In Kliegman, Robert M.; St Geme, Joseph W. (eds.).
577:
Oxygen saturation < 90 % in either extremity,
1962:
1789:"Symptoms and Diagnosis of Congenital Heart Defects"
1321:"Congenital Heart Defects – Facts about TAVPR | CDC"
1931:
1929:
1538:van Grinsven, Hans JM; Ward, Mary H = 2006 (2006).
2011:. University of Pennsylvania Press, Incorporated.
1438:EPA: United States Environmental Protection Agency
1397:
671:is the most common cyanotic cardiac heart defect.
342:can be acquired or congenital. It occurs when the
1922:. American Academy of Pediatrics. pp. 33–65.
931:. Elsevier Health Sciences. pp. 910–913.e4.
2478:
1926:
1858:"US EPA Archive Document- Nitrates and Nitrites"
1537:
1690:
1152:"Orphanet: Transposition of the great arteries"
16:Two situations that lead to cyanosis in infants
923:Enlow, Elizabeth; Greenberg, James M. (2019).
922:
2101:
1732:
1730:
1660:
1658:
1656:
1434:"National Primary Drinking Water Regulations"
2461:Anomalous aortic origin of a coronary artery
2115:
869:
867:
865:
746:
744:
632:to be pumped to the body. Many also receive
222:1. Persistent (or patent) truncus arteriosus
1596:: CS1 maint: numeric names: authors list (
1531:
1345:"Total Anomalous Pulmonary Venous Return".
1304:: CS1 maint: numeric names: authors list (
1241:: CS1 maint: numeric names: authors list (
1175:: CS1 maint: numeric names: authors list (
1109:: CS1 maint: numeric names: authors list (
639:
611:
466:used in agricultural lands, waste dumps or
58:Note the blue coloration of the fingertips.
2108:
2094:
1727:
1653:
1325:Centers for Disease Control and Prevention
1196:Centers for Disease Control and Prevention
1130:Centers for Disease Control and Prevention
750:
446:activity, and they have a higher level of
354:from Fe to Fe, leading to poor binding of
316:
295:
274:
253:
232:
40:
1833:
1764:
1754:
1664:
1636:
1573:
1563:
1514:
1347:The Pediatric Cardiac Anesthesia Handbook
1027:
899:
862:
741:
188:
1488:
1482:
954:Textbook of Pediatric Emergency Medicine
505:One of the key tools in diagnosing is a
486:
330:
1904:from the original on 11 September 2014.
573:A screening is considered positive if:
560:
2479:
2006:
983:Neonatal respiratory distress syndrome
873:
814:
751:Pahal, Parul; Goyal, Amandeep (2024).
2089:
1913:
1911:
1673:, New York, NY: McGraw-Hill Education
1378:
1376:
1374:
1050:
956:. Lippincott Williams & Wilkins.
951:
521:, blood culture, chest X-ray, and an
462:. The sources of nitrate can include
306:Anomalous pulmonary venous connection
123:
1604:
1279:Reserved, INSERM US14 – All Rights.
1278:
1216:Reserved, INSERM US14 – All Rights.
1215:
1150:Reserved, INSERM US14 – All Rights.
1149:
1084:Reserved, INSERM US14 – All Rights.
1083:
326:
1894:"Critical Congenital Heart Defects"
1387:. Elsevier Inc. pp. 2540–2558.
1318:
1189:
1123:
1055:. Elsevier Inc. pp. 2371–2373.
13:
2196:Sinus venosus atrial septal defect
2154:Transposition of the great vessels
2037:Johns Hopkins Medical Institutions
1920:Textbook of Neonatal Resuscitation
1908:
1874:from the original on 30 April 2022
1671:Clinical Guidelines in Neonatology
1371:
243:Transposition of the great vessels
14:
2503:
2061:
1667:"Approach to the Cyanotic Infant"
1617:Environmental Health Perspectives
1495:Environmental Health Perspectives
1262:"Facts about Tetralogy of Fallot"
753:"Central and Peripheral Cyanosis"
1693:The American Journal of Medicine
1489:Fewtrell, Lorna (22 July 2004).
1067:"Facts about Truncus Arteriosus"
2055:
2025:
2000:
1983:
1956:
1886:
1850:
1781:
1684:
1452:
1426:
1338:
1312:
1281:"Orphanet: Tetralogy of Fallot"
1272:
1209:
1183:
1143:
1117:
1077:
1059:
1044:
987:
662:
116:Both of these conditions cause
2229:Atrioventricular septal defect
1086:"Orphanet: Truncus arteriosus"
970:
945:
916:
858:Blue discoloration of the skin
845:
808:
791:
450:which converts more easily to
417:microbial reduction of nitrate
113:saturation of < 85 %.
1:
2492:Syndromes affecting the heart
2171:Persistent truncus arteriosus
2142:Double outlet right ventricle
1385:Nelson Textbook of Pediatrics
1218:"Orphanet: Tricuspid atresia"
1053:Nelson Textbook of Pediatrics
929:Nelson Textbook of Pediatrics
734:
587:
178:Respiratory distress syndrome
2134:Aortopulmonary septal defect
1705:10.1016/j.amjmed.2012.11.004
1383:Smith-Whitley, Kwiatkowski.
478:
183:
7:
677:
10:
2508:
2007:Thomas, Vivien T. (1998).
1355:10.1002/9781119095569.ch16
1349:. 2017. pp. 107–111.
707:, and surgical technician
690:
2400:
2346:
2286:
2277:
2245:
2227:
2211:Ventricular septal defect
2209:
2186:
2132:
2123:
1971:. StatPearls Publishing.
1944:. StatPearls Publishing.
1464:World Health Organization
759:. StatPearls Publishing.
648:, a medication that will
168:Decreased blood perfusion
154:
90:, which is a category of
62:
48:
39:
31:
26:
2117:Congenital heart defects
1938:"Cyanotic Heart Disease"
1743:Translational Pediatrics
1460:"Water-related diseases"
1319:CDC (19 November 2019).
1266:Congenital Heart Defects
1190:CDC (19 November 2019).
1124:CDC (15 November 2019).
1071:Congenital Heart Defects
978:MedlinePlus Encyclopedia
853:MedlinePlus Encyclopedia
799:MedlinePlus Encyclopedia
782:MedlinePlus Encyclopedia
717:patent ductus arteriosus
640:Severe methemoglobinemia
628:open and allow for more
624:after birth to keep the
2456:Coronary artery anomaly
1835:10.1542/peds.112.2.e158
444:cytochrome b5 reductase
367:cytochrome b5 reductase
92:congenital heart defect
2279:Valvular heart disease
2258:Cyanotic heart disease
2201:Lutembacher's syndrome
2033:"That First Operation"
1756:10.21037/tp.2019.04.06
1565:10.1186/1476-069X-5-26
815:Snider, H. L. (1990).
787:Cyanotic heart disease
713:Blalock-Thomas-Taussig
618:cyanotic heart disease
616:Some babies born with
612:Cyanotic heart disease
495:
472:drinking water quality
336:
189:Cyanotic heart disease
144:Rapid respiratory rate
88:Cyanotic heart disease
2466:Ventricular inversion
2178:Aortopulmonary window
2147:Taussig–Bing syndrome
2064:"Information on Anna"
490:
427:of Fe into Fe in the
334:
2265:Eisenmenger syndrome
2188:Atrial septal defect
874:Silove, E D (1994).
600:(connection between
561:Prevention/Screening
313:6-12/100,000 births
2219:Tetralogy of Fallot
2125:Heart septal defect
1965:"Methemoglobinemia"
1556:2006EnvHe...5...26V
1051:Bernstein, Daniel.
1012:2016NatSR...625903L
892:10.1136/fn.70.1.f71
697:tetralogy of Fallot
669:Tetralogy of Fallot
546:tetralogy of Fallot
285:Tetralogy of Fallot
271:1-9/100,000 births
229:3-5/100,000 births
150:Shortness of breath
1440:. 30 November 2015
1412:10.1007/BF02840703
1000:Scientific Reports
725:open heart surgery
496:
415:) produced by the
337:
292:1-5/10,000 births
250:1-5/10,000 births
210:Brief Description
165:Airway obstruction
124:Signs and symptoms
81:Blue baby syndrome
27:Blue baby syndrome
2474:
2473:
2396:
2395:
2336:Ebstein's anomaly
2273:
2272:
2018:978-0-8122-1634-9
1991:Methemoglobinemia
1623:(11): 1607–1614.
1501:(14): 1371–1374.
1364:978-1-119-09553-8
1020:10.1038/srep25903
963:978-0-7817-5074-5
938:978-0-323-56888-3
830:978-0-409-90077-4
804:Methemoglobinemia
626:ductus arteriosus
620:are treated with
598:ductus arteriosus
542:electrocardiogram
511:oxygen saturation
494:on infant's foot.
340:Methemoglobinemia
327:Methemoglobinemia
324:
323:
264:Tricuspid atresia
132:Failure to thrive
98:Methemoglobinemia
78:
77:
56:, or "blue baby".
21:Medical condition
2499:
2451:Brugada syndrome
2446:Crisscross heart
2316:tricuspid valves
2294:pulmonary valves
2284:
2283:
2130:
2129:
2110:
2103:
2096:
2087:
2086:
2080:
2079:
2077:
2075:
2070:on 31 March 2016
2066:. Archived from
2059:
2053:
2052:
2050:
2048:
2039:. Archived from
2029:
2023:
2022:
2004:
1998:
1987:
1981:
1980:
1960:
1954:
1953:
1933:
1924:
1923:
1915:
1906:
1905:
1890:
1884:
1883:
1881:
1879:
1873:
1862:
1854:
1848:
1847:
1837:
1828:(2): e158–e161.
1813:
1804:
1803:
1801:
1799:
1785:
1779:
1778:
1768:
1758:
1734:
1725:
1724:
1688:
1682:
1681:
1680:
1678:
1662:
1651:
1650:
1640:
1629:10.1289/ehp.8043
1608:
1602:
1601:
1595:
1587:
1577:
1567:
1535:
1529:
1528:
1518:
1507:10.1289/ehp.7216
1486:
1480:
1479:
1477:
1475:
1470:on 21 April 2017
1466:. Archived from
1456:
1450:
1449:
1447:
1445:
1430:
1424:
1423:
1395:
1389:
1388:
1380:
1369:
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1048:
1042:
1041:
1031:
991:
985:
974:
968:
967:
949:
943:
942:
920:
914:
913:
903:
871:
860:
849:
843:
842:
823:. Butterworths.
812:
806:
795:
789:
778:
769:
768:
748:
630:oxygenated blood
622:prostaglandin E1
606:pulmonary artery
523:echocardiography
448:fetal hemoglobin
414:
413:
412:
409:
394:
393:
392:
389:
320:
299:
278:
257:
236:
204:
203:
44:
24:
23:
2507:
2506:
2502:
2501:
2500:
2498:
2497:
2496:
2477:
2476:
2475:
2470:
2441:Cor triatriatum
2407:Underdeveloped
2392:
2342:
2269:
2241:
2223:
2205:
2182:
2119:
2114:
2084:
2083:
2073:
2071:
2060:
2056:
2046:
2044:
2043:on 12 June 2020
2031:
2030:
2026:
2019:
2005:
2001:
1988:
1984:
1961:
1957:
1934:
1927:
1916:
1909:
1892:
1891:
1887:
1877:
1875:
1871:
1867:. 22 May 2007.
1860:
1856:
1855:
1851:
1814:
1807:
1797:
1795:
1787:
1786:
1782:
1735:
1728:
1689:
1685:
1676:
1674:
1663:
1654:
1609:
1605:
1589:
1588:
1536:
1532:
1487:
1483:
1473:
1471:
1458:
1457:
1453:
1443:
1441:
1432:
1431:
1427:
1396:
1392:
1381:
1372:
1365:
1344:
1343:
1339:
1329:
1327:
1317:
1313:
1297:
1296:
1289:
1287:
1277:
1273:
1260:
1259:
1250:
1234:
1233:
1226:
1224:
1214:
1210:
1200:
1198:
1188:
1184:
1168:
1167:
1160:
1158:
1148:
1144:
1134:
1132:
1122:
1118:
1102:
1101:
1094:
1092:
1082:
1078:
1065:
1064:
1060:
1049:
1045:
992:
988:
975:
971:
964:
950:
946:
939:
921:
917:
872:
863:
850:
846:
831:
813:
809:
796:
792:
779:
772:
749:
742:
737:
693:
680:
665:
642:
614:
590:
563:
516:
481:
410:
407:
406:
404:
390:
387:
386:
384:
329:
191:
186:
157:
141:Rapid heartbeat
126:
112:
73:cardiac surgery
57:
22:
17:
12:
11:
5:
2505:
2495:
2494:
2489:
2472:
2471:
2469:
2468:
2463:
2458:
2453:
2448:
2443:
2438:
2433:
2428:
2427:
2426:
2421:
2416:
2409:heart chambers
2404:
2402:
2398:
2397:
2394:
2393:
2391:
2390:
2389:
2388:
2383:
2373:
2372:
2371:
2366:
2361:
2350:
2348:
2344:
2343:
2341:
2340:
2339:
2338:
2333:
2328:
2323:
2313:
2312:
2311:
2306:
2301:
2290:
2288:
2281:
2275:
2274:
2271:
2270:
2268:
2267:
2262:
2261:
2260:
2249:
2247:
2243:
2242:
2240:
2239:
2233:
2231:
2225:
2224:
2222:
2221:
2215:
2213:
2207:
2206:
2204:
2203:
2198:
2192:
2190:
2184:
2183:
2181:
2180:
2174:
2173:
2168:
2167:
2166:
2161:
2151:
2150:
2149:
2138:
2136:
2127:
2121:
2120:
2113:
2112:
2105:
2098:
2090:
2082:
2081:
2062:Smith, Chris.
2054:
2024:
2017:
1999:
1982:
1955:
1925:
1907:
1885:
1849:
1805:
1780:
1749:(2): 114–126.
1726:
1699:(3): 210–212.
1683:
1652:
1603:
1544:Environ Health
1530:
1481:
1451:
1425:
1390:
1370:
1363:
1337:
1311:
1271:
1248:
1208:
1182:
1142:
1116:
1076:
1058:
1043:
986:
969:
962:
944:
937:
915:
886:(1): F71–F74.
861:
844:
829:
807:
790:
770:
739:
738:
736:
733:
705:Alfred Blalock
692:
689:
679:
676:
664:
661:
646:methylene blue
641:
638:
634:oxygen therapy
613:
610:
589:
586:
585:
584:
581:
578:
562:
559:
538:echocardiogram
514:
507:pulse oximeter
492:Pulse oximeter
480:
477:
376:in the blood.
328:
325:
322:
321:
314:
311:
308:
301:
300:
293:
290:
287:
280:
279:
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269:
266:
259:
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211:
208:
190:
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172:
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156:
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148:
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139:
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133:
125:
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110:
106:
105:
95:
76:
75:
66:
60:
59:
46:
45:
37:
36:
33:
29:
28:
20:
15:
9:
6:
4:
3:
2:
2504:
2493:
2490:
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2485:
2484:
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2467:
2464:
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2459:
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2434:
2432:
2429:
2425:
2422:
2420:
2417:
2415:
2412:
2411:
2410:
2406:
2405:
2403:
2399:
2387:
2386:regurgitation
2384:
2382:
2379:
2378:
2377:
2376:mitral valves
2374:
2370:
2367:
2365:
2364:insufficiency
2362:
2360:
2357:
2356:
2355:
2354:aortic valves
2352:
2351:
2349:
2345:
2337:
2334:
2332:
2329:
2327:
2326:regurgitation
2324:
2322:
2319:
2318:
2317:
2314:
2310:
2307:
2305:
2304:insufficiency
2302:
2300:
2297:
2296:
2295:
2292:
2291:
2289:
2285:
2282:
2280:
2276:
2266:
2263:
2259:
2256:
2255:
2254:
2253:Cardiac shunt
2251:
2250:
2248:
2244:
2238:
2237:Ostium primum
2235:
2234:
2232:
2230:
2226:
2220:
2217:
2216:
2214:
2212:
2208:
2202:
2199:
2197:
2194:
2193:
2191:
2189:
2185:
2179:
2176:
2175:
2172:
2169:
2165:
2162:
2160:
2157:
2156:
2155:
2152:
2148:
2145:
2144:
2143:
2140:
2139:
2137:
2135:
2131:
2128:
2126:
2122:
2118:
2111:
2106:
2104:
2099:
2097:
2092:
2091:
2088:
2069:
2065:
2058:
2042:
2038:
2034:
2028:
2020:
2014:
2010:
2003:
1997:
1993:
1992:
1986:
1978:
1974:
1970:
1966:
1959:
1951:
1947:
1943:
1939:
1932:
1930:
1921:
1914:
1912:
1903:
1899:
1895:
1889:
1870:
1866:
1859:
1853:
1845:
1841:
1836:
1831:
1827:
1823:
1819:
1812:
1810:
1794:
1793:www.heart.org
1790:
1784:
1776:
1772:
1767:
1762:
1757:
1752:
1748:
1744:
1740:
1733:
1731:
1722:
1718:
1714:
1710:
1706:
1702:
1698:
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1687:
1672:
1668:
1661:
1659:
1657:
1648:
1644:
1639:
1634:
1630:
1626:
1622:
1618:
1614:
1607:
1599:
1593:
1585:
1581:
1576:
1571:
1566:
1561:
1557:
1553:
1549:
1545:
1541:
1534:
1526:
1522:
1517:
1512:
1508:
1504:
1500:
1496:
1492:
1485:
1469:
1465:
1461:
1455:
1439:
1435:
1429:
1421:
1417:
1413:
1409:
1406:(10): 20–30.
1405:
1401:
1394:
1386:
1379:
1377:
1375:
1366:
1360:
1356:
1352:
1348:
1341:
1326:
1322:
1315:
1307:
1301:
1286:
1285:www.orpha.net
1282:
1275:
1267:
1263:
1257:
1255:
1253:
1244:
1238:
1223:
1222:www.orpha.net
1219:
1212:
1197:
1193:
1186:
1178:
1172:
1157:
1156:www.orpha.net
1153:
1146:
1131:
1127:
1120:
1112:
1106:
1091:
1090:www.orpha.net
1087:
1080:
1072:
1068:
1062:
1054:
1047:
1039:
1035:
1030:
1025:
1021:
1017:
1013:
1009:
1005:
1001:
997:
990:
984:
980:
979:
973:
965:
959:
955:
948:
940:
934:
930:
926:
919:
911:
907:
902:
897:
893:
889:
885:
881:
877:
870:
868:
866:
859:
855:
854:
848:
840:
836:
832:
826:
822:
818:
811:
805:
801:
800:
794:
788:
784:
783:
777:
775:
766:
762:
758:
754:
747:
745:
740:
732:
730:
726:
720:
718:
714:
710:
709:Vivien Thomas
706:
702:
701:Helen Taussig
698:
688:
684:
675:
672:
670:
660:
658:
655:
651:
647:
637:
635:
631:
627:
623:
619:
609:
607:
603:
599:
593:
582:
579:
576:
575:
574:
571:
567:
558:
555:
549:
547:
543:
539:
535:
531:
526:
524:
520:
519:blood glucose
512:
509:to determine
508:
503:
501:
493:
489:
485:
476:
473:
469:
465:
461:
457:
453:
452:methemoglobin
449:
445:
441:
437:
433:
430:
426:
422:
418:
402:
398:
382:
377:
375:
374:methemoglobin
372:
368:
365:
361:
357:
353:
349:
345:
341:
333:
319:
315:
312:
309:
307:
303:
302:
298:
294:
291:
288:
286:
282:
281:
277:
273:
270:
267:
265:
261:
260:
256:
252:
249:
246:
244:
240:
239:
235:
231:
228:
225:
223:
220:
219:
215:
213:Epidemiology
212:
209:
206:
205:
202:
199:
195:
179:
176:
173:
170:
167:
164:
163:
162:
159:
149:
146:
143:
140:
138:Nasal flaring
137:
134:
131:
130:
129:
121:
119:
114:
103:
102:methemoglobin
99:
96:
93:
89:
86:
85:
84:
82:
74:
70:
67:
65:
61:
55:
52:
47:
43:
38:
34:
30:
25:
19:
2431:Dextrocardia
2246:Consequences
2072:. Retrieved
2068:the original
2057:
2045:. Retrieved
2041:the original
2036:
2027:
2008:
2002:
1989:
1985:
1968:
1958:
1941:
1919:
1897:
1888:
1876:. Retrieved
1864:
1852:
1825:
1821:
1796:. Retrieved
1792:
1783:
1746:
1742:
1696:
1692:
1686:
1675:, retrieved
1670:
1620:
1616:
1606:
1592:cite journal
1547:
1543:
1533:
1498:
1494:
1484:
1472:. Retrieved
1468:the original
1463:
1454:
1442:. Retrieved
1437:
1428:
1403:
1399:
1393:
1384:
1346:
1340:
1328:. Retrieved
1324:
1314:
1288:. Retrieved
1284:
1274:
1265:
1225:. Retrieved
1221:
1211:
1199:. Retrieved
1195:
1185:
1159:. Retrieved
1155:
1145:
1133:. Retrieved
1129:
1119:
1093:. Retrieved
1089:
1079:
1070:
1061:
1052:
1046:
1006:(1): 25903.
1003:
999:
989:
976:
972:
953:
947:
928:
918:
883:
879:
851:
847:
820:
810:
797:
793:
780:
756:
729:Eileen Saxon
721:
694:
685:
681:
673:
666:
663:Epidemiology
643:
615:
594:
591:
572:
568:
564:
550:
527:
504:
497:
482:
468:pit latrines
429:tetrapyrrole
378:
338:
200:
196:
192:
160:
158:
127:
115:
107:
80:
79:
18:
2487:Neonatology
2424:Uhl anomaly
2047:13 November
1798:13 November
1330:20 November
1290:20 November
1227:20 November
1201:20 November
1161:20 November
1135:20 November
1095:20 November
554:CO-oximeter
534:chest x-ray
464:fertilizers
32:Other names
2481:Categories
2436:Levocardia
1969:StatPearls
1942:StatPearls
1822:Pediatrics
1677:21 January
817:"Cyanosis"
757:StatPearls
735:References
703:, surgeon
588:Management
436:hemoglobin
399:or foods.
397:well water
395:) through
348:hemoglobin
207:Pathology
69:Pediatrics
1996:eMedicine
1721:244083635
1550:(1): 26.
1420:117099503
1400:Resonance
530:tachypnea
479:Diagnosis
425:oxidation
421:oxidizers
184:Mechanism
64:Specialty
2381:stenosis
2369:bicuspid
2359:stenosis
2331:stenosis
2299:stenosis
1977:30726002
1950:29763177
1902:Archived
1869:Archived
1844:12897322
1775:31161078
1713:23410559
1647:16263519
1584:16989661
1525:15471727
1300:cite web
1237:cite web
1171:cite web
1105:cite web
1038:27181339
839:21250208
765:32644593
678:Outcomes
654:oxidizes
500:cyanosis
460:bacteria
456:nitrites
401:Nitrites
381:nitrates
360:cyanosis
352:oxidized
216:Diagram
147:Seizures
135:Lethargy
118:cyanosis
51:cyanotic
2321:atresia
2309:absence
2074:22 July
1878:2 March
1766:6514285
1638:1310926
1575:1586190
1552:Bibcode
1516:1247562
1474:14 July
1444:14 July
1029:4867629
1008:Bibcode
910:8117134
901:1060995
691:History
371:reduces
54:newborn
2159:dextro
2015:
1975:
1948:
1865:US EPA
1842:
1773:
1763:
1719:
1711:
1645:
1635:
1582:
1572:
1523:
1513:
1418:
1361:
1036:
1026:
960:
935:
908:
898:
837:
827:
763:
711:, the
650:reduce
540:, and
369:which
364:enzyme
356:oxygen
155:Causes
2414:right
2401:Other
2287:Right
1872:(PDF)
1861:(PDF)
1717:S2CID
1416:S2CID
657:NADPH
602:aorta
544:. In
2419:left
2347:Left
2164:levo
2076:2016
2049:2019
2013:ISBN
1973:PMID
1946:PMID
1880:2023
1840:PMID
1800:2019
1771:PMID
1709:PMID
1679:2022
1643:PMID
1598:link
1580:PMID
1521:PMID
1476:2018
1446:2018
1359:ISBN
1332:2019
1306:link
1292:2019
1243:link
1229:2019
1203:2019
1177:link
1163:2019
1137:2019
1111:link
1097:2019
1034:PMID
958:ISBN
933:ISBN
906:PMID
835:PMID
825:ISBN
761:PMID
604:and
440:NADH
432:heme
344:iron
1994:at
1898:CDC
1830:doi
1826:112
1761:PMC
1751:doi
1701:doi
1697:126
1633:PMC
1625:doi
1621:113
1570:PMC
1560:doi
1511:PMC
1503:doi
1499:112
1408:doi
1351:doi
1024:PMC
1016:doi
896:PMC
888:doi
727:on
458:by
434:of
350:is
346:in
304:5.
283:4.
262:3.
241:2.
2483::
2035:.
1967:.
1940:.
1928:^
1910:^
1900:.
1896:.
1863:.
1838:.
1824:.
1820:.
1808:^
1791:.
1769:.
1759:.
1745:.
1741:.
1729:^
1715:.
1707:.
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1655:^
1641:.
1631:.
1619:.
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1590:{{
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884:70
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878:.
864:^
856::
833:.
819:.
802::
785::
773:^
755:.
743:^
536:,
525:.
442:-
405:NO
385:NO
71:,
49:A
2109:e
2102:t
2095:v
2078:.
2051:.
2021:.
1979:.
1952:.
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