Blue Baby Syndrome - A Hope Under THE BLUE Blue Baby Syndrome - the bluish coloration of A NEONATE Etiology included... covered briefly CONGENITAL HEART DEFECTS also briefed whic are related etiology to Blue Baby syndrome like TETRALOGY OF FALLOT, PATENT TRUNCUS ARTERIOSUS, TRICUSPID ATRESIA, TRANSPOSITION OF THE GREAT VESSELS, Anomalous pulmonary venous connection... Another etiologic reason  METHEMOGLOBINEMIA also covered... Treatment also included like Blalock–Thomas–Taussig shunt... THANK YOU - Hope you like it

2. Let's see……
B L U E B A B Y
S Y N D R O M E
BIKRANT ROY

3. BLUE BABY
SYNDROME
Refers to a number
of conditions that
results in blueness
of the skin in babies

4. WHAT HAPPENS???

5. It’s characterized by an overall skin color
with a blue or purple tinge, called cyanosis.

6. This bluish
appearance is most
noticeable where
the skin is thin, such
as the lips,
earlobes, and nail
beds.

8. Other potential symptoms of blue baby syndrom
include:
 Difficulty in breathing
 Vomiting
 Diarrhea
 Lethargy
 Increased salivation
 Loss of consciousness
 Seizures
In severe cases, blue baby syndrome can even
cause death.

9. AT HAPPENS INSIDE???

10. BASICALLY,
WHAT HAPPENS
IS
When there’s a
problem with the
heart, lungs, or
blood, blood may
not be oxygenated
properly.
This causes the skin
to take on a blue
color.

11. ETIOLOGY

12. Cyanotic heart
disease occurring due
to a congenital heart
defect

13. Methemoglobinemiap
otentially caused
by nitrates in drinking
water

14. LET’S GO TO THE DEPTH OF THE
BLUES

15. CONGENITAL
HEART
DEFECTS

16. TETRALOGY OF FALLOT
Classically there are four defects :
1. pulmonary stenosis, narrowing of the exit from the right
ventricle
2. a ventricular septal defect, a hole between the two ventricles
3. right ventricular hypertrophy, thickening of the right
ventricular muscle
4. an overriding aorta, which allows blood from both ventricles
to enter the aorta

17. Overriding Aorta
Pulmonary
Stenosis
VSD
Right
Ventricular
Hypertrophy
Normal Heart Tetralogy Of Fallot

18. PATENT TRUNCUS ARTERIOSUS
Persistent truncus arteriosus (or patent truncus
arteriosus or common arterial trunk), is a rare form
of congenital heart disease that presents at birth. In this
condition, the embryological structure known as the truncus
arteriosus fails to properly divide into the pulmonary
trunk and aorta. This results in one arterial trunk arising from
the heart and providing mixed blood to the coronary
arteries, pulmonary arteries, and systemic circulation.

19. RA. Right Atrium SVC. Superior Vena Cava TV. Tricuspid Valve
RV. Right Ventricle IVC. Inferior Vena Cava MV. Mitral Valve
LV. Left Ventricle AO. Aorta
Truncus Arteriosus

20. TRICUSPID ATRESIA
Tricuspid atresia is a form of congenital heart
disease whereby there is a complete absence of the tricuspid
valve. Therefore, there is an absence of right atrioventricular
connection. This leads to a hypo plastic (undersized) or
absent right ventricle.

21. TRICUSPID ATRESIA
Superior Vena Cava
Pulmonary
Artery
Pulmonary
Vein
Inferior Vena Cava
Rudimentary
Right
Ventricle
Atresia
Tricuspid
Valve
Aorta

22. TRANSPOSITION OF THE
GREAT VESSELS
Transposition of the great vessels (TGV) is a group
of congenital heart defects involving an abnormal spatial
arrangement of any of the great
vessels: superior and/or inferior venae cavae, pulmonary
artery, pulmonary veins, and aorta. Congenital heart diseases
involving only the primary arteries (pulmonary artery and aorta)
belong to a sub-group called transposition of the great
arteries.

24. Anomalous pulmonary
venous connection
Anomalous pulmonary venous
connection (or anomalous pulmonary venous
drainage or anomalous pulmonary venous return)
is a congenital defect of the pulmonary veins.

26. NOBEL
NITRATES

27. Blue baby syndrome can also be caused
by nitrates in drinking water leading
to methemoglobinemia.

28. Dr. Comly
In 1987, the Journal of the American Medical
Association reprinted a case study originally published
in 1945.
The author of the original paper, Hunter Comly, was a
pediatric resident in Iowa City when he described a
previously unrecognized blood condition and skin
coloration in infants.

29. But what was the nature of the
difference between the hospital
and my farm house water?????
After the third episode of admission
and treatment with methylene blue for
one child, her father demanded to
know exactly what “poison” in his well
was responsible. Analyses of the
water showed high levels of nitrate.

30. AFTER ANALYSIS OF
THE DRINKING
WATER SOURCES
OF OTHER
NEIGHBOURING
CASES SHOWED
THE PRESENCE OF
NITRATES IN
ABUNDANCE

31. Dr. Comly
how biologically
inert nitrate was
responsible for
oxidizing
hemoglobin to
methemoglobin???

32. The most
plausible
candidate for the
oxidizing agent
was nitrite, which
was known to be
a potent
generator of
methemoglobin.

33. Many common
organisms found in
the bowel were
known to convert
nitrate to nitrite; the
nitrite could then
be readily
absorbed into the
blood to do its
damage.
GOTCHA!!!

34. That led to a
consideration of the
second-most common
finding in affected infants,
namely evidence of
gastrointestinal upset in
the form of vomiting or
diarrhea.

35. According to WHO’s latest
recommendation , 5 mg/l of
nitrate is the standard for
normal drinking water
supplies.
In river water, it can go up to
17 mg/l, which is also
normal.

36. METHEMOGLOBINEMIA

37. TREATMENT

38. CONGENITAL HEART DEFECTS
SURGERY
Blalock–Thomas–Taussig shunt
Commonly called the Blalock–Taussig shunt is a
surgical procedure used to increase pulmonary
blood flow in cyanotic heart defects which are
common causes of blue baby syndrome.

39. In modern surgery, this procedure is temporarily used to direct blood
flow to the lungs and relieve cyanosis while the infant is waiting for
corrective or definitive surgery.

40. Complete Intracardiac Repair
Surgery to repair Tetralogy of Fallot is done to
improve blood flow to the lungs and to make
sure that oxygen-rich and oxygen-poor blood
flows to the right places. The surgeon will:
1. Widen the narrowed pulmonary blood
vessels.
2. Close the ventricular septal defect (VSD).

41. Fixing these two defects resolves problems caused by the
other two defects.
When the right ventricle no longer has to work so hard to pump
blood to the lungs, it will return to a normal thickness.
The incision (cut) that the surgeon makes to reach the heart
usually heals in about 6 weeks.
The surgeon or a hospital staff member will explain when it's
okay to give your baby a bath, pick him or her up under the
arms, and take your baby for his or her regular shots
(immunizations).

42. METHEMOGLOBINEMIA
For babies with methemoglobinemia MEDICATION
is recommended.
The condition can be reversed by taking a drug
called methylene blue, which can provide oxygen to
the blood. This drug needs a prescription and is
usually delivered via a needle inserted into a vein.

43. OUTLOOK

44. The number of cases fell off steadily through the early
1950s. Today the disease has all but disappeared.
Only two cases have been reported since the mid-1960s
and none since 2000.
Within 10 years the epidemic had waned as suddenly as it
had appeared, without any preventive action having
knowingly been taken.
Whether it was because of public awareness, a massive
improvement in rural drinking water quality, a trend toward
breastfeeding or other factors may never be known.

45. THANK
YOU