Unexpected episodes of cyanosis in late preterm and term neonates prompted admission to a neonatal care unit

Carlo Dani,Simone Pratesi,Livia Drovandi,Chiara Poggi,Giovanna Bertini

doi:10.1186/s13052-017-0349-9

Abstract

BackgroundWe studied late preterm and term infants who were admitted to our neonatal care unit in a tertiary hospital for unexpected episodes of cyanosis that occurred during rooming-in for evaluation of their frequency, most frequent associated diseases, and documentation of the diagnostic clinical approach.MethodsWe carried out a retrospective study of infants with a gestational age ≥35 weeks who were admitted from the nursery with the diagnosis of cyanosis from January 2009 to December 2016. Exclusion criteria were the occurrence of acrocyanosis and the diagnosis of sudden unexpected postnatal collapse (SUPC).ResultsWe studied 49 infants with a mean gestational age of 38 ± 2 weeks. The frequency of admission for cyanosis was 1.8/1000 live births and was similar (p = 0.167) in late preterm and term infants. The majority of episodes occurred during the first 24 h of life (57%). Only 16 infants (33%) were discharged with a diagnosis, that was mostly (n = 5;10%) gastro-esophageal reflux.ConclusionsUnexpected episodes of cyanosis caused admission of 1.8/1000 live births to the neonatal care unit without differences between late preterm and term infants. These episodes occurred mainly during the first day of life and infants were mostly discharged without a known diagnosis.

Highlights

We studied late preterm and term infants who were admitted to our neonatal care unit in a tertiary hospital for unexpected episodes of cyanosis that occurred during rooming-in for evaluation of their frequency, most frequent associated diseases, and documentation of the diagnostic clinical approach
Inborn infants with gestational age ≥35 weeks who were admitted from the nursery with the clinical diagnosis of cyanosis from January 2009 to December 2016 were included in the study
Exclusion criteria were the occurrence of cyanosis limited to the extremities and lips [6], and the diagnosis of sudden unexpected postnatal collapse (SUPC) as defined by the British Association of Perinatal Medicine: SUPC is (1) a sudden and unexpected postnatal collapse occurring within the first postnatal week (2) in an infant born >35 weeks gestational age, with a 5-min Apgar of >7, appearing well at birth and considered healthy, (3) requiring cardiopulmonary resuscitation and intensive care, and resulting in death or encephalopathy [7]

Summary

Introduction

We studied late preterm and term infants who were admitted to our neonatal care unit in a tertiary hospital for unexpected episodes of cyanosis that occurred during rooming-in for evaluation of their frequency, most frequent associated diseases, and documentation of the diagnostic clinical approach. The word cyanosis indicates the dark bluish discoloration of the skin, mucus membranes, and nail beds that becomes detectable when the levels of deoxygenated hemoglobin (Hb) in arterial blood exceed 3-5 g/dl [1]. It is sometimes difficult to detect cyanosis in the newborn due to factors such as skin colour, exposure to light, or presence of jaundice [2]. The sudden appearance of an episode of cyanosis in a newborn in the hospital nursery who is expected to be healthy generally prompts his/her admission to neonatal care unit to monitor vital signs and carry out biochemical and instrumental diagnostic tests. Cyanosis episodes are not rare in the neonatal period, there are few studies in the literature reporting

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