Blue Baby Syndrome: Causes, Symptoms, Treatment & Prevention

Blue Baby Syndrome – Causes, Symptoms, and Treatment

Medically Reviewed By
Dr. Gunjan Baweja (Paediatrician)
View more Paediatrician Our Panel of Experts

Does your baby look somewhat blue lately? Have you noticed a blue, dusky, or purple hue in body parts where the skin is thinner? Watch out, your baby may be suffering from blue baby syndrome!

What Is Blue Baby Syndrome?

You may have a blue baby at birth, because this syndrome occurs due to congenital reasons. This condition is characterised by bluish or purple skin, and this is known as cyanosis. In Greek, ‘cyanoses’ literally means ‘dark blue’. The blue tinge is caused by lack of oxygen, and de-oxygenated blood flowing in the body.

The bluishness begins at around two to three months. Initially, the bluish tinge is seen when the baby is cranky or having a bowel movement. Later, the baby always tends to be blue.

This condition may also be accompanied by blue baby heart defect in some cases.

Causes of Blue Baby Disease

Causes of Blue Baby Disease

Blue baby syndrome is caused by environmental and congenital or genetic factors, like associated dysfunction of the heart, lungs, and blood pigment. These dysfunctions are explained below:

1. Congenital Down Syndrome

This is an abnormality in one chromosome that usually leads to physical and mental developmental delays.

2. Maternal Type 2 Diabetes

This can lead to the baby developing Congenital Cyanotic Heart Disease. This is a group of heart diseases. (Please note that not all heart diseases cause cyanosis.)

3. Methemoglobinemia Caused by Nitrate Poisoning

Methemoglobinemia blue baby syndrome occurs when you mix the baby’s formula milk or food with nitrate-rich well water, or make homemade baby food rich on nitrate (using spinach, beets, etc.). This is common in rural areas where soil nitrates are used in agriculture. Nitrate, when not properly processed in the baby’s underdeveloped system, hinders sufficient oxygen flow in the blood. Blue Baby Syndrome can also be caused by other chemicals and antibiotics in food and water.

Babies tend to retain nitrate, which reacts with blood haemoglobin and creates high amounts of methemoglobin. It occurs mostly in under 6 month old babies, because their gastrointestinal systems are not fully formed. So, they cannot convert methemoglobin, an enzyme that cannot carry oxygen, to haemoglobin, which carries oxygen throughout the body. The bluish tinge thus occurs due to insufficient oxygen in the blood, as nitrate decreases the oxygen-carrying capacity of the blood. Sometimes, Methemoglobinemia is congenital, and is a serious condition that needs immediate treatment.

4. Tetralogy of Fallot (TOF)

This is a major cause of blue baby syndrome. It is congenital, and includes four heart defects. These defects affect blood circulation in the lungs. This, in turn, results in oxygen deficient blood flow in the entire body.

5. Transposition of Great Arteries (TGA)

This is a defect in the two main arteries of our body that stem from the heart. It causes deoxygenated blood to circulate in the body, and oxygenated blood cannot come out of the lungs. It requires urgent treatment.

6. Other Diseases

There are a few other conditions that cause blue baby syndrome, like tricuspid artesia, persistent truncus arteriosus, hypoplastic left heart syndrome, dextro-transposition of the main arteries, and total anomalous pulmonary venous connection.

Symptoms of Blue Baby Syndrome

There are many symptoms of this disease other than a blue face:

  • Always cranky and crying
  • Excess salivation
  • Feeding tantrums
  • Weight loss
  • Cold baby
  • Slow growth
  • Racing heartbeat
  • Rapid breathing
  • ‘Clubbed’/swollen fingertips and toes
  • Murmuring sounds in baby heart, and poor pulse detected by the doctor
  • State of shock and fainting in extreme cases
  • Fever, headache, joint pain

How Is the Diagnosis Done?

The best way to diagnose this condition is with medical tests prescribed by your doctor:

  • Blood examinations
  • Tests for lungs:
    1. Chest X-ray
    2. Oxygen saturation
  • Tests for the heart:
    1. Electrocardiogram (EKG)
    2. Echocardiogram
    3. Cardiac catheterization

Treatment for Blue Baby Syndrome

The treatments for blue baby syndrome depend on the underlying disease that is causing it.

1. Medication

Methylene blue that supplies oxygen to blood is used to cure Methemoglobinemia.

2. Surgical Procedures

Heart surgery is sometimes required for TOF and TGA, though it is a high-risk intervention on a newborn.

Surgery for TOF

It is an open-heart surgery called Blalock-Thomas-Taussig shunt. It is performed for total correction. Surgery is required in TOF because there is:

  • A hole in the heart that has to be surgically closed.
  • An obstruction in blood flow to the lungs that has to be surgically corrected.

The surgery lasts six to eight hours, and is done under general anaesthesia. The recovery period is typically two weeks.

Surgery for TGA

Surgical intervention called Balloon Atrial Septostomy is often required to correct a natural hole in the baby’s heart. It is done under anaesthesia. The surgical procedure is completed with another intervention in two to three weeks of age, and best completed within a month of baby’s birth. It is called the Arterial Switch Operation, which restores normal circulation. These procedures improve circulation of deoxygenated and oxygenated blood.

How Can You Prevent This Condition?

In many cases, the causes are unknown, and so prevention can be difficult. However, as a thumb rule:

1. Don’t use well water.

Don’t make baby formula milk or cook baby food with well water. Boiling the water does not remove nitrates. The only way to avoid this is to get information about the nitrate levels in local water. You may get the well water tested with help from local health officials. It should ideally not be more than 10 mg/L. According to WHO, more than 50mg/L of nitrates can cause methaemoglobinaemia.

2. Reduce the amount of foods full of nitrates.

Foods that have a lot of nitrates (that come from the soil) are broccoli, spinach, beets, and carrots. These can be given in limited amount. Do not eliminate them completely, as most of them come with Vitamin C, which is essential.

3. Avoid medications like Sulphonamides and Phenacetin.

Sulfonamides are mostly antibiotics, and some are used as medication for ulcerative colitis. Phenacetin is a painkiller and medication for fever. These drugs are, however, rarely prescribed these days.

4. Avoid narcotics, alcohol, and certain antenatal medicines.

This may help to prevent congenital heart defects.

5. Control diabetes.

If you have antenatal diabetes, it should be controlled properly.

Outlook for Infants with This Disorder

This is a rare disorder in babies, caused by an underlying condition or disease. The doctor can start immediate treatment with medication, or in extreme cases, surgery. After a cure, blue babies glow pink with good health. They can lead normal lives with few health concerns.

If you ever notice your little one turning a little blue, it is best to consult a doctor immediately, and not delay seeking help for your baby.

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