BLUE BABIES

Blueness is an important indicator of heart disease.  The blueness due to heart disease is present on fingers, toes, lips even when they are warm.  However in normal children exposure to cold results in blueish discoloration of fingers and toes.  This blueness disappears on warming the finger and toes.   Blue babies always have severe form of heart disease.  Generally  earlier the blueness appears  more serious is the heart disease.

IF THE BABY IS BLUE

In the new born period the commonest cause is transposition of great arteries i.e. the main arteries of the heart are coming from wrong ventricles.  These babies also breath fast and have feeding difficulty.  Presently this condition is completely correctable.  After confirming the diagnosis on Echo cardiography the babies are given a special intravenous infusion to keep the arterial duct open which supplies the body with oxygenated blood in these cases.  Subsequently “ballooning” is done to increase the communication between the two sides of the atrium.  After this the baby is stabilised and  undergo corrective surgery is done by 14-21 days of life.  At surgery the great vessels are disconnected from the ventricles and switched over so that how they are connected to appropriate ventricles and the normal pathway of  cirulation restored.

The other common condition which results in blueness within first year of life is “Tetralogy of Fallot”  These babies are prone to get episodes of “Cyanotic spells” characterised by increased in the rate and depth of breathing with increase blueness.  Usually precipated by crying, waking in morning or defecation.  If prolonged the child may become limp, convulse or become unconscious.  These episodes need very   emergent treatment.  Some children have episodes of breath-holding attacks following temper tantrum, and may become blue.  These babies stop breathing transiently.  These episodes  do not indicate heart disease.  In Tetralogy of fallot the basic defect is a large hole in the ventricular septum and  obstruction to the pulmonary blood flow.  If the baby is stable the elective correctively surgery is done around 6 months of age depending upon the oxygen level of the child.  If the baby is symptomatic before that and unfit for total surgical correction, palliative PDA stenting , percutaneous balloon dilation or stenting  of the pulmonary outflow is done or BT shunt is done.  This procedure increases the pulmonary blood flow and stabilized the patient.  The corrective surgery is subsequently done generally after one year.    These babies need iron supplements.

HOLE IN THE HEART

The babies may be born with hole in the heart.  The ‘Hole’ could be in the upper septum i.e. atrial septum which seperates the two receiving chambers the “atria”.  These holes are called atrial septal defects.   The ‘Hole’ could be in the lower septum i.e. ventricular septum which seperates the two pumping chambers – the ventricles.  These holes are called ventricular septal defects.  These holes result in increased flow to the lungs and babies may have frequent chest infections,  feeding difficulty and inadequate weight gain.  The holes in the atrial septum are better tolerated and can be closed electively around three years of age either without surgery by putting specialised device across the defect via the vein in the leg-percutaneously or by   surgery by direct suturing or putting a dacron patch in the atrial septum.  Similarly  ventricular septal defects may be closed by a device without surgery. If defects are large they may need surgical correction around 4-6 months of age.  Till that time they need medication to support the heart-decongestive therapy and high calorie feeds.  If  the hole is of moderate size surgical correction can be delayed to 8-9 months.  In some cases the ‘Holes’ can become smaller on followup, so these babies need very careful assessment to decide which of these need early surgery.  Delaying surgery in babies with large defects can result in irreversible complications.

IS YOUR CHILD BLUE ?

If the baby is blue there is a strong possibility of the blueness should be seen on the tongue lips and on toes and fingers if they are warn.  During exposure to cold finger and toes may became cold and blueness may be seen but this is not abnormal.  Blue babies usually have severe forms of heart disease and need urgent medical attention.  The blue babies may have difficulty in feeding.  Some of the blue babies get episodes of excessive crying, breath fast and deeply – and may faint or even have conversions.  These are called cyanotic spells.

WHAT SHOULD YOU DO

The parent must keep a high index of suspision and recognise early.  The parents should get the baby examined by a competent doctor as soon as there is any suggestion of your baby being blue at rest or during crying or feeding.

WHAT WILL BE THE COURSE OF ACTION

The pediatrician will evaluate the baby and if he or she is convinced that the baby is not ‘blue’ you will be reassess  but in case the baby is blue i.e.having cyanosis the baby will be advised complete cardiological evaluation.  This will mean,a visit to a pediatric cardiologist, X-Ray, chest Electrocardiogram and Echocardiogram (Ultrasound  examination of the heart).

ARE THE BLUE BABIES DOOMED BABIES?

 No not at all!

With the present state of art expertise and technological support, most of the blue babies can be offerred definative therapy with catheter based and or surgical procedures.  One only needs  to act fast and tap the correct centres of excellence in pediatric cardiac care at the earliest suspision.  High index of Suspision and timely action are the key to successful outcome.