Developmental disorders

III./4.6.: Differential diagnosis

Differential diagnosis must be conducted at the time of birth. Neonates born with DORV– aside few exceptions –manifest with cyanosis or signs of circulator failure early on. Cause of neonatal cyanosis may be numerous, which often require immediate intervention. Most frequent causes of neonatal cyanosis are listed in categories below.

III./4.6.1.: Central or peripheral nervous system diseases causing neonatal cyanosis

• - asphyxia;

• - increased intracranial pressure;

• - intracranial haemorrhage;

• - sedative over dosage (maternal or direct) diaphragm paralysis;

• - neuromuscular disorders;

• - seizure.

III./4.6.2.: Respiratory system disorders causing neonatal cyanosis

• - Choanal atresia;

• - Pierre-Robin syndrome;

• - Laryngeal or tracheal stenosis;

• - Respiratory distress syndrome (RDS);

• - meconium aspiration;

• - pneumonia, sepsis;

• - Diaphragmatic herniation, pulmonary hypoplasia.

III./4.6.3.: Cardiovascular disorders causing neonatal cyanosis

1. Congenital heart defects with decreased pulmonary circulation

• - Fallot IV;

• - pulmonary atresia;

• - DORV + pulmonary stenosis;

• - d-great vessel transposition + VSD + pulmonary stenosis;

• - Ebstein-anomaly.

2. Congenital heart defects with increased pulmonary circulation

• - d-great vessel transposition;

• - truncus arteriosus;

• - univentricular heart;

• - complete pulmonary vein transposition and hypoplastic left cardiac syndrome.

3. Heart defects with congestive cardiac failure

• - right to left shunting with pulmonary edema and with low cardiac output (hypoplastic left cardiac syndrome and aortic coarctation.

4. Heart failure in itself

• - pulmonary edema and ineffective myocardial contractility (sepsis, myocarditis, supraventricular tachycardia, complete (3rd degree) AV block;

• - heart failure with increased arterial volume (ductus arteriosus, Galenus vein, or other AVM).

III./4.6.4.: Neonatal metabolic disorders causing cyanosis

• - Methaemoglobinaemia M;

• - Enzymes playing role in reduction of haem iron (cytochrome -b5, cytochrome -b5 reductase, NADPH-flavin reductase) deficiency or decreased function.

III./4.6.5.: Technical issues causing neonatal cyanosis

E.g.; disruption of O2 supply of respirator.

III./4.6.6.: Miscellaneous causes of neonatal cyanosis

• - hypoglycemia (in general: periodic with cyanosis);

• - polycythemia;

• - sever acute blood loss;

• - adrenogenital syndrome (shock).