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What is Blue Baby Syndrome?

By C. Ausbrooks
Updated Mar 03, 2024
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Blue baby syndrome, also known as simply blue baby, is a term used to describe infants with cyanosis, or blue-tinted skin. The condition develops when the organs, cells and tissues do not receive adequate oxygen, and the tissue begins to turn blue in color instead of pink, indicating poor oxygen levels. Although this syndrome can be fatal if left untreated, modern therapies can typically correct the problem. It occurs most frequently in infants under six months of age, but it can also affect older children and adults, in rare cases.

The most common cause of blue baby syndrome is Tetralogy of Fallot, a congenital heart condition in which four different abnormalities cause a reduction in blood oxygen. These abnormalities include ventricular septal defect (VSD), pulmonary stenosis, thickening of the right ventricle, and a displaced or deviated aorta. VSD is characterized by a hole in the wall of the two lower chambers of the heart. Pulmonary stenosis occurs when the pulmonic valve and the muscular area below the valve are narrower than normal.

Blue baby may also be caused by excessive nitrates in drinking water. When consumed, the nitrates are converted to nitrite in the digestive system. The nitrites then react with the hemoglobin, causing dangerously high levels of methemoglobin. This enzyme cannot carry oxygen through the blood like hemoglobin does, resulting in organs, cells, and tissues that are deprived of oxygen and skin with the characteristic bluish tint. Rural areas where high levels of nitrates are present in the ground water often produce higher numbers of infants born with this condition.

Other causes are also related to congenital heart problems. Transposition of the great arteries (TGA) occurs when the aorta and pulmonary artery are switched, causing oxygen-poor blood to be carried throughout the body instead of being sent to the lungs. Hypoplastic left heart syndrome (HLHS) can also cause this problem and is caused when the left side of the heart is underdeveloped, resulting in a left ventricle that does not pump enough oxygen-rich blood through the body.

Blue-tinted skin may be difficult to recognize in children with darker skin tones, but there are other symptoms to alert parents and healthcare professionals to a potential problem. These other symptoms include fatigue, low tolerance for exercise, rapid breathing and shortness of breath, difficulty breathing or eating, and heart murmurs. The child may also fail to gain weight and appear lethargic for no apparent reason.

Treatments for blue baby syndrome depend on the cause and severity of the condition. The problem is typically evident just after birth, and medical professionals will work quickly to correct any defect contributing to the syndrome. If the symptoms become apparent later, the infant should be taken to a pediatric cardiac center as quickly as possible, as a serious heart defect is usually the culprit. Medication may be prescribed to manage the symptoms, but in most cases, heart surgery will be required to fix the underlying cause of the disorder.

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Discussion Comments

By GlassAxe — On Oct 24, 2010

@ PelesTears- Nitrates in the water are mostly due to fertilizer run-off and contamination. Most metropolitan areas monitor their water and ensure that the water supply maintains levels of nitrates less than 10 parts per million. The areas of concern are rural communities near agricultural land that get their water from ground water wells and aquifers. The run-off from agricultural land can contaminate these ground water resources elevating levels beyond 10 parts per million. If you live in these areas, you can buy a water test kit for about $20 to check for contaminant levels.

I would also like to point out that a large source for nitrites is processed meats and lunchmeats. Most of these meats are cured with nitrites that can cause blue baby syndrome in large amounts, and can be carcinogenic to children in smaller amounts. For this reason, the FDA regulates the use of nitrates in baby, infant, and toddler food products. This is also the reason that pregnant women should not eat large quantities of food containing nitrites, and young children should not be given hot dogs and lunchmeats cured with nitrites.

By PelesTears — On Oct 24, 2010

@ ValleyFiah- How do I know if there are nitrates in my water? Are these the only source of nitrates that can harm my baby? Wouldn't my city make sure that there were not dangerous levels of nitrates in my drinking water? I am always concerned about what I put in my body, but I have little control over the water that comes out of my faucet.

By ValleyFiah — On Oct 24, 2010

One of the leading causes of blue baby disease is the presence of nitrates in drinking water. Nitrates in drinking water turn to nitrites in the body, changing hemoglobin to methemoglobin. Methemoglobin does not carry oxygen so the result is a lack of oxygen delivered through the blood.

You cannot boil nitrates out of water so often the only course of action is to buy purified water or install a water purification system. Although blue blood disease can affect anyone, young children are particularly at risk since their body cannot produce enough methemoglobin reductase to return the blood back to normal hemoglobin levels. This can cause the body to take a long time to adjust, if it adjusts at all, causing complications that affect the child for life.

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