{
"topic": "Acrocyanosis",
"slug": "acrocyanosis",
"category_id": 15414,
"passage_count": 14,
"source_chars": 10988,
"enough_material": true,
"references": [
{
"title": "Signs and Symptoms in Pediatrics",
"author": "Henry M. Adam,Jane Meschan Foy",
"pages": [
171,
181
]
},
{
"title": "Common Cardiac Issues in Pediatrics",
"author": "Jonathan N. Johnson,Deepak M. Kamat",
"pages": [
197
]
},
{
"title": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub",
"author": null,
"pages": []
},
{
"title": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024",
"author": null,
"pages": [
1525
]
},
{
"title": "Textbook of Neonatal Resuscitation (8th ed)",
"author": null,
"pages": [
48
]
},
{
"title": "Gomella's Neonatology: Management, Procedures, On-Call Problems, Diseases, and Drugs, Eighth Edition",
"author": "Tricia Lacy Gomella, Fabien G. Eyal and Fayez Bany-Mohammed",
"pages": [
97,
515,
521
]
},
{
"title": "Cover",
"author": "Vitalsource Download",
"pages": [
4793,
8670
]
},
{
"title": "Netters Pediatrics (Florin \u0422., Ludwig St.)",
"author": null,
"pages": [
292
]
}
],
"passages": [
{
"source": "Signs and Symptoms in Pediatrics, p. 171",
"text": "_Acrocyanosis_ refers to bluish color in the hands and feet and around the mouth (circumoral cyanosis). Th e mucus membranes generally remain pink. A form of peripheral cyanosis that usually refl ects benign vasomotor changes in the aff ected extremities, acrocyanosis does not indicate pathology unless cardiac output is extremely low, resulting in severe venous desaturation from increased oxygen extraction. In the newborn, acrocyanosis is a striking example of cyanosis arising from intense peripheral vasoconstriction and variable perfusion in the extremities compared with the central circulation.[7,8] It is seen in well babies and resolves within the fi rst few days of life."
},
{
"source": "Signs and Symptoms in Pediatrics, p. 171",
"text": "Acrocyanosis may also occur in infants when they cry, regurgitate, vomit, cough, or hold their breath. Th is fi nding is often very alarming to the caregiver who witnesses the event, and it requires careful questioning and observation to diff erentiate it from serious underlying pathology (eg, seizure, apneic episode, cardiac arrhythmia, congenital heart defect). Th e child with acrocyanosis typically does not have major changes in mental status during the event and appears well on physical examination. Cyanosis Moderate cold exposure slows the transit time of blood through capillary beds and allows for increased unloading of oxygen from the blood to the tissues in infants and young children, leading to cyanosis, especially in the lips and perioral region. Th is form of acrocyanosis rapidly resolves with warming of the patient. ## \ufffd **OXYGEN CONTENT, DELIVERY, AND TRANSPORT**"
},
{
"source": "Common Cardiac Issues in Pediatrics, p. 197",
"text": "177 COMMON CARDIAC ISSUES IN PEDIATRICS Acrocyanosis can also occur in neonates and describes the bluish discoloration of the hands, feet, and perioral area, which is attributed to benign vasomotor changes in diffuse venous structures in the periphery of the body. ## _**Heart Failure**_"
},
{
"source": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub",
"text": "Goals of Treatment. The goals of ED evaluation of the cyanotic infant include early recognition of cardiorespiratory pathology or pharmacologic causes. Clinical Considerations Clinical Recognition. Proper lighting is important to assess cyanosis in neonates. Location of cyanosis helps determine its cause. Cyanosis noted in the mucous membranes, tongue, trunk, and extremities is central. In contrast, acrocyanosis is limited to hands, feet, and perioral region, with the tongue and rest of skin remaining pink. This condition may be associated with cool ambient temperature. Acrocyanosis is benign and may resolve with warming. Local blue discoloration of a single extremity could be the result of compromised distal circulation. A local blue hue to skin may also be the result of pigment from blue clothing dye. Triage Consideration . \u201cBlue babies\u201d should be evaluated promptly for cardiorespiratory disease. The degree of oxygen desaturation associated with cyanosis should be documented by pulse oximetry."
},
{
"source": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024, p. 1525",
"text": "**Raynaud disease** often begins in adolescence and is characterized by symmetric occurrence, the absence of digital ulcers, tissue necrosis and gangrene, and the lack of manifestations of an underlying rheumatic disease. Children have normal nail fold capillaries (absence of periungual telangiectasias). RP should be distinguished from acrocyanosis and chilblains. **Acrocyanosis** is a vasospastic disorder resulting in cool, painless, bluish discoloration in the hands and feet despite normal tissue perfusion. It may be exacerbated by stimulant medications used to treat attention- deficit disorder. **Chilblains** is a condition with episodic color changes and the development of nodules related to severe cold exposure and spasm- induced vessel and tissue damage; it has been associated with SLE and is also referred to as _lupus pernio,_ but the majority of children with chilblains do not have lupus. ## **DIAGNOSIS**"
},
{
"source": "Textbook of Neonatal Resuscitation (8th ed), p. 48",
"text": "**----- Start of picture text -----**
1
**----- End of picture text -----**
**Figure 3. 11.** This baby has cyanosis of the hands and feet (acrocyanosis), but the trunk and mucous membranes are pink. Acrocyanosis is normal. Supplemental oxygen is only needed if oxygen saturation is below the target range. ## **What is a pulse oximeter?** Oxygen is carried by the hemoglobin inside red blood cells. Hemoglobin that is carrying oxygen absorbs red light differently than hemoglobin that is not carrying oxygen. A pulse oximeter uses a light **45**"
},
{
"source": "Gomella's Neonatology: Management, Procedures, On-Call Problems, Diseases, and Drugs, Eighth Edition, p. 521",
"text": "- **A. Physical examination** **1. Assess the infant for central, peripheral, acrocyanosis, perioral/circumoral, or differential cyanosis.** See Section II.A. - **a. Central cyanosis.** Skin, lips, and tongue appear blue. It may be difficult to assess cyanosis in infants with darker skin pigmentation. Focus on nailbeds, tongue, and mucous membranes. - **b. Peripheral cyanosis.** Skin is bluish, but the oral mucous membranes are pink. - **c. Acrocyanosis.** Hands and feet are blue but nothing else. - **d. Perioral/circumoral cyanosis.** Blue appearance around the mouth. - **e. Poor peripheral perfusion with cyanosis.** These infants \u201cdon\u2019t look good,\u201d \u201clook mottled,\u201d or \u201clook washed out or have poor perfusion.\u201d (See Chapter 77.) - **f. Differential cyanosis.** Cyanosis of the upper or lower part of the body only (see Section II.I)."
},
{
"source": "Signs and Symptoms in Pediatrics, p. 181",
"text": "## \ufffd **CYANOSIS IN THE NEWBORN** Acrocyanosis of the hands and feet is common in the fi rst 6 to 24 hours of life and is usually of little signifi cance in an otherwise well newborn. Central cyanosis persisting beyond the fi rst few minutes of life may indicate inadequate oxygen delivery and necessitates further evaluation. Newborns can have cyanosis over the lower half of the body in the presence of right-to-left shunting across a PDA. Newborns with persistent cyanosis or hypoxemia despite oxygen administration may have CCHD, primary lung disease, or pulmonary artery hypertension."
},
{
"source": "Gomella's Neonatology: Management, Procedures, On-Call Problems, Diseases, and Drugs, Eighth Edition, p. 97",
"text": "- **c. Acrocyanosis (bluish hands and feet only). Normal oxygen saturation (normal PaO2).** Peripheral cyanosis of the extremities. This may be normal immediately after birth or within the first few hours after birth or with cold stress. Spasm of smaller arterioles can cause this (up to 24\u201348 hours of life). In a normothermic older infant, consider hypovolemia. - **d. Perioral cyanosis (bluish color around the lips and philtrum [nose to upper lip]). Normal oxygen saturation at birth.** Common after birth, due to the close proximity of the blood vessels to the skin (infants have a superficial perioral venous plexus). It is not a sign of peripheral or central cyanosis and usually resolves after 48 hours. - **e. Traumatic cyanosis. Normal oxygen saturation (normal PaO2).** This is cyanosis of the head and face, usually with petechiae, that results from **7:** NEwBorN PhySICAl ExAMINATIoN 65 - venous congestion. It occurs due to a birth face presentation or an umbilical cord around the neck."
},
{
"source": "Cover, p. 4793",
"text": "but is fixed in a focal, often unilateral, distribution ( **Fig. 352-8** ). The condition may be complicated by associated skin atrophy and ulceration, ipsilateral soft tissue, or even bony hypotrophy. Acrocyanosis results from the pooling of venous blood in the hands and feet; the deep purple color does not mark a pathologic process in an otherwise healthy infant and is reversed by warming. Harlequin color change is transient erythema or duskiness of the dependent half of the body, a sharp midline demarcation, and pallor of the upper half that resolves with change in position."
},
{
"source": "Netters Pediatrics (Florin \u0422., Ludwig St.), p. 292",
"text": "The differential diagnosis of cyanosis in an infant or young child includes the congenital cardiac lesions described below but also includes acrocyanosis (blue discoloration of extremities caused by peripheral vasoconstriction), pulmonary disease, and methemoglobinemia. Evaluation of these patients includes a thorough physical examination and pre- and postductal saturations, chest radiography, electrocardiography, and hyperoxia test. Transthoracic echocardiography confirms the anatomy of the lesions and may provide important information regarding cardiac physiology. The _hyperoxia test_ can be a useful tool for differentiating cardiac and noncardiac cyanosis. It relies on the principle that hypoxemia caused by cardiac abnormalities is not corrected by increasing the inspired fraction of inspired oxygen (FiO2). Therefore, in a child with FiO2 of 100%, a right radial (i.e., 270 SECTION VIII \u2022 Disorders of the Cardiovascular System "
},
{
"source": "Cover, p. 8670",
"text": "**TABLE 568-2 PHYSICAL SIGNS OF AUTONOMIC DYSFUNCTION**  [Figure OCR, page 8670, figure 1] Skin Pupils and eyes Tongue Vital signs Neurologic signs Pallor, flushing, red hands and feet, cold limbs, excessive sweating, dependent acrocyanosis, atrophy, telangiectasia, angiokeratomas, hyperalgesia, edema Horner syndrome, tonic pupil, anisocoria, poor accommodation to near, ptosis, miosis Absent fungiform papillae Tachycardia, bradycardia, arrhythmia, hypotension, hypertension, tachypnea, apnea, fever, hypothermia, orthostatic tachycardia, orthostatic hypotension or hypertension Areflexia, sensory loss, weakness   **FIGURE 568-1** Acrocyanosis in an adolescent with orthostatic intolerance."
},
{
"source": "Gomella's Neonatology: Management, Procedures, On-Call Problems, Diseases, and Drugs, Eighth Edition, p. 515",
"text": "**3. Acrocyanosis (bluish hands and feet only).** There is normal oxygen saturation in the blood. A type of peripheral cyanosis, it is cyanosis of the extremities and around the mouth and may be considered a normal finding immediately after birth, within the first 1 to 2 days, or with cold stress. Spasm of smaller arterioles is the cause. In a normothermic older infant, consider hypovolemia as the main cause. **4. Perioral/cirumoral cyanosis (bluish color around the lips and philtrum [nose to upper lip]).** There is normal oxygen saturation in the blood. It is common after birth and is due to the close proximity of the blood vessels to the skin. Infants have a prominent superficial perioral venous plexus that can engorge with feeding, and this is not a sign of peripheral or central cyanosis and usually resolves after 48 hours."
},
{
"source": "Textbook of Neonatal Resuscitation (8th ed), p. 48",
"text": "treated the same as an absent heart rate (asystole). What do you do if the baby is breathing and the heart rate is at least 100 bpm, but the baby appears persistently cyanotic? The term cyanosis describes skin or mucous membranes with a blue hue caused by poorly oxygenated blood. Cyanosis limited to the hands and feet (acrocyanosis) is acommon finding in the newborn and