Postpartum Infant Cyanosis Question

[Finally2008]

I am a student in my final semester in Mother/Baby and I am feeling nervous about one of my infants that I cared for yesterday. I noticed that his nail beds were "purple" yesterday and asked the anchor nurse what she thought about it. She told me that he could have just been cold (he had been unwrapped, getting a diaper change just previously) or he could have been flinging his hands around (he had), so she thought it was okay. When I got home, I looked online to see what I could find out and saw that this was a sign of cyanosis. I did not notice any other signs of respiratory distress (nasal flaring, retractions, etc) but I am afraid I should have done on O2 sat on him. Also, he was having a lot of mucous (spitting up, gagging) throughout the day whenever I assessed him. His parents said he didn't have the difficulty with the gagging except when I was in the room (great). He was not blue anywhere else (actually he was almost red at times) except for his feet (acrocyanosis?) He was about 15 hours post delivery when I noticed this (emergency c-section for fetal intolerance, decreased fetal heartrate). Any suggestions?

[llg, PhD, RN]

Newborn nailbeds are not a very reliable source of information about the baby's cardiorespiratory status. If there was no other sign of respiratory or cardiovascular compromise, I strongly doubt there was anything wrong with your patient.

You pointed it out to the regular staff nurse. That was the right thing to do. Unless you had some additional reason to suspect a problem, I don't think you had any need to do anything else.

[Elvish, BSN, DNP, RN, NP]

Bluish/purple discoloration of hands and feet and consequently nailbeds - acrocyanosis - is a normal finding for a newborn. As the newborn circulation is still adjusting to extrauterine life, it's pretty common to see this.

Were this a big person, we'd be a bit more concerned but in newborns it's not so big a deal. Now, if you'd seen central cyanosis (around the nose/mouth), grunting, flaring, or any sort of retractions, you'd definitely want to listen to his heart/lungs and put him on a pulse ox.

Pulse ox is never a bad idea if you're concerned about his cardiac or respiratory status. It's noninvasive and painless.

As a student, you did the right thing by letting the nurse know.

Good assessment.