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All about blue babies

Blue babies are those who are born with multiple problems in the heart. It is essential to know the normal heart circulation to be able to understand why babies are blue when they are born with multiple problems within the heart. In a normal heart, there are four chambers, two upper chambers which collect blood and two lower chambers which pump blood.

The right upper chamber collects (blue) impure blood from the body and the right lower chamber pumps this blue blood to both the lungs through a tube called pulmonary artery. In the lungs, the impure blood picks up oxygen and becomes pure (red) and flows to the left upper collecting chamber of the heart. From here, the pure blood flows to the left lower chamber which pumps it to all parts of the body through a tube called aorta. Once this pure blood gives up the oxygen to the body tissues, it becomes impure (blue) and returns to the right side of the heart and the cycle continues. As you have noticed, in a normal heart the blue and the red blood do not mix. 

However, in a complex congenital heart disease multiple problems are seen resulting in mixing of blue and red blood within the heart. As a result blue impure blood would find its way in to the body circulation, resulting in bluish discolouration of the whole body. 

This may be due to

1.Abnormal connections, for eg., where the red blood from the lungs flows to the right side of the heart instead of flowing to the left ( Total anamolous pulmonary venous connection- TAPVC) or where the two tubes which takes the blood out of the heart are switched around so that red blood from the lungs goes to the lungs again instead of flowing to the body and blue blood from the body flows to the body again instead of flowing to lungs ( Transposed great arteries-TGA) 

2.Abnormally small pumping chambers (Left ventricular hypoplastic syndrome –LVHS and Right ventricular hypoplastic syndrome).

As adequate blood flow is the stimulus for the various cardiac structures to develop properly during pregnancy, small chambers or small tubes are most often a result of inadequate blood flow through them, resulting in under-development. In such situations, again there is mixing of blue and red blood within the heart resulting in a blue baby.

3 . Large holes within the heart ( Tetralogy of Fallot, Atrio-ventricular septal defect).

The presence of large holes in the heart with associated lesions again result in mixing of blue and red blood within the heart and the timing of surgery depends on the nature of blood flow to the lungs. If blood flow to the lungs is controlled due to an associated narrowing in the right sided valves, then surgery may be delayed until the child is older (eg., Tetralogy of Fallot). However, if there is excessive blood flow to the lungs resulting in lung congestion, then immediate surgical intervention is required (eg., Complete Atrio-ventricular septal defect). 

It is important to understand at this stage that some bluish discolouration of the tips of hands and feet and around the mouth is occasionally seen in all normal babies and does not point to a heart problem. When a baby is noticed to be blue all over and especially the tongue and inside of the mouth is blue, then a strong suspicion of complex heart disease should be entertained. With better understanding of the natural course of these complex congenital heart problems, it is nowadays possible to offer palliative surgeries for all such children and it is very rare for any such children to be termed unoperable provided an early diagnosis has been made.

Dr R Prem Sekar, 
Consultant Paediatric Cardiologist,
Apollo Hospitals, 
Chennai. 

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