JIMS ENGINNERING MANAGEMENT

TECHNICAL CAMPUS

“AN ENVIRONMENTAL
CASE STUDY”
ON
“BLUE BABY
SYNDROME”

Name-shivam rathi

Branch-btech(ee)

Enrollment no.-40125511018


 :
Blue baby syndrome, also known as infant methemoglobinemia, is a
condition where a baby's skin turns blue. This occurs due to a
decreased amount of hemoglobin in the baby's blood.

Hemoglobin is a blood protein that is responsible for carrying oxygen around the
body and delivering it to the different cells and tissues.

When the blood is unable to carry oxygen around the body, the baby turns blue
(cyanotic).

Blue baby syndrome is rare in industrialized countries, but it does occasionally

occur in rural areas. Babies born in developing countries with poor water supply
continue to be at risk for the condition.

Causes:
 Blue baby syndrome is not common in industrialized countries.

The most common cause of blue baby syndrome is water contaminated with
nitrates.

After a baby drinks formula made with nitrate-rich water, the body converts the
nitrates into nitrites. These nitrites bind to the hemoglobin in the body, forming
methemoglobin, which is unable to carry oxygen.

Nitrates are most common in drinking water in farming communities that use well
water. This contamination is due to the use of fertilizers and manure.

Infants younger than 3 months are at highest risk for blue baby syndrome, but it
can also occur in other populations.

People at risk for methemoglobinemia include adults with:

 a genetic predisposition

 ulcers or gastritis

 kidney failure requiring dialysis

Other conditions that can cause a baby to appear blue include:
 Tetralogy of Fallot (TOF): TOF is a serious congenital heart condition
causing four structural abnormalities in the heart that lead to a lack of oxygen
in the blood. This condition can cause a baby to look blue, though it usually
occurs at birth.

 Other congenital heart abnormalities: Any congenital heart abnormality

that affects the amount of oxygen in a baby's blood can cause their skin to
turn blue.

 Methemoglobinemia: This is due to exposure to inhaled nitric oxide, or

certain anesthetics and antibiotics.

Symptoms:
The most common symptom of blue baby syndrome is a blue discoloration of the
skin around the mouth, hands, and feet. This is also known as cyanosis and is a
sign that the child or person is not getting enough oxygen

Other potential symptoms of blue baby syndrome include:

 difficulty breathing
 vomiting

 diarrhea

 lethargy

 increased salivation

 loss of consciousness

 seizures
In severe cases, blue baby syndrome can even cause death.

Prevention:
Diagnosis

A doctor may request a blood test to diagnose blue baby syndrome.

A doctor may suspect that an infant has blue baby syndrome during a regular
checkup. Parents or caregivers who notice a bluish discoloration should schedule
an appointment with a doctor.
 The doctor will begin the diagnosis by taking a thorough medical history by
asking about any symptoms, feeding patterns, and the conditions at home. They
will then perform a physical exam, looking at the discolored areas discoloration
and listening to the heart and lungs.

Additional diagnostic tests may include:

 blood tests

 chest X-rays to look at the lungs and heart

 echocardiogram to look at the heart and how well it functions

 oxygen saturation to determine how much oxygen is in the blood

 cardiac catheterization to directly look at the blood vessels and structures

inside the heart
In addition to testing the baby, it is possible to get the tap water tested to
measure the nitrate levels.

In general, water with nitrate levels below 10miligrams per liter (mg/L) is
considered safe. If a water sample has nitrate levels above 10mg/L, do not give it
to an infant.

Treatment
Treatment will vary depending on what is causing the baby to turn blue.
If congenital heart disease is causing the discoloration, surgery may be required
to correct the abnormalities.

A surgeon will usually operate before the baby turns 1 year old, ideally at around
6 months of age, or even a little earlier. Successful surgery means that the baby
will start to get more oxygen and will no longer look blue.
If high nitrate levels in the water are causing blue baby syndrome, the doctor will
likely need to consult with the local poison control center or toxicologist to help
figure out the best way to treat the condition.

Avoiding the source of nitrate contamination, such as well water or tap water, is
essential for all children with this condition.

Doctors may monitor children with a mild form of blue baby syndrome to make
sure that they do not develop any further health problems as a result of the
condition.

Children with a more severe form of the condition may need a medication called
methylene blue, which a doctor will give as an injection.

Outlook:
Blue baby syndrome is a rare condition that occurs when infants drink formula
that has been made with water contaminated by high levels of nitrates.

For this reason, it is essential to avoid giving infants water from a well until they
turn at least 1 year of age. Medication and monitoring the baby can usually
prevent any complications. Left untreated, however, blue baby syndrome can be
life-threatening.

Most children with blue baby syndrome go on to live a normal and healthy life
without lasting health complications.
 Cases in india:
Medical aid for 'blue babies' - Heart surgeons
operate on children at almost one-third of
what Delhi hospitals charge
 Published 26.10.14
Ajit Pradhan (second from left) operates on six-year-old Ashish Kumar at Jeevak Heart
Hospital and Research Institute in Patna on Saturday. Picture by Nagendra Kumar Singh

Patna, Oct. 25: Jeevak Heart Hospital and Research Institute today held a workshop
focusing on “blue baby syndrome”, which usually occurs among patients of tetralogy of
fallot.
Tetralogy of fallot (TOF) is a congenital heart disease, which results in newborn babies
with blue skin. Ashish Kumar, a six-year-old patient suffering from blue baby syndrome,
was operated upon by Ajit Pradhan, chief cardiac surgeon of the hospital. Pradhan would
operate two more patients of blue baby syndrome in the next two days.
“TOF is a rare heart condition caused by a combination of four heart defects that are
present since the time of birth. Patients develop a hole between their ventricles of their
heart. Besides, the muscular wall of the right ventricle becomes thicker and the
pulmonary valve narrows. The aortic valve is enlarged in this condition and it seems to be
open from both ventricles rather than from left ventricle only which happens in the
normal heart. These defects affect the structure of the heart and it also causes poor supply
of oxygen in the heart and also into the rest of the body. Infants and children with TOF
usually have blue skin tone because their blood does not carry enough oxygen. Early
diagnosis of the disease is necessary for the patients suffering from the disease so that
their treatment could be started on time,” said Pradhan.
Pradhan added: “So far as treatment for blue baby syndrome and TOF is concerned,
surgery is the only option. Even after surgery, the patient is put on medication for six
months. If surgery is not done in the initial phase of the disease, the patient may not lead
a normal life. The heart ailments would grow and it might endanger the life of patient. So
for patients of TOF, it is better to get the surgery done.”
The surgery, however, also involves risks, said Pradhan. “Around 2 per cent patients die
during the surgery. There might be liver failure, kidney failure or any other problem but
surgery is the best option because the chances of patients’ survival is already low in this
case,” added Pradhan.
At Jeevak Heart Hospital, he said, one needs to pay Rs 1.5 lakh for the surgery while
people need to shell out around Rs 4 lakh for the same surgery at hospitals in Delhi.
“Incidents of congenital heart diseases are 8 to 10 per 1000 births. Some of the congenital
heart diseases are life-threatening in the first few months of life and thereby need early
diagnosis and prompt treatment,” said Pradhan.