Blue Baby Syndrome

What is Blue Baby Syndrome?

Blue baby syndrome is a blood disorder occurs due to intake of water which is contaminated with large amount of nitrates. Inside the body nitrates metabolised and converted to nitrites which then bind with oxy-haemoglobins and convert them to metheglobin.

Metheglobin are unable to circulated oxygen throughout the different organs and hiders the oxygen circulation. Lack of oxygen causes cyanosis and turn to bluish colouration of the skin.

This effect is very prominent in infants. More than 50mg/litre can cause blue baby syndrome. Some infants have a congenital heart defect which also is a reason of development of blue baby syndrome.

Blue Baby Syndrome Causes



Image 1: Cause of blue baby syndrome

The causes of blue baby syndrome are:

  • High concentration of nitrates in drinking water causes methaemoglobinaemia, which hinder the oxygen transport to the different cellular structure. Rural areas, mainly affected as they spread manure and fertilizers which contain high nitrates concentrations on agricultural land.
  • The water, which passed, stored or collected from the adjoining area are having more than 50mg/liter of nitrates. As per WHO, more than 50mg/liter of nitrates causes methaemoglobinaemia and affects mainly bottle fed babies.
  • Vegetables obtain from these lands also contain nitrates, which are harmful for body.
  • Some medications including sulphonamides and phenacetin possess blue baby syndrome as a side effect. But currently medical industry has safer drugs, so these drugs are rarely prescribed.
  • Except the direct consumption of nitrates through contaminated water to infants, if pregnant women are consuming the nitrates through drinkable water which also affects the fetus.
  • Gastric acid reduction is also caused cyanosis
  • Insufficiency of methemoglobin reductase enzymes due to hereditary disorder, also causes cyanosis, as this enzyme is required for catabolism of metheglobin.
  • Other than nitrates toxicities, tetralogy of Fallot (TOF) is a congenital heart defect which also causes blue baby syndrome. In this defect heart is unable to completely oxygenate the blood, so the blood coming out from left ventricle, which circulate to every parts of the body not contain a sufficient amount of oxygen and resultant is cyanosis. It has been found that genetic disorder mainly affects the DNA structure is responsible for progression of TOF.


Image 2 : Tetralogy of Fallot


The major symptoms associated with a Blue baby syndrome are:

Blue baby syndrome symptoms


Image 3: Symptoms of Blue baby syndrome


Cyanosis is characterized as blue colouration of skin, nail beds and lips, this occurs due to lack of oxygen supply. In blue baby syndrome development of methemoglobin, which is altered form of haemoglobin and unable to carry oxygen cause decrease oxygen supply. Some cases, infants born with bluish coloured skin, which is unusual, this will happen in congenital heart or lung defect. Cyanosis produces breathlessness, gasping, fatigue, exhaustion, apathy and unconsciousness.

Breathing difficulty

Respiratory distress causes efforts to take breath in and out. Shrinking, increased salivation, lassitude and seizure attacks are frequent, if immediate medical assistance is not incorporated.

Impaired growth

The whole physiological system gets the less amount of oxygen than normal including brain. This hampers the physical and mental growth. The rate of development is lesser than the normal infants in all respects which also cause of mental retardation in severe case. Other than this episode of seizure attacks, internal malfunctioning interferes in thrive.


The proper diagnosis is important to treat the infants. The major symptom associated with blue baby syndrome is cyanosis, which can be characterized with other disease conditions. It is very often reported that misdiagnosis with hypertension, migraine attacks and psoriasis is common with blue baby syndrome.

Timely diagnosis and immediate medical attention is very important to treat the patient effectively and save their life. The onset of syndrome need immediate management, as it leads to fatal condition. Doctors usually conduct the following test for diagnosis:

  • Blood test for haemoglobin estimation and red blood cells count
  • Chest X-ray to get the image of lungs and position of the heart
  • Electrocardiogram (ECG) which helps to analyze the heart rate


Treatment depends upon the underlying cause of the syndrome development. Medicine and surgical process are available to correct the condition.


The available medicine, methylene blue injection can alter metheglobin to haemoglobin.  Methylene blue provides prompt action within minutes.


The first successful surgical process to rectify the Tetralogy of Fallot conducted in 1944 at Johns Hopkins Hospital by Surgeon Alfred Blalock, Vivien Thomas – a surgical technician and pediatric cardiology specialist Helen B. Taussig. Cooperative efforts of them developed a procedure which able to join the subclavian artery with the pulmonary artery and complete oxygenation of blood could possible and blue baby syndrome which is associated with TOF can treat. This technique is known as ‘Blalock-Thomas-Taussig shunt’.

Blue Baby Images



  2. Water-related diseases at
  5. The Blue Baby Syndromes: Did environment or infection cause a blood disorder in newborns? AT
  7. How Pediatric Cardiology Defended Blue Baby Syndrome? at

Leave a Reply

Your email address will not be published. Required fields are marked *