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Purple fingernails, cough. Had lung problem, pneumonia, high liver enzymes.

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Pediatrician, Infectious Diseases
Practicing since : 2005
Answered : 1528 Questions
I noticed today that my great grandbaby had purple fingernails. She is 3 weeks. She had a strange cough at one time today but my grandson said she did the same thing last night and it was a sneeze and burp at the same time. She cried from 1 to 4 last night. She was born under stress. Left in the birth canal too long and ingested her own bowel movement and had some lung problems, pneumonia, and high liver enzynes. Now I am worried.
Posted Tue, 22 May 2012 in Child Health
Answered by Dr. Hema Yadav 7 hours later
Hello ,
Thanks for posting your query .
What you have described seems to be most likely acrocyanosis i.e. bluish discolouration of the peripheral extremities especially fingers, toes.If its occasional and there is no other symptoms like fast breathing, chest indrawing during breathing and wheezing sound during breathing or persistent cough, fever etc then it may be normal in newborns especially if they are not adequately hydrated and the climate is cold.Normal newborns may have it due to inadequate circulation in limbs due to low temperature or decreased feeding.In that case it usually subsides on it's own by keeping the baby well fed and warm.Sometimes excessive crying can precipitate something called a cyanotic spell where baby turns bluish purple for few seconds or few minutes.
Its not a very serious condition but the sight is frightening to the parents .
In this case minor positioning and stopping the cry may resolve the symptoms.
However if respiratory symptoms as mentioned above are observed then it most likely indicates a decreased oxygenation of blood either due to respiratory or cardiac problem.
If there is bluish discolouration of tongue and lips as well then it is more likely a cardiac condition causing central cyanosis i.e inadequate oxygen in blood throughout body.
The condition your great granddaughter suffered from during labour is called meconium aspiration and resultant Elevated liver enzymes may be due to associated neonatal jaundice or infection..
This condition can decrease the capacity of the lungs to function optimally and therefore decrease the oxygenation of blood.In severe cases it may lead to backpressure cardiac problems like pulmonary hypertension.
So according to the information provided I would say that your granddaughter might have peripheral acrocyanosis but her birth history makes it necessary to rule out significant respiratory or cardiac pathological illness.
Please do not panic as I do not mean to say the probability of a pathological cause is more, I just mean that to be on the safer side its best to get her evaluated.
You may consult her pediatrician who after thorough examination and tests like oxygen saturation, blood pressure check, chest auscultation, chest xrays and blood tests if needed, can confirm the cause and start apropriate management.
Most respiratory pathologies like meconium aspiration and respiratory distress can be completely treated and the baby may not have future problems.Nowadays many cardiac conditions are also very much treatable and have good prognosis.But her prognosis can only be commented on after confirmation of diagnosis.

So hope that answers your query.
Wishing her good health forever.

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