Baby Health

Blue Baby Syndrome- Causes, Symptoms, And Treatments

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Blue baby syndrome or infant methemoglobinemia is a congenital condition in babies. The condition is characterized mainly by the blue skin of the affected, as the name indicates. Though it is a congenital condition in most cases, some may develop it after birth. A significant decrease in the level of haemoglobin in the baby’s blood is the main cause of blue baby syndrome. The blood protein called haemoglobin carries oxygen around the body and supplies to the tissues and cells in the human body.

A decrease in the haemoglobin level results in insufficient oxygen flow around the body. Eventually, the baby’s skin colour turns blue. The condition is seen mostly in rural areas among poverty-affected societies. It is not common in industrialised countries. Some congenital heart defects, genetic factors, and other environmental factors can also contribute to the development of this condition.

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Poorly oxygenated blood stands out to be the prime cause of why the baby turns blue. Problems with the heart, blood, and lungs, can cause the skin to discolor. There can be several reasons behind the lack of oxygenation. Let's look at the possible causes of the blue baby syndrome in infants.

  • Methemoglobinemia

Infants have very sensitive and tiny gastrointestinal tracts. These underdeveloped tracts convert nitrate into nitrite. Methemoglobin production is a result of nitrite circulation in the body. Though methemoglobin is oxygen-rich, it doesn’t release oxygen. The root of this condition is nitrate poisoning. If the baby consumes water contaminated with nitrates, it can affect the blood flow. Many cases of methemoglobinemia are the result of nitrate-contained water. Feeding the baby with well water mixed infant formula or other homemade baby food that contains nitrate can also result in the condition. Methemoglobinemia is mostly seen in babies under the age of 6 months. It can even occur as a congenital condition in rare cases.

  • Tetralogy of Fallot (TOF)

It is a rare congenital heart defect in babies and is the primary cause of the blue baby syndrome. Tetralogy of Fallot is a complex condition, where a combination of four structural abnormalities in the heart develops together. It can be a hole between the right and left ventricle, a blocked valve between the pulmonary arteries and the right ventricle, thickening of the right ventricular valve, or a displaced aorta. The condition finally results in reduced blood flow and poor oxygen flow throughout the body.

  • Other congenital heart defects

Most of the congenital heart diseases are the result of genetics. There are chances that babies born with Down Syndrome can also have heart problems. Poorly managed type2 diabetes during pregnancy can also result in congenital heart defects. Cyanosis causes only a few congenital heart defects.


Babies born with the condition will have a blue discolouration of the skin around hands, feet, and mouth. Discolouration of these areas is known as Cyanosis, which is a sign that suggests that the baby is not getting enough oxygen. Other symptoms associated with blue baby syndrome are:

  • Seizures         
  • Diarrhea
  • Difficulty breathing
  • Loss of consciousness
  • Vomiting
  • Increased salivation
  •  Lethargy
  • Rapid heartbeat
  • Clubbed fingers and toes   


The doctor will identify symptoms of blue baby syndrome during the regular checkup. If the parent or caregiver notices the bluish discolouration in the baby, they should immediately visit the doctor for a detailed consultation. The diagnosis will begin with tracking of medical history. To understand the medical history, a doctor may ask about the symptoms in the baby, conditions at home, feeding patterns, and medical history of the family. While performing the physical exam, the doctor may examine the discoloured area and listen to the heart and lungs of the baby. Apart from the physical examination, the doctor may also suggest additional tests to diagnose the condition. The doctor may suggest the following tests:

  • Chest x-rays for a detailed view of the lungs and heart
  • Blood tests
  • Echocardiogram to see how well the heart functions
  • To understand the oxygen level in the blood, the doctor may advise oxygen saturation
  • If the doctor needs to look at the blood vessels and other structures inside the heart directly, he shall also suggest cardiac catheterization
To understand the underlying cause, it is good to get the tap water tested for nitrate levels. If the nitrate level is below 10miligrams per liter (mg/L), the water is safe. Do not feed it an infant if the nitrate level is above 10mg/L.


The doctor shall decide the treatment procedure based on the cause that turned the baby to blue. Surgery is the primary mode of treatment if the underlying cause is any abnormality. The doctor will correct abnormalities like congenital heart disease through surgery. Surgery should be done before the baby turns 1-year old as the condition can get worse with age. The ideal age of surgery is around 6-months or a little earlier. The baby will get more oxygen, and the discoloration will fade once the surgery is successful. 

Blue baby syndrome

If the cause is high nitrate levels in the water, you may need to get help from a toxicologist or a poison control center to treat the condition. It is important to avoid the sources of nitrate contamination, like using well water, for the health of the baby. If the baby develops any further health issues in connection with the blue baby syndrome, the doctor may suggest a combination of other treatments as well. Methylene blue is a medication given in the form of an injection to babies with severe forms of the syndrome. 

The doctor may suggest correcting surgery if the condition is caused by the tetralogy of Fallot. In this case, the intra-cardiac corrective repair is the main solution. The procedure involves closing the ventricular septal defect with a synthetic Dacron patch. It can correct the blood flow properly from the left ventricle to aorta. The procedure also helps in repairing the pulmonary arteries. The narrowed arteries broaden and improve the blood flow to the lungs after the procedure is successfully carried out. In emergency cases with premature babies with underdeveloped pulmonary arteries, the doctor may carry out a temporary procedure. In the procedure, the doctor creates a shunt between the pulmonary artery and a branch of the aorta. This is a temporary procedure that will be reconstructed following a corrective procedure.


The blue baby syndrome is a rare disorder and can be caused due to many causes. Sometimes, the doctor may advise no immediate treatment too. As performing surgery in newborns can be risky, the doctor may suggest any other treatment alternative. A baby with the blue baby syndrome can lead a normal life after successful treatment. It might hardly have a few health consequences. 


Babies bring heaven to every family. The bundle of joy is a dream to many. From the beginning of conceiving, the family starts to prepare for the welcoming. Baby’s health is considered of utmost importance than anything. When you prepare to welcome the new member to the family, always keep their health in mind. There can be some flukes of nature that cannot be prevented. However, many of the other causes can be avoided. Here are a few steps to take to prevent blue baby syndrome to an extent:

  • Avoid using well water: Well water is a good choice for the elderly, but not the little ones. Avoid using well water to prepare baby formula or other baby drinks until the baby turns over 12 months. Many think that boiling well water solves all the problems. But, boiling cannot remove the nitrates in the water. It is highly recommended to check your well water for nitrate levels. If the nitrate levels in well water exceed 10mg/L, it can be unhealthy and poisonous for the baby. You can get the right direction about checking the well water from your local health department.
  • Put a break on nitrate-rich foods: Try to exclude nitrate-rich food from your baby’s menu. Some of them are broccoli, beets, and carrots. You can limit feeding these foods until the baby turns at least 7-months of age. If you cannot avoid these vegetables from your baby’s food, try using frozen ones rather than fresh ones.
  • Avoid smoking, alcohol, and drugs during pregnancy: Alcohol, drugs, and smoking during pregnancy can also contribute to congenital heart defects in the little one. Avoiding them can prevent serious health complications.  
  • Medication during pregnancy: If the expectant has other health issues, and under any medical treatment, let the Gynaecologist know the details. Diabetes can be a serious health issue to consider for a pregnant woman. It should be well-controlled under a doctor’s supervision. Do not use illegal medicines during pregnancy.

The blue baby syndrome is a rare condition that can be caused by nitrate-contaminated water. Though it is rare, it can be successfully treated. Avoid giving well water to babies until they turn 1-year old. Proper medical attention and monitoring can prevent any further complications from the blue baby syndrome. But, it can also turn out life-threatening if left untreated.

Industrial and agricultural revolutions have backed the country in economic enhancement. But the consequences like waste and fertilizers have polluted the land. It is one of the main reasons for high nitrite concentration on land and water. The underlying cost to industrialisation might be the health of our next generation. Rare conditions like blue baby syndrome are on the rise, as the studies suggest.      

Dr. Patrick Ryan is an experienced and dedicated pediatrician. He became a part of Medical counsel to provide the best medical and health care services for your child. Patrick Ryan started his career as a pediatrician back in 1995. He is an avid writer and provides a caring and compassionate service that is focused on your child’s individual health care through his articles in this blog.

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