Infant Methemoglobinemia (Blue Baby Syndrome)
Infant methemoglobinemia is also called “blue baby syndrome.” It is a condition where a baby’s skin turns blue. This happens when there is not enough oxygen in the blood.
Parents should immediately contact a physician if baby's skin is unusually bluish in color.
Methemoglobinemia is a condition that some babies are born with (congenital) or some develop early in life (acquired).
Acquired methemoglobinemia is more common than the congenital form. It can be caused by exposure to a variety of substances and by some health conditions.
Blue baby syndrome 101
- Infants under 12 months of age that eat foods high in nitrate or drink water with nitrate in it are more likely to have methemoglobinemia.
- Methemoglobinemia can be also caused by certain medications (e.g., benzocaine, dapsone) and chemicals (e.g., aniline, naphthalene).
- Some health conditions, such as anemia, milk protein intolerance, severe metabolic acidosis, and urinary tract infections, can increase an infant’s risk of methemoglobinemia.
- Symptoms can include bluish skin (cyanosis), rapid heartbeat, shortness of breath, nausea, diarrhea, lethargy, loss of consciousness, and seizures.
- A high percentage of methemoglobin in the blood can lead to death.
- Mild cases of methemoglobinemia may not require treatment.
- The main treatment for severe cases of acquired methemoglobinemia is the drug methylene blue, which can provide oxygen to the blood.
- Other treatments include ascorbic acid, blood transfusion, exchange transfusion, and oxygen therapy.
- Congenital methemoglobinemia cannot be prevented.
- Do not feed infants under 6 months nitrate rich foods such as spinach, beets or carrots.
- Test private wells for nitrate to ensure that it is safe to drink.
- Don’t allow infants to drink water with nitrate in it.
- If a private well has nitrate levels above 10 milligrams per liter (mg/L), then pregnant and breastfeeding women should use bottled water instead of the well water.
- Test your well for nitrate every year and take action, P-02128, if levels are high.
- High levels of nitrate in drinking water can affect everyone, P-02559 (PDF).
- Learn more about the health effects that nitrate can cause on the DHS Nitrate in Private Wells page.
Provider information
Reportable condition information
- DPH/BEOH Memo: Public Health Follow-up of Suspected Cases of Infant Methemoglobinemia (PDF)
- EpiNet: Infant methemoglobinemia case reporting and investigation protocol, P-02619 (PDF)
General resources
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