Color

Essentially all neonates have a blue-tinged cast to their skin at the moment of birth. By the time they are 60 seconds old, most neonates are entirely pink, except for their hands and feet, which remain blue. If central cyanosis persists beyond 90 seconds of age, asphyxia, low cardiac output, pulmonary edema, methemoglobinemia, polycythemia, congenital heart disease, arrhythmias, and pulmonary disorders (e.g., respiratory distress, airway obstruction, hypoplastic lungs, diaphragmatic hernia) should be considered, especially when the infant remains cyanotic despite oxygen and controlled ventilation.

Neonates who are pale at birth are often asphyxiated, hypovolemic, acidotic, or anemic or have congenital heart disease, usually left-sided obstructive disease. Neonates whose skin is entirely pink within 2 minutes of birth may be intoxicated with alcohol or magnesium, or they may be alkalotic (pH >7.50). Rubrous neonates are usually polycythemic.