• Shruti GOCHHWAL

What Causes Blue Baby Syndrome, Symptoms, Diagnosis, Treatment And Prognosis

Methemoglobinemia, or blue baby syndrome most commonly develops in the infants. This condition is caused by high intake of nitrate (NO:f) and nitrite (N(V). Nitrates and nitrites are found in most types of food, including cured and fresh meats, fruits, vegetables, baked goods, and dairy products. Nitrates are everywhere and in small quantities are present in the air. Drinking-Water Link Very high nitrate levels can occur in drinking water under the right conditions. The major use of nitrate is in fertilizers. Nitrates not used by plant life are washed into the groundwater. Nitrate in water does not react with other chemicals and is not retained on soil. It can migrate long distances with the flow of groundwater.

Other forms of nitrogen in the soil can be oxidized to nitrate by soil bacteria when oxygen is present. Levels of 30 mg/L-N (expressed in nitrogen content) and higher have been found in drinking water wells in agricultural areas. Nitrite is usually found only in trace amounts in drinking water. It is more reactive than nitrate and can be oxidized to nitrate in the environment. Infants can be exposed to these contaminants when they drink formula made with water high in nitrate and nitrite.

Drinking water is the most significant source of these contaminants for infants during the first three to six months of life if fed formula made with water high in nitrate or nitrite. Health Effects The health effects of ingested nitrate and nitrite are related. When water con taining nitrate is consumed, a portion of it is converted to nitrite in the mouth and stomach. The nitrite and nitrate get absorbed via the intestine and the body reacts with hemoglobin and forms methemoglobin. Methemoglobin is incapable to carry oxygen to body organs and tissues. The result is asphyxia, or suffocation, causing a blue skin color leading to death. Infants with diarrhea are particularly prone to the effects of methemoglobinemia because they synthesize the nitrite

Causes of blue baby syndrome

blue baby syndrome causes

Happy Baby


If the skin or organs like heart, lungs do not receive enough or the required amount of oxygen then, the skin becomes blue in color. Hence, the name given to this is blue baby syndrome.

Methemoglobinemia is a condition of nitrate poisoning. If babies drink well water and eat foods filled with nitrates then this syndrome could occur.

Symptoms of blue baby syndrome

  1. Inability to grow normally

  2. Irritation

  3. Feeding difficulty

  4. Tiredness

Diagnosis can be made by blood tests, chest x-ray, ECG, oxygen levels can be tested.

A drug called methylene blue can be taken to provide oxygen to the body.

Treatment of blue baby syndrome

blue baby syndrome treatment

New born


The presence of nitrates and nitrites in agricultural products are very dangerous and hazardous. Abundant uses of compost, manure, and chemical fertilizers are considered to be some of the primary causes of high levels of nitrates in produce (1). Nitrate may also be present as a natural metabolite of nitrogen intake by green plants (2). Although it is generally accepted that nitrate itself is not toxic, it can act as a reservoir for the production of nitrite by bacterial action on food during storage or within the body during digestion (3). They can also react with hemoglobin [Fe(II)], oxidizing it to methemoglobin [Fe(III)] in a condition known as methemoglobinemia or blue baby syndrome.

The oxidized methemoglobin is then incapable of performing the important task of oxygen transport. This is of particular concern for infants under 4 months of age because of the higher stomach pH (greater than the pH of adult stomachs; pH = 4), which can facilitate the conversion of nitrate to nitrite. Several analytical approaches to the determination of nitrate and nitrite in food are available. The current AOAC Official Method (993.03) for determination of nitrate and nitrite in baby food  is a spectrophotometric method requiring reduction of nitrate to nitrite using spongy cadmium followed by colorimetric determination at 530 nm. Several liquid chromatography (LC) methods, including that used by the European Committee for Standardization, consist of chromatographic separation followed by UV detection at 214 nm.

The disadvantage of the spectrophotometric method is the use of cadmium, which is toxic and carcinogenic. Also, this method does not directly distinguish nitrate from nitrite. The disadvantage of the LC/UV methods is that sample matrix compounds remaining in the extract can mask the response at the selected wavelength. The method reported here easily detects both nitrate and nitrite using suppressed conductivity without the use of hazardous metals and without interferences.

A new method was developed for the extraction and determination of nitrate and nitrite in fruit and vegetable baby foods. Using electrolytically generated potassium hydroxide eluant, nitrate and nitrite were separated on a hydroxide-selective, high-capacity anion exchange column and detected by using suppressed conductivity.

A simple extraction followed by clarification and centrifugation yielded a final extract that could be diluted and filtered for analysis. Use of borate buffer for the extraction of highly acidic. Representative chromatogram obtained for nitrate/nitrite standards. Peak identification: 1 = nitrite, 2 = carbonate (due to dissolved CO2), 3 = nitrate. Standard and samples with incurred nitrate residue: (a) multi-ion standard; 1: fluoride, 2: chloride, 3: nitrite, 4: carbonate (from dissolved CO2), 5: sulfate, 6: bromide, 7: nitrate, 8: phosphate; (b) butternut squash; (c) banana; (d) garden vegetables; (e) creamed spinach. This new method uses mostly aqueous reagents, eliminates cadmium, and eliminates interferences seen with LC/UV methods.

Chromatography Optimization Initially, isocratic elution was used. Separation of the analytes (fluoride, chloride, nitrite, sulfate, bromide, nitrate, and phosphate) was sufficient in the multi-ion standard; however, nitrite and chloride eluted closely. The baby food contained sufficient amounts of anions to cause resolution problems. Therefore, a gradient was chosen to obtain further separation of nitrite and chloride. Although there are ways of removing the chloride from the samples (e.g., silver pretreatment column), a gradient program was the most cost-effective solution. The conditions for the chromatography were as described above.

A representative chromatogram of a nitrate/nitrite standard. A small peak for carbonate was caused by dissolved CO2 in the buffer used to dilute the standards. The chromatograms for the samples with incurred nitrate residues, along with the multi-ion standard, are seen in. There are many other ions in the samples, including chloride, carbonate, and sulfate but the nitrate peak is well resolved in all of the chromatograms. The recoveries for nitrite in acidic matrixes, namely fruits, were diminished by using the water extraction.

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