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Macroscope
Did environment
or infection cause
a blood disorder in
newborns?
the lungs to be resupplied with oxygen. The hemoglobin in red blood cells
turns red when iron in the molecule
binds to oxygen; it turns bluish-purple
when the oxygen is unloaded, which is
why veins are bluish. With too much
deoxygenated blood in the arteries, the
skin turns from pink to blue (cyanosis
comes from the Greek kyanos, meaning
dark blue).
Alternatively, some chemicals can
oxidize the iron in hemoglobin. The
altered form, called methemoglobin,
loses the ability to bind oxygen, and
the pigment now changes to greenish brown or almost black. The human body contains enzymes to reverse
methemoglobinemia, but only up to
certain levels. After blood levels reach
15 percent, adults become visibly cyanotic. If more than half of the hemoglobin is converted, oxygen transport,
particularly to the brain, is severely
hampered, respiratory distress is likely,
and death is possible.
In congenital heart disease the cyanosis is apt to improve if treated with
oxygen, and if a sample of shed blood
is shaken in air, it often becomes lighter and redder in color. Since methemoglobin does not bind oxygen, infants with that condition do not pink
up on oxygen, and samples of shed
blood exposed to air undergo little or
no change in color.
The two conditions also look a little
different. During the influenza epidemic of 1918, the word heliotrope
was used to describe the color of the
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Classic Stock/Alamy
fants who had been fed powdered formula prepared with well water grew,
measurements of the nitrate content
of Iowa wells showed that more than
half of the 91 wells initially sampled
contained nitrate nitrogen in excess of
10 parts per million, and 20 contained
more than 65 parts per million.
Those wells that tested high for nitrates were clearly undesirable from a
public health standpoint. Most of them
were old, shallow and dug rather than
drilled, and they often had inadequate
casings. Many were poorly covered so
that surface runoff containing nitrate fertilizers or animal excreta rich in nitrates
could enter freely. They were often found
near barnyards, feedlots or pit privies, and some were contaminated with
coliform bacteria. Although the wells
served as the drinking water source for
the entire family, only formula-fed infants were affected, and most were less
than three months of age.
Subsequent independent surveys in
midwestern states confirmed the initial results in Iowa. The most complete
survey of all 48 states, plus what were
then the territories of Alaska and Hawaii, was compiled in 1951 and identified 278 cases with 39 deaths. No cases
were found in which wells contained
10 parts per million nitrate nitrogen or
less, and only 2.3 percent of the cases
involved wells with between 10 and
20 parts per million. Above 20 parts
per million, the severity of the symptoms seemed to parallel the amount of
nitrate present. Breastfed infants were
never involved; neither were families
who used municipal water supplies.
No reports of cases prior to World War
II were found. However, physician
reporting was not mandatory for the
condition, and the true number may
have been much higher.
But by the time that report was
published, the worst seemed to have
passed, and the number of cases fell
off steadily through the early 1950s.
Today the disease has all but disappeared, with reports appearing only
sporadically in the literature. Only
two cases have been reported since the
mid-1960s and none since 2000. Within
10 years the epidemic had waned as
suddenly as it had appeared, without
any preventive action having knowingly been taken. Whether it was because of public awareness, a massive
improvement in rural drinking water
quality, a trend toward breastfeeding
or other factors may never be known.
From the mid-1940s through the early 1950s, a number of midwestern farm babies developed
a potentially fatal blood disorder that leads to cyanosis, or blue baby syndrome. The infants
were all healthy at birth, but upon returning home, they were all fed with formula prepared
with well water. The miniepidemic had 278 cases and 39 deaths, but physician reporting was
not mandatory for the condition, so the true number may have been higher.
Nitrates to Nitrites
2009 MarchApril
95
Cyanosis, caused by blood insufficiently supplied with oxygen, turns areas of an infants
skin visibly blue. The condition can be a
symptom of a heart defect, as is the case for this
infant. But it can also indicate exposure to a
chemical that alters hemoglobin in the blood.