Algorithm for managing a baby with dusky soles

We have been using dusky colour of the sole in newborns as proxy to cyanosis. An algorithm for management of dusky soles was developed presupposing that a baby can have dusky soles due commonly to hypothermia, hypoxaemia, or hypotension in isolation or in combination. Fifty-one consecutive babies were managed according to a predetermined algorithm based largely on clinical signs. Forty babies were covered by these three broad groups and 37 of them could be managed successfully. Of the remaining babies two were found to have congenital malformations on autopsy and one died of hyperthermia. Algorithmic approach has simplified the management with low failure rate and can be useful when hi-tech neonatal care is unaffordable.