Nitrates and nitrites entering a distribution system due to a cross-connection lead to which infant health concern?

• A. Neonatal Jaundice
• B. Blue Baby Syndrome
• C. Renal Failure
• D. Hypotension

Answer: (B)

Nitrates and nitrites in drinking water can cause methemoglobinemia in infants, commonly called Blue Baby Syndrome. Nitrite converts some of the infant’s hemoglobin into methemoglobin, which can’t carry oxygen effectively. Infants are especially vulnerable because they have higher levels of fetal hemoglobin and lower activity of the enzyme that reduces methemoglobin back to normal hemoglobin, and their stomachs can promote nitrite formation from nitrate. When a cross-connection lets nitrate-rich water into the system, bottles and formulas prepared with that water can expose infants to this risk, leading to a bluish skin color, rapid breathing, and fatigue in more serious cases. The other health issues listed don’t reflect this specific infant risk from nitrate/nitrite in drinking water. Neonatal jaundice involves bilirubin, while renal failure and hypotension aren’t the typical acute effects of nitrate/nitrite exposure in this context.