View source for Neonatal lower gastrointestinal bleeding

==Background==
Acute GI bleeding in children carries ''low'' mortality and is often a self-limited condition in infants<ref>Romano C1, Oliva S1, Martellossi S1, Miele E1, Arrigo S1, Graziani MG1, Cardile S1, Gaiani F1, de’Angelis GL1, Torroni F1. Pediatric gastrointestinal bleeding: Perspectives from the Italian Society of Pediatric Gastroenterology. World J Gastroenterol. 2017 Feb 28;23(8):1328-1337. PMID: 28293079</ref><ref>Arvola T1, Ruuska T, Keränen J, Hyöty H, Salminen S, Isolauri E. Rectal bleeding in infancy: clinical, allergological, and microbiological examination.</ref>

==Clinical Features==
*Bloody stool
*+/- additional features of underlying condition
*+/- signs of [[anemia]], [[shock]] if significant bleed

==Differential Diagnosis==
*Emergent: typically do not present with isolated hematochezia
**[[Necrotizing enterocolitis]]
**Malrotation with [[volvulus (peds)|volvulus]]
**[[Hirschsprung's disease]]
**[[Coagulopathy]] (see other bleeding symptoms (cephalohematoma, mucocutaneous bleeding, petechiae)
***[[Vitamin K deficiency]] (if not given after delivery)
***Maternal [[thrombocytopenia]]
***[[DIC]]
**Infectious [[colitis]]
**[[FPIES]]

*Other conditions
**Swallowed maternal blood (e.g. from chapped nipples)
**Milk protein enterocolitis
**Perianal/rectal [[anal fissure|fissure]]

==Evaluation==
*Examine stool directly and test for blood
**Apt test: distinguishes maternal versus infant's blood (fetal Hgb is resistant to alkali and stays pink, adult Hgb hydrolyzed by alkali--> yellow/brown)
*Evaluate for underlying emergent etiology if sick or suggestive presentation
**abnormal abdominal exam (distension, tenderness, abnormal bowel sounds): [[KUB|abdominal plain film]]

==Management==
*Treat underlying condition, resuscitate prn 
*If well-appearing with low-moderate blood and suspect milk or soy protein induced colitis, trial eliminating milk/soy  are well appearing, stools with low-moderate blood, trial eliminating milk and soy from the diet

==Disposition==
*Dependant on degree of bleeding and underlying etiology; most can be discharged

==See Also==


==External Links==


==References==
*https://pedemmorsels.com/neonate-with-bloody-stool/
*https://www.uptodate.com/contents/lower-gastrointestinal-bleeding-in-children-causes-and-diagnostic-approach

<references/>
[[Category:Pediatrics]] [[Category:GI]]