Neonatal lower gastrointestinal bleeding
Background
Acute GI bleeding in children carries low mortality and is often a self-limited condition in infants[1][2]
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
- 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 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): 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
- ↑ 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
- ↑ Arvola T1, Ruuska T, Keränen J, Hyöty H, Salminen S, Isolauri E. Rectal bleeding in infancy: clinical, allergological, and microbiological examination.