Neonatal lower gastrointestinal bleeding: Difference between revisions
Ostermayer (talk | contribs) (Prepared the page for translation) |
|||
| (3 intermediate revisions by one other user not shown) | |||
| Line 1: | Line 1: | ||
<languages/> | |||
<translate> | |||
==Background== | ==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== | ==Clinical Features== | ||
* | |||
* | *Bloody stool | ||
*+/- additional features of underlying condition | |||
*+/- signs of [[Special:MyLanguage/anemia|anemia]], [[Special:MyLanguage/shock|shock]] if significant bleed | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*Emergent | |||
**[[ | *Emergent: typically do not present with isolated hematochezia | ||
**[[ | **[[Special:MyLanguage/Necrotizing enterocolitis|Necrotizing enterocolitis]] | ||
**[[Hirschsprung disease]] | **Malrotation with [[Special:MyLanguage/volvulus (peds)|volvulus]] | ||
** | **[[Special:MyLanguage/Hirschsprung's disease|Hirschsprung's disease]] | ||
*** | **[[Special:MyLanguage/Coagulopathy|Coagulopathy]] (see other bleeding symptoms (cephalohematoma, mucocutaneous bleeding, petechiae) | ||
*** | ***[[Special:MyLanguage/Vitamin K deficiency|Vitamin K deficiency]] (if not given after delivery) | ||
***DIC | ***Maternal [[Special:MyLanguage/thrombocytopenia|thrombocytopenia]] | ||
**Infectious colitis | ***[[Special:MyLanguage/DIC|DIC]] | ||
**Infectious [[Special:MyLanguage/colitis|colitis]] | |||
**[[Special:MyLanguage/FPIES|FPIES]] | |||
*Other conditions | *Other conditions | ||
**Swallowed maternal blood | **Swallowed maternal blood (e.g. from chapped nipples) | ||
**Milk protein enterocolitis | |||
**Milk protein | **Perianal/rectal [[Special:MyLanguage/anal fissure|fissure]] | ||
**Perianal/rectal fissure | |||
==Evaluation== | ==Evaluation== | ||
* | *Examine stool directly and test for blood | ||
*abnormal abdominal exam (distension, tenderness, abnormal bowel sounds) abdominal plain film | **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): [[Special:MyLanguage/KUB|abdominal plain film]] | |||
==Management== | ==Management== | ||
* | |||
*milk or soy protein induced colitis are well appearing, stools with low-moderate blood, trial eliminating milk and soy from the diet | *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== | ==Disposition== | ||
* | |||
*Dependant on degree of bleeding and underlying etiology; most can be discharged | |||
==See Also== | ==See Also== | ||
| Line 42: | Line 59: | ||
==References== | ==References== | ||
*https://pedemmorsels.com/neonate-with-bloody-stool/ | *https://pedemmorsels.com/neonate-with-bloody-stool/ | ||
*https://www.uptodate.com/contents/lower-gastrointestinal-bleeding-in-children-causes-and-diagnostic-approach | *https://www.uptodate.com/contents/lower-gastrointestinal-bleeding-in-children-causes-and-diagnostic-approach | ||
<references/> | <references/> | ||
[[Category:Pediatrics]] [[Category:GI]] [[category:Symptoms]] | |||
</translate> | |||
Latest revision as of 23:47, 4 January 2026
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.