Neonatal lower gastrointestinal bleeding: Difference between revisions
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==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> | 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 | *Bloody stool | ||
*+/- additional features of underlying condition | *+/- additional features of underlying condition | ||
*+/- signs of [[anemia]], [[shock]] if significant bleed | *+/- signs of [[Special:MyLanguage/anemia|anemia]], [[Special:MyLanguage/shock|shock]] if significant bleed | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*Emergent: typically do not present with isolated hematochezia | *Emergent: typically do not present with isolated hematochezia | ||
**[[Necrotizing enterocolitis]] | **[[Special:MyLanguage/Necrotizing enterocolitis|Necrotizing enterocolitis]] | ||
**Malrotation with [[volvulus (peds)|volvulus]] | **Malrotation with [[Special:MyLanguage/volvulus (peds)|volvulus]] | ||
**[[Hirschsprung's disease]] | **[[Special:MyLanguage/Hirschsprung's disease|Hirschsprung's disease]] | ||
**[[Coagulopathy]] (see other bleeding symptoms (cephalohematoma, mucocutaneous bleeding, petechiae) | **[[Special:MyLanguage/Coagulopathy|Coagulopathy]] (see other bleeding symptoms (cephalohematoma, mucocutaneous bleeding, petechiae) | ||
***[[Vitamin K deficiency]] (if not given after delivery) | ***[[Special:MyLanguage/Vitamin K deficiency|Vitamin K deficiency]] (if not given after delivery) | ||
***Maternal [[thrombocytopenia]] | ***Maternal [[Special:MyLanguage/thrombocytopenia|thrombocytopenia]] | ||
***[[DIC]] | ***[[Special:MyLanguage/DIC|DIC]] | ||
**Infectious [[colitis]] | **Infectious [[Special:MyLanguage/colitis|colitis]] | ||
**[[FPIES]] | **[[Special:MyLanguage/FPIES|FPIES]] | ||
*Other conditions | *Other conditions | ||
**Swallowed maternal blood (e.g. from chapped nipples) | **Swallowed maternal blood (e.g. from chapped nipples) | ||
**Milk protein enterocolitis | **Milk protein enterocolitis | ||
**Perianal/rectal [[anal fissure|fissure]] | **Perianal/rectal [[Special:MyLanguage/anal fissure|fissure]] | ||
==Evaluation== | ==Evaluation== | ||
*Examine stool directly and test for blood | *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) | **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 | *Evaluate for underlying emergent etiology if sick or suggestive presentation | ||
**abnormal abdominal exam (distension, tenderness, abnormal bowel sounds): [[KUB|abdominal plain film]] | **abnormal abdominal exam (distension, tenderness, abnormal bowel sounds): [[Special:MyLanguage/KUB|abdominal plain film]] | ||
==Management== | ==Management== | ||
*Treat underlying condition, resuscitate prn | *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 | *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 | *Dependant on degree of bleeding and underlying etiology; most can be discharged | ||
==See Also== | ==See Also== | ||
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==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:Pediatrics]] [[Category:GI]] [[category:Symptoms]] | ||
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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.