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> | |||
==Clinical Features== | ==Clinical Features== | ||
* | *Bloody stool | ||
* | *+/- additional features of underlying condition | ||
*+/- signs of [[anemia]], [[shock]] if significant bleed | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*Emergent | *Emergent: typically do not present with isolated hematochezia | ||
**[[ | **[[Necrotizing enterocolitis]] | ||
**[[ | **Malrotation with [[volvulus (peds)|volvulus]] | ||
**[[Hirschsprung disease]] | **[[Hirschsprung's disease]] | ||
** | **[[Coagulopathy]] (see other bleeding symptoms (cephalohematoma, mucocutaneous bleeding, petechiae) | ||
*** | ***[[Vitamin K deficiency]] (if not given after delivery) | ||
*** | ***Maternal [[thrombocytopenia]] | ||
***DIC | ***[[DIC]] | ||
**Infectious colitis | **Infectious [[colitis]] | ||
**[[FPIES]] | |||
*Other conditions | *Other conditions | ||
**Swallowed maternal blood | **Swallowed maternal blood (e.g. from chapped nipples) | ||
**Milk protein enterocolitis | |||
**Milk protein | **Perianal/rectal [[anal fissure|fissure]] | ||
**Perianal/rectal fissure | |||
==Evaluation== | ==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) | |||
*abnormal abdominal exam (distension, tenderness, abnormal bowel sounds) abdominal plain film | *Evaluate for underlying emergent etiology if sick or suggestive presentation | ||
**abnormal abdominal exam (distension, tenderness, abnormal bowel sounds) abdominal plain film | |||
==Management== | ==Management== | ||
* | *Treat underlying condition, resuscitate prn | ||
*milk or soy protein induced colitis 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 | ||
==See Also== | ==See Also== | ||
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<references/> | <references/> | ||
[[Category:Pediatrics]] [[Category:GI]] | |||
Revision as of 19:25, 21 August 2019
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.