Neonatal lower gastrointestinal bleeding

Background

Mortality from acute GIB in children is low with rectal bleeding in infancy often self-limited condition

Clinical Features

• blood stool
• hemodynamic instability if emergent and not minimal bleeding

Differential Diagnosis

• Emergent
  • necrotizing enterocolitis
  • malrotation with volvulus
  • Hirschsprung disease
  • systemtic coagulopathy (see other bleeding symptoms (cephalohematoma, mucocutaneous bleeding, petechiae)
    • vit K deficiency (was it given after birth)
    • maternal thrombocytopenia
    • DIC
  • Infectious colitis

• Other conditions
  • Swallowed maternal blood
    • Apt test :qualitative test using alkali to detect maternal hemoglobin, fetal hgb resistant to alkali stays pink, adult hgb hydrolyzed by alkali turn yellow brown
  • Milk protein entercolitis
  • Perianal/rectal fissure

Evaluation

• hemodynamically stable treat for shock
• examine stool directly and test for blood
• abnormal abdominal exam (distension, tenderness, abnormal bowel sounds) abdominal plain film

Management

• emergent conditions don't typically present with only hematochezia
• milk or soy protein induced colitis are well appearing, stools with low-moderate blood, trial eliminating milk and soy from the diet

Disposition

• depending on etiology

References

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