Neonatal lower gastrointestinal bleeding


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

  • Other conditions
    • Swallowed maternal blood (e.g. from chapped nipples)
    • Milk protein enterocolitis
    • Perianal/rectal fissure


  • 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


  • 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


  • Dependant on degree of bleeding and underlying etiology; most can be discharged

See Also

External Links


  1. 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
  2. Arvola T1, Ruuska T, Keränen J, Hyöty H, Salminen S, Isolauri E. Rectal bleeding in infancy: clinical, allergological, and microbiological examination.