Neonatal lower gastrointestinal bleeding - Revision history

Ostermayer: Prepared the page for translation

2026-01-04T23:47:52Z

Prepared the page for translation

← Older revision		Revision as of 23:47, 4 January 2026
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			<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>		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
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	<references/>		<references/>
	[[Category:Pediatrics]] [[Category:GI]] [[category:Symptoms]]		[[Category:Pediatrics]] [[Category:GI]] [[category:Symptoms]]
			</translate>

ClaireLewis: /* References */

2019-10-06T18:41:33Z

References

← Older revision		Revision as of 18:41, 6 October 2019
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	<references/>		<references/>
	[[Category:Pediatrics]] [[Category:GI]]		[[Category:Pediatrics]] [[Category:GI]] [[category:Symptoms]]

ClaireLewis: /* Evaluation */

2019-09-29T23:12:03Z

Evaluation

← Older revision		Revision as of 23:12, 29 September 2019
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	**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) abdominal plain film		**abnormal abdominal exam (distension, tenderness, abnormal bowel sounds): [[KUB\|abdominal plain film]]

	==Management==		==Management==

ClaireLewis at 19:25, 21 August 2019

2019-08-21T19:25:49Z

← Older revision		Revision as of 19:25, 21 August 2019
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	==Background==		==Background==
	~~Mortality from acute GIB~~ in children is ~~low with rectal bleeding in infancy~~ often self-limited condition		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==
	*~~blood~~ stool		*Bloody stool
	*~~hemodynamic instability~~ if ~~emergent and not minimal bleeding~~		*+/- 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]]		**[[Necrotizing enterocolitis]]
	**[[~~malrotation with~~ volvulus]]		**Malrotation with [[volvulus (peds)\|volvulus]]
	**[[Hirschsprung disease]]		**[[Hirschsprung's disease]]
	**~~systemtic coagulopathy~~ (see other bleeding symptoms (cephalohematoma, mucocutaneous bleeding, petechiae)		**[[Coagulopathy]] (see other bleeding symptoms (cephalohematoma, mucocutaneous bleeding, petechiae)
	***~~vit~~ K deficiency (~~was it~~ given after ~~birth~~)		***[[Vitamin K deficiency]] (if not given after delivery)
	***~~maternal~~ thrombocytopenia		***Maternal [[thrombocytopenia]]
	***DIC		***[[DIC]]
	**Infectious colitis		**Infectious [[colitis]]
			**[[FPIES]]

	*Other conditions		*Other conditions
	**Swallowed maternal blood		**Swallowed maternal blood (e.g. from chapped nipples)
	***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 enterocolitis
	**Milk protein ~~entercolitis~~		**Perianal/rectal [[anal fissure\|fissure]]
	**Perianal/rectal fissure

	==Evaluation==		==Evaluation==
	*~~hemodynamically stable treat for shock~~		*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)
	*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==
	*~~emergent conditions don't typically present with only hematochezia~~		*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==
	*~~depending~~ on etiology		*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]]

Gregtong: /* References */

2019-08-21T00:36:31Z

References

← Older revision		Revision as of 00:36, 21 August 2019
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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/>

Gregtong: Created page with "==Background== Mortality from acute GIB in children is low with rectal bleeding in infancy often self-limited condition ==Clinical Features== blood stool hemodynamic instab..."

2019-08-21T00:35:26Z

Created page with "==Background== Mortality from acute GIB in children is low with rectal bleeding in infancy often self-limited condition ==Clinical Features== *blood stool *hemodynamic instab..."

New page

==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

==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

<references/>