Blood in the stool of a newborn

Blood in the stool of a newborn can appear in situations with varying degrees of severity. The presence of a large amount of blood in the stool is usually a serious symptom, but it can also be the result of the mother swallowing blood during childbirth or from a sore nipple during breastfeeding. The cause often remains undetected.

Causes
Occult bleeding:
 * swallowed mother's blood during childbirth or breastfeeding (typically on the 2nd to 3rd day of life);
 * nasogastric tube injury;
 * necrotizing enterocolitis;
 * artificial feeding intolerance (cow's or soy milk intolerance; typically 2nd to 3rd week of life);
 * gastritis or stress ulcer (after prolonged illness, after treatment with steroids or theophylline; treatment: ranitidine);
 * unknown cause.

Stools of normal appearance with streaks of fresh blood - anal fissure, rectal trauma (thermometer injury).

Macroscopic bleeding:
 * hemorrhagic disease of the newborn due to vitamin K deficiency (typically on the 2nd to 3rd day of life);
 * necrotizing enterocolitis (NEC);
 * disseminated intravascular coagulation is often accompanied by other bleeding manifestations; often secondary to infection;
 * coagulopathy – abnormalities of platelets and clotting factors;
 * volvulus, intussusception (typical occurrence from 3 to 12 months of age), intestinal duplication, herniated inguinal hernia, Meckel's diverticulum, Hirschsprung's enterocolitis;
 * colitis:
 * intestinal infection (viral or bacterial; can cause temporary lactose intolerance);
 * intolerance to cow's or soy milk ("allergic enterocolitis") - milk without lactose or with hydrolyzed proteins is suitable;
 * Neonatal transient eosinophilic colitis – development without an obvious allergen (e.g. before starting enteral nutrition);
 * severe liver disease;
 * other infections (CMV, toxoplasmosis, syphilis, bacterial sepsis).

Diagnosis

 * anamnesis;
 * physical exam:
 * periferní prokrvení – zhoršené při NEC;
 * krvácivé kožní projevy – hematomy při koagulopatii;
 * vyšetření břicha – distendované a citlivé při NEC, intususcepci, volvulu;
 * vyšetření konečníku – anální fisury atd.
 * laboratory examination:
 * blood count and differential;
 * coagulation tests (APTT, PT, FBG);
 * test to distinguish maternal and fetal blood (adult and fetal hemoglobin);
 * occult bleeding in the stool;
 * stool culture;
 * event ABR, Na, K;
 * Abdominal X-ray if NEC is suspected.
 * Apt's test (to differentiate between maternal and newborn blood): mixing blood with NaOH → hemolysis → maternal blood; fetal erythrocytes are resistant to alkali.

Related articles

 * Bleeding from the alimentary canal