Blood in the stool of a newborn
From WikiLectures
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.[1][2]
Causes[edit | edit source]
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.[2]
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).[2][1]
Diagnosis[edit | edit source]
- anamnesis;
- physical exam:
- peripheral blood circulation – worsened by NEC;
- bleeding skin manifestations – hematomas in coagulopathy;
- examination of the abdomen – distended and sensitive in NEC, intussusception, volvulum;
- examination of the rectum – fissures, etc.
- 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.[2]
- Apt's test (to differentiate between maternal and newborn blood): mixing blood with NaOH → hemolysis → maternal blood; fetal erythrocytes are resistant to alkali.[3]
Sources[edit | edit source]
Related articles[edit | edit source]
References[edit | edit source]
- ↑ a b HRODEK, Otto – VAVŘINEC, Jan, et al. Pediatrie. 1. edition. Galén, 2002. pp. 82. ISBN 80-7262-178-5.
- ↑ a b c d GOMELLA, TL, et al. Neonatology : Management, Procedures, On-Call Problems, Diseases, and Drugs. 6. edition. Lange, 2009. pp. 264-267. ISBN 978-0-07-154431-3.
- ↑ DORT, Jiří, et al. Neonatologie : vybrané kapitoly pro studenty LF. 1. edition. Karolinum, 2005. pp. 71. ISBN 80-246-0790-5.
