Bloody Stools in a 3-Day-Old Term Infant

• Published in: Pediatrics (Evanston) 2017-09, Vol.140 (3)
• Main Authors: Bray-Aschenbrenner, Amelia, Feldenberg, L Richard, Kirby, Amelia, Fitzpatrick, Colleen M, Josephsen, Justin B
• Format: Article
• Language: English
• Subjects: Bicarbonates; Bilirubin; Blood; Carbonates; Chlorides; Colon; Company business management; Diabetes Insipidus, Nephrogenic - complications; Diabetes Insipidus, Nephrogenic - diagnosis; Diagnosis, Differential; Electrolytes; Emergency medical services; Emergency service; Enterocolitis, Necrotizing - complications; Enterocolitis, Necrotizing - diagnosis; Erythromycin; Evaluation; Feces; Gastrointestinal Hemorrhage - etiology; Health aspects; Hospital emergency services; Hospitals; Humans; Infant, Newborn; Infants; Male; Males; Management; Neonates; Newborn babies; Nursing; Pediatrics; Penicillin; Potassium; Pregnancy; Pregnancy complications; Pregnancy, Complications of; Prophylaxis; Prothrombin; Radiology; Risk factors; Sodium; Tachycardia; Tachypnea; Thromboplastin; Vagina; Vitamin K; Vomiting
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.2017-0073

A 3-day-old term, male infant presented to the emergency department for evaluation of bloody stools. The infant was born after an uncomplicated pregnancy followed by a normal spontaneous vaginal delivery. The mother was group B colonized, and received antenatal penicillin prophylaxis. The infant received routine delivery room care, and was given ophthalmic erythromycin and intramuscular vitamin K. Circumcision was performed without bleeding and he was discharged from the newborn nursery and the hospital after 48 hours. On the day of presentation, he had streaky bright red blood in 4 consecutive stools. After discussion with the infant's pediatrician, the parents took him to the emergency department. The infant was afebrile, nursing well without emesis, and had made ∼10 wet diapers that day. The physical examination revealed a fussy infant with mild tachycardia, tachypnea, and scleral icterus. The complete blood count was unremarkable. Serum total bilirubin was 11.9 mg/dL, sodium 156 mmol/L, chloride 120 mmol/L, potassium 4.7 mmol/L, and bicarbonate 16 mmol/L. International normalized ratio was prolonged at 2.7, prothrombin time 26.6 seconds, partial thromboplastin time 38.9 seconds. The stool was hemeoccult positive. An obstructive radiograph series of the abdomen showed a nonobstructed gas pattern. Official radiology interpretation the following day reported possible pneumatosis intestinalis in the left and right colon. Our multidisciplinary panel will discuss the assessment of bloody stools in the term newborn, evaluation of electrolyte abnormalities, the diagnosis, and patient management.