Risk factors of mild rectal bleeding in very low birth weight infants: a case control study

Abstract

BackgroundMild rectal bleeding (MRB) is a particular clinical entity different from necrotizing enterocolitis, which significantly influences neonatal care in preterm infants. We aimed to determine the risk factors and to evaluate prospectively the clinical course of MRB.MethodsWe consecutively included in a case–control study all infants with birth weight ≤ 1500 g or gestational age ≤ 32 weeks admitted to our unit, and presenting MRB, defined as either isolated or associated with mild clinical or radiological signs. We matched each Case with two Controls. Clinical data before, after and at time of MRB were collected, together with stool cultures at time of MRB (or at similar postnatal age in Controls). Multiple logistic regression analysis was performed to determine independent risk factors for the development of MRB.ResultsDuring 4 years, among 823 very low birth weight (VLBW) infants admitted to our unit, 72 (8.8%) had MRB. The median duration of rectal bleeding was 1.1 [1–2] days and the fasting period lasted 2.9 [2–10] days. A relapse occurred in 24% of cases. In multivariate analysis, only hypertension during pregnancy (p = 0.019), growth restriction at onset of bleeding (p = 0.026), and exposure to ibuprofen (p = 0.003) were independent risk factors for MRB. In Cases there were more infants with Clostridium Difficile in stools than in Controls (p = 0.017).ConclusionHypertension during pregnancy, even without intrauterine growth restriction, appeared to carry the same risk for MRB as exposure to ibuprofen and extrauterine growth restriction.

Near-Infrared Spectroscopy: A Tool for Diagnosing Necrotizing Enterocolitis at Onset of Symptoms in Preterm Neonates with Acute Gastrointestinal Symptoms?

“…They occurred on average on the day 13, which is earlier than the asymptomatic or benign rectal bleeding that most often occurs after the first 15 postnatal days. 24,25 The pathogenesis of NEC remains poorly understood as it seems to combine intestinal immaturity, enteral feeds, intestinal microbiome, immune response, and local ischemia and/or reperfusion injury. 1,26 In these situations, diagnostic uncertainty is high, as our study points out, none of the demographic or clinical features helped to distinguish neonates with and without NEC.…”

Induced Proctocolitis - Oral Food Challenge Should Be Done to Confirm the Diagnosis of Cow’s Milk Allergy in Neonates?

“…Allergic proctocolitis due to cow's milk allergy (CMA) is only one of the possible diagnoses in the presence of blood in stools in neonates (1) . Bleeding can occur in severe diseases, such as idiopathic neonatal transient colitis (2) , Hirschsprung's disease (3) and necrotizing enterocolitis related to changes in the intestinal microbiota due to the significant growth of Escherichia coli (4) , intussusception (5) , Meckel's diverticulum (6) , drug gastritis (7) , necrotizing enterocolitis (8) and related nosological entities (9) , infectious colitis (9) , lymphoid nodular hyperplasia, vitamin K deficiency (10) , anal fissure and evacuation of swallowed blood (11) .…”