Upper Gastrointestinal Tract Bleeding in Critically Ill Pediatric Patients

Abstract

Similar to adults, children under physiologic stress can develop an imbalance in defensive (mucosal layer, motility) and aggressive (gastric acid, bile salts, enzymes) factors responsible for maintaining a healthy gastrointestinal tract. Hypoxia in the gastrointestinal tract likely disrupts the defensive factors, thereby permitting damage by aggressive factors to upper gastrointestinal epithelium that may progress to stress ulceration and acute upper gastrointestinal tract bleeding (UGIB). The basic pathophysiology may be similar in children and adults; however, differences in the time to developing ulceration, ulcer location, and number of ulcers have been reported. Functional development of the gastrointestinal tract is influenced by disease, gestational and postnatal age, and exposure to and type of enteral feedings, thereby confounding the development and prophylaxis of UGIB in neonates and infants. In addition, pharmacotherapy decisions are often complicated by drug administration issues and adverse effects.

Prophylactic ranitidine treatment in critically ill children – a population pharmacokinetic study

“…Stress ulcers and upper gastrointestinal bleeding are frequent complications of critical illness in children admitted to paediatric intensive care units , of whom up to 25% develop gastrointestinal bleeding or perforation .…”

Hemorrhagic Stress-induced Gastric Ulcer in a Healthy Toddler

“…However, significant UGIB is uncommon. Hemorrhagic complications are described in only 6% of children, even in intensive care ( 5 , 7 ). In such patients, mucosal ulcers are usually classified as secondary stress ulcers or are associated with other serious conditions, such as intracerebral bleeding, raised intracranial pressure, congenital heart disease, asphyxia, respiratory failure, and hypoglycemia ( 8 , 9 ).…”

A review of stress‐related mucosal disease

“…Additional disease processes associated with a high risk of stress‐related GI bleeding in people include sepsis, renal failure, hepatic failure, hypotension/shock, trauma, burns on greater than 35% of the body, neurologic trauma and surgery, myocardial infarction, multiple organ failure, aspiration pneumonia, organ transplant, major surgery and postsurgical states, prolonged ICU hospitalization, ileus, and high‐dose corticosteroid use (Table ) . Frequency of bleeding increases when multiple risk factors are identified in a single human patient …”