Upper GI bleeding in healthy full-term infants: a case-control study

Abstract

UGIB in the newborn babies is often associated with clinically relevant mucosal lesions of the upper GI tract. The evolution, after treatment with antisecretory drugs, is generally rapid and favorable, with clinical recovery usually obtained within 24-48 h. The higher serum pepsinogen levels may only represent a significant risk factor of mucosal lesions and complications.

Endoscopy in Infants With Gastrointestinal Bleeding Has Limited Diagnostic or Therapeutic Benefit

“…Additionally, most infants in our cohort (55.1%) had no abnormalities on EGD or COL. This finding contrasts with existing literature regarding GIB in neonates, where high percentages of healthy term neonates with GIB were found to have esophagitis (45.6%), gastritis (40.3%), and gastric ulcers (32.3%) (4).…”

“…To the best of our knowledge, our study is the first to report on outcomes of GIB in hospitalized infants up to 12 months of age. The current body of literature reporting on GIB in infants is, instead, limited to the neonatal period and overall suggests that endoscopy provides little value in healthy neonates with GIB (4,(11)(12)(13)(14). In a 2002 study, 75% of term infants with GIB and abnormal endoscopic findings had complete mucosal healing within 28 days (4).…”

Association of H2-Blocker Therapy and Higher Incidence of Necrotizing Enterocolitis: A Case of Excessive Collateral Damage?

“…13 The frequency of prophylactic H2-blocker therapy of up to 72.2% is disturbing given that there is not much high-quality evidence to support it. [14][15][16][17][18] Clinically significant bleeding as well as the mortality related to stressrelated upper-gastrointestinal ulcerations are currently an uncommon phenomenon, possibly because of the improved management of hypoxia and shock, with its accompanying gastric hypoperfusion in critically ill neonates. 5,[19][20][21][22] The fact that gastric acid alone is not the only culprit in the causation of stress ulcers was demonstrated clearly years ago by their occurrence in patients with congenital achlorhydria.…”

Commentary

“…The physical examination of infants with severe acute blood loss may reveal cutaneous or conjunctival pallor, tachycardia, decreased capillary refill, and hypotension. 2 Goyal et al 1 reported 3 cases of UGIB in healthy full-term neonates; 1 of these infants had diffuse hemorrhagic gastritis, 1 patient had 2 duodenal ulcers, and 1 had a single duodenal ulcer. Essential laborator y studies include complete blood count, prothrombin and partial thromboplastin times, and liver function tests.…”

“…Isolated gastric lesions were found in 29 patients. 2 Goyal et al 1 reported 3 cases of UGIB in healthy full-term neonates; 1 of these infants had diffuse hemorrhagic gastritis, 1 patient had 2 duodenal ulcers, and 1 had a single duodenal ulcer. 1 Sick infants, especially if premature, often develop stress ulcerations and acute UGIBs.…”