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Evaluation of Hematochezia in a Two-Day-Old Infant
1Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota.
Insights
Infants presenting with hematochezia (bloody stools) require prompt evaluation. This case highlights milk protein enterocolitis as a treatable cause, differentiating it from serious conditions like necrotizing enterocolitis.
Area of Science:
- Pediatric Gastroenterology
- Emergency Medicine
- Neonatal Care
Background:
- Hematochezia in infants presents a broad differential diagnosis, necessitating careful evaluation in the emergency department (ED).
- Distinguishing between benign and life-threatening causes of bloody stools is crucial for appropriate management.
- Risk factor identification aids in risk stratification for pediatric patients with hematochezia.
Observation:
- A 2-day-old infant presented with 8-10 episodes of bright red blood in stools.
- The infant had a sibling with Escherichia coli O157:H7 infection and a family history of lactose intolerance.
- Initial abdominal X-ray was normal, and the infant was exclusively formula-fed.
Findings:
- Milk protein enterocolitis was suspected based on clinical presentation and history.
- Transitioning to hydrolyzed formula led to the resolution of bloody stools.
- This diagnosis was confirmed by symptom resolution after dietary modification.
Implications:
- Emergency physicians must consider milk protein enterocolitis in the differential diagnosis of infant hematochezia.
- Prompt recognition and dietary management can prevent unnecessary investigations and consultations.
- Awareness of benign causes like milk protein enterocolitis is vital to avoid over-treatment of serious conditions.
Background:
Hematochezia in the pediatric population, particularly infants, has a wide differential diagnosis ranging from benign to life-threatening causes. Obtaining a thorough history and identifying risk factors for more ominous disease is vital during the emergency department (ED) evaluation.
Case Report:
The patient is a 2-day-old female who presented to the ED with 8-10 episodes of bright red blood in her stools. She was otherwise asymptomatic, with an uncomplicated pregnancy and delivery. Her history was significant for a sibling who recently tested positive for Escherichia coli O157:H7 in his stool and a family history of lactose intolerance. She was exclusively formula fed. An abdominal plain film was obtained and was normal. Milk protein enterocolitis was suspected and she was transitioned to hydrolyzed formula with resolution of her symptoms. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: As emergency physicians, we need to be aware of the life-threatening conditions that are associated with hematochezia, such as necrotizing enterocolitis, and act quickly. However, many patients will have benign conditions, and recognizing the key historical and diagnostic pieces of the infant's presentation will prevent unnecessary evaluations and consultations.
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