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Isolated rectal bleeding in neonates: a scoping review
Alexandra Markevich1, Júlia G Botelho2, Luana L Morikawa2
1Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas (FCM), Department of Pediatrics, Campinas, SP, Brazil.
Jornal De Pediatria
|July 27, 2026
Summary
Isolated rectal bleeding in newborns is usually benign. Cow's milk protein allergy is the second most common cause, but often lacks diagnostic confirmation.
Area of Science:
- Neonatal Medicine
- Gastroenterology
- Pediatric Research
Background:
- Rectal bleeding in neonates presents a diagnostic challenge.
- Identifying etiological factors is crucial for appropriate management.
- Asymptomatic presentation complicates diagnosis.
Purpose of the Study:
- To review the causes of isolated rectal bleeding in asymptomatic neonates.
- To synthesize current evidence on etiological factors.
- To inform clinical practice and future research.
Main Methods:
- Scoping review following PRISMA-adapted guidelines.
- Comprehensive database search (PubMed, Scopus, Embase, etc.).
- Inclusion of studies on neonates up to 28 days with rectal bleeding, no symptoms.
Main Results:
- 56 studies included 1,154 neonates.
- Most frequent diagnosis: isolated rectal bleeding (IRB), benign and self-resolving.
- Second most frequent: cow's milk protein allergy (CMPA), often without oral food challenge confirmation.
Conclusions:
- IRB is the primary diagnosis in asymptomatic neonates with rectal bleeding.
- CMPA diagnosis requires further validation, typically via oral food challenge.
- Current management of neonatal rectal bleeding lacks standardized protocols.