RT Book, Section
A1 Gomella, Tricia Lacy
A1 Eyal, Fabien G.
A1 Bany-Mohammed, Fayez
SR Print(0)
ID 1168356769
T1 Gastrointestinal Bleeding from the Upper Tract
T2 Gomella's Neonatology: Management, Procedures, On-Call Problems, Diseases, and Drugs, 8e
YR 2020
FD 2020
PB McGraw-Hill Education
PP New York, NY
SN 9781259644818
LK accesspediatrics.mhmedical.com/content.aspx?aid=1168356769
RD 2024/04/24
AB Vomiting  of  bright  red  blood  or  active  bleeding  from  the  nasogastric  (NG)  tube  is  seen  in  a  newborn.  Upper  gastrointestinal  (GI)  bleeding  is  bleeding  that  occurs  proximal  to  the  ligament  of  Treitz  (duodenojejunal  flexure)  which  arises  from  the  esophagus,  stomach,  or  duodenum.  It  usually  presents  with  hematemesis  (vomiting  of  blood)  most  commonly  bright  red  or  less  commonly  the  color  of  coffee  grounds,  or  it  can  present  with  melena  (black  tarry  stools).  Rarely,  a  brisk  upper  GI  (UGI)  bleed  has  such  a  short  intestinal  transit  time  that  it  presents  with  hematochezia  (fresh  blood  through  the  anus).  Coffee  ground  emesis  means  the  blood  has  been  altered  by  gastric  contents,  which  indicates  slow  bleeding  from  the  esophagus  and  duodenum.  Diagnosis  is  made  most  commonly  by  blood-stained  aspirates  in  the  NG  or  orogastric  (OG)  tube,  by  hematemesis,  or  by  endoscopy  (gastric  mucosa  shows  bleeding).  UGI  bleeding  is  more  common  in  sick  newborns  in  the  NICU,  than  in  term  neonates.  The  majority  of  UGI  bleeds  in  neonates  are  benign,  self-limiting,  and  require  minimal  workup  and  treatment,  but  some  can  be  severe,  especially  those  associated  with  other  underlying  conditions.