Gastrointestinal Bleeding in the Newborn
@ GI bleeding in children is most commonly due to lesions located in the colorectal region.
@ There are two major causes of hematemesis in the first week of life. The first is "hemorrhagic disease of the newborn" due to vitamin K deficiency, and the other is "swallowed maternal blood" during childbirth.
Necrotizing Enterocolitis
It is seen at the frequency of 1-3/1000 live births.
@ It is more common in premature and low birth weight babies.
@ It usually occurs after the postnatal 10th day and especially after the start of enteral feeding.
@ The earlier the disease occurs, the greater the complication and mortality.
@ The disease is characterized by circulatory disorder, necrosis and bacterial invasion in the intestinal wall.
@ Babies who have had an exchange transfusion due to hyalen membrane disease, hyperbilirubinemia, and who have a catheter in their umbilical artery or vein are also at risk.
@ It is frequently observed in the ileum (86%) and colon (74%).
@ Full thickness necrosis of the intestinal wall (pan-necrosis) in 18-38% of cases.
@ Perforations are usually from the antimesenteric side and terminal ileum.
@ There is coagulation necrosis of the intestine. There is acute/chronic inflammation, bacterial proliferation and pneumatosis intestinalis.
@ While healing, it heals with fibrosis and causes strictures.
Clinic
• Difficult to differentiate from sepsis; There are lethargy, irregularity in body temperature, apnea, bradycardia and hypoglycemia.
• There is abdominal distention, bilious vomiting, rectal bleeding.
• Septic shock develops if early action is not taken.
• Midgut volvulus, sepsis and megacolon are important in the differential diagnosis.
• There is often neutropenia, thrombocytopenia, hyponatremia and metabolic acidosis.
• ADBG has enlarged intestinal loops, air bubbles under the intestinal serosa (pneumatosis intestinalis) or in the clogged vein tract.
• If perforation occurs, free air can be seen under the diaphragm.
Treatment
• An energetic treatment should be started immediately.
• Complications are prevented with timely medical treatment.
• If there is intestinal perforation and gangrene, surgical treatment is performed. The most ideal is to perform surgery after gangrene has formed but without perforation.