Clinical assessment and risk stratification
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- Hematemesis in a healthy new-born is most often caused by swallowed maternal blood during delivery31-32.
- After the first 24 hours cracked nipples during breastfeeding is the most common cause31-32.
- Obviously this should not occur in bottle-fed infants after the first 24 hours.
- Differential diagnoses in well neonates include coagulopathy (especially if the infant did not receive a full dose of vitamin K) and congenital vascular lesions. In sick neonates consider DIC and liver failure.
Image caption: Digested blood
- What is a full dose of vitamin K?
- A single intramuscular dose into the thigh given shortly after birth
- OR three oral doses given within the first month of life
- If any are omitted the infant is at risk of haemolytic disease of the newborn (HDN)
Management
- If an obvious source of maternal blood is found reassurance is all that is required.
- Parents should be advised to return if the child is unwell or they are concerned.
- If there are any doubt the patient should be referred for a paediatric opinion.