Abstract
51 neonates with rectal bleeding (RB) of unknown etiology were investigated with proctosigmoidoscopy; 44 had rectal biopsy (Bx). The mean birth wt was 3.0kg (1.1-5.0); age at Bx 17.3 (4-28) days. All were fed cow's milk protein formula. Endoscopic abnormalities (END) were graded retrospectively (41) or prospectively (10) and compared to Bx findings, including graded inflammation score (inflam) and criteria of allergic proctitis (eos infiltration and intraepithelial eos [EoIn], 46/51 had END evidence of colitis, ranging from erythema and edema (mild, 24) friability and ulceration (moderate, 16), to spontaneous bleeding and exudation (severe, 6). 41/44 Bx had mild to severe colitis and 24/44 met histologic criteria of allergic proctitis. END appearance did not predict the severity of inflam or EoIn on Bx. There was no difference in birth wt, duration of feeds or age of RB in patients with and without moderate to severe inflam. The blood eos count was higher in patients with mod-severe inflam (597 vs 328, p<0.05). EoIn was associated with mod-severe inflam (p<.001). 10 patients had NEC. Blood eos count, END, and EoIn were not different with and without NEC. RB ceased in all 51 when enteral feeds were stopped; protein hydrolysate or soy formula was given subsequently without RB in 44/44.
Conclusions. 1) newborn infants with RB have END and Bx evidence of colitis; 2) END and Bx did not differentiate patients with and without NEC: 3) histologic features diagnostic of allergic colitis are present in half of newborns with RB, suggesting milk protein intolerance is an important cause of neonatal RB.
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Taxman, T., Dahtns, B., Rothstein, F. et al. PROCTOSIGMOIDOSCOPY IN THE EVALUATION OF RECTAL BLEEDING IN NEWBORN INFANTS. Pediatr Res 21 (Suppl 4), 279 (1987). https://doi.org/10.1203/00006450-198704010-00669
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DOI: https://doi.org/10.1203/00006450-198704010-00669