II. GI HEMORRHAGE
GI hemorrhage is relatively rare in the NICU population. An essential part of the
initial work-up is to send the blood from the GI tract for an Apt test to determine the
presence/absence of maternal blood.
When consulted, differentiate between upper and lower GI hemorrhage. Blood
per rectum can definitely be from upper GI source. Upper GI causes include gastritis,
swallowed maternal blood, iatrogenic cause (OG tube, suctioning trauma). Lower GI
bleed etiologies include NEC, anorectal fissures.
Management recommendations include: OG tube, CBC, abdominal Xrays, PPI.
Mostly supportive therapy, APT test.
III. ABDOMINAL MASSES
(^) Nearly 50% of neonatal abdominal masses are of renal origin. Other masses in
the newborn include neuroblastoma, hepatoblastoma, proximal intestinal atresia, in
utero intestinal perforation. In addition to physical exam, check BP, UA, BUN,
creatinine, ultrasound. Then proceed as dictated by these tests to CT, MRI and/or
appropriate consultation.