Bloody Stool in the Newborn: Harmless Symptom or Indicator of Severe Disease?

ALTINÖZ A. M., BARSAN KAYA T., SÜRMELİ ONAY Ö., AYDEMİR Ö., TEKİN A. N.

6th Congress of Joint European Neonatal Societies, Belgrade, Sırbistan, 21 - 25 Ekim 2025, sa.288, ss.3, (Tam Metin Bildiri)

  • Yayın Türü: Bildiri / Tam Metin Bildiri
  • Basıldığı Şehir: Belgrade
  • Basıldığı Ülke: Sırbistan
  • Sayfa Sayıları: ss.3
  • Eskişehir Osmangazi Üniversitesi Adresli: Evet

Özet

Bloody Stool in the Newborn: Harmless Symptom or Indicator of Severe Disease?

Meriç Altınöz, Tuğba Barsan Kaya, Özge Sürmeli Onay, Özge Aydemir, Ayşe Neslihan Tekin

Eskisehir Osmangazi University Faculty of Medicine Department of Pediatrics, Subdivision of Neonatology, Eskisehir

Background:
Bloody stool in newborns may indicate serious conditions such as necrotizing enterocolitis (NEC), infection, or volvulus, but can also occur in stable infants without systemic illness. While often attributed to food protein allergy (FPA), minor fresh rectal bleeding may reflect a benign, self-limiting condition known as idiopathic transient colitis (ITC). Diagnostic uncertainty may lead to unnecessary antibiotic use and feeding interruptions. This study presents a five-year single-center experience aiming to identify clinical factors that may aid differential diagnosis.

Methods:
This retrospective study included 89 newborns hospitalized with bloody stools between 2019 and 2024. Infants were classified by final diagnosis into three groups: the Sepsis–NEC group (bloody stool with systemic infection signs or radiologic NEC); the non-IgE FPA group (findings suggestive of non-IgE-mediated food protein allergy); and the ITC group (stable infants with benign course and no identifiable cause beyond bloody stool). Demographic, clinical, laboratory, and radiologic data were analysed.

Results:
Initial and final diagnoses were consistent in 96% of infants in the Sepsis–NEC group (n=25), but only in 61.1% and 64.4% of those in the non-IgE FPA (n=18) and ITC groups (n=46), respectively. Infants with discrepant diagnoses had lower gestational age and birth weight, and higher white blood cell counts. The Sepsis–NEC group had the lowest birth weight (2065.4 ± 733.1 g), lowest 5-minute Apgar (median 8, p=0.028), and highest intrauterine growth restriction rate (48%). Absolute eosinophil count and percentage were significantly higher in the non-IgE FPA group (Table 1). Although not statistically significant, urinary tract infections were more common in this group. Antibiotics were given to all infants in the Sepsis–NEC group, and to 44.4% and 43.5% in the non-IgE FPA and ITC groups, respectively.

Conclusion:
While the Sepsis–NEC group showed the most severe clinical picture and highest diagnostic accuracy, diagnostic discordance was more frequent in the non-IgE FPA and ITC groups, particularly among more premature infants. Elevated eosinophil count may offer diagnostic clue in the non-IgE FPA group. The high UTI rate in this group may be related to dysbiosis, as supported by recent studies. Improved diagnostic strategies are needed to prevent unnecessary treatment.