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The differential diagnosis of bloody stools in a 33-35 week infant is among the most difficult ones we have in neonatology. There are at least 3-4 major possibilities and not uncommonly, interns are at the front line of trying to figure this out. So, lets try a case - remember, more senior members to let the med students and interns have a crack at this.
So, you are a general pediatrician covering a community hospital when you are called at 0200 about a 4 day old infant that you are cross-covering for. You otherwise don't know anything about the patient. The nursery that is calling you is a "lower" level 2 nursery - will take care of babies at 32 weeks or above, can do short term IVs and n/g tubes, no cpap and no vents.
The call nurse says "Baby Bear is a 4 day old, now 1900 gram former 33 weeker who is getting n/g feeds of 40 cc q 3 hours and just had a big bloody stool. His vital signs are HR 170, RR - 40, T- 98.8 and BP 90/60."
you ask about abdominal distension and color and get fairly vague "slightly distended, color looks okay, we're putting a pulse ox on now" response.
What do you ask now and what do you recommend they do during the 30 minutes it will take you to get dressed and come see the baby? Note that this is a very small hospital and the only 24/7 doc is an EM moonlighting resident and X-rays, labs don't exactly happen at 2 AM too fast.
So, you are a general pediatrician covering a community hospital when you are called at 0200 about a 4 day old infant that you are cross-covering for. You otherwise don't know anything about the patient. The nursery that is calling you is a "lower" level 2 nursery - will take care of babies at 32 weeks or above, can do short term IVs and n/g tubes, no cpap and no vents.
The call nurse says "Baby Bear is a 4 day old, now 1900 gram former 33 weeker who is getting n/g feeds of 40 cc q 3 hours and just had a big bloody stool. His vital signs are HR 170, RR - 40, T- 98.8 and BP 90/60."
you ask about abdominal distension and color and get fairly vague "slightly distended, color looks okay, we're putting a pulse ox on now" response.
What do you ask now and what do you recommend they do during the 30 minutes it will take you to get dressed and come see the baby? Note that this is a very small hospital and the only 24/7 doc is an EM moonlighting resident and X-rays, labs don't exactly happen at 2 AM too fast.