| Objective:Lower Gastrointestinal Bleeding(LGIB)in neonates is common.And it is often for gastrointestinal emergencies,serious and even can be life threatening,drawing great attention of medical staff.The aim of this article is to understand the clinical characteristics and related factors of LGIB in neonates in our hospital,and to provide some references for its timely diagnosis and intervention.Methods:From January 2016 to January 2018,the clinical data of 274 neonates with lower gastrointestinal bleeding who were admitted to our our neonatal intensive care unit(NICU)were analyzed retrospectively.Clinical data of all eligible children included gestational age,sex,birth weight,age,delivery and feeding methods,maternal history of pregnancy,characteristics of the disease were collected.The use of antibiotics and auxiliary examination and other factors were recorded and analyzed.The aim is to analyze the etiology,clinical characteristics and related factors.Results:1.This study met inclusion and exclusion criteria of neonatal lower gastrointestinal bleeding,a total of 274 cases,accounting for the same period the total incidence of hospitalized neonates was 2.87‰.There are 160 males and 114 females,and a ratio of male to female is 1.4:1.The onset during the entire newborn period is from 1d to 28 d with a median of 10 d.The average gestational age is(35.71±5.74)weeks,and the average birth weight is(2640±870)g.Causes of lower gastrointestinal bleeding in neonates include,delivery methods,feeding methods,and so on.The pregnancy-related factors contain 18 cases(6.6%)of placental abruption,2 cases(0.7%)of coagulation abnormalities,1 case(0.3%)of thrombocytopenia,71 cases(25.9%)of premature rupture of membranes,30 cases(10.9%)of gestational hypertension,and 17 cases(6.2%)of gestational diabetes.In terms of delivery methods,there are 158 cases(57.7%)of cesarean section and 116 cases(42.3%)of natural delivery.There are four ways about feeding patterns:feeding formula feeding 142 cases(51.8%),exclusive breastfeeding 55 cases(20.0%),mixed feeding 55 cases(20.0%),completely parenteral nutrition(i.e.before under the neonatal gastrointestinal bleeding of fasting state)22 cases(8.2%).The number of using antibiotics prior incidence lower gastrointestinal bleeding is 42 cases(15.3%).About a total of 23 cases(8.4%)used antibiotics,whose using time is 7 days or more.2.In this study,the causes of neonatal LGIB are as follows: 145 cases(53.0%)of allergic enterocolitis,83 cases(30.3%)of necrotizing enterocolitis,9 cases(3.3%)of neonatal asphyxia,8 cases(2.9%)of neonatal respiratory distress syndrome,8 cases(2.9%)of neonatal anemia,6 cases(2.2%)of sepsis,4 cases(1.4%)of infective enteritis,3 cases(1.1%)of Meckel's diverticulum,2 cases(0.7%)of vitamin K deficiency,and others(including anal fissure,mucosal injury caused by artificial ventilation and bleeding after intestinal surgery).3.The proportion of allergic enteritis occurs mostly in full-term neonates,but NEC occurs in preterm infants.There is significant difference in the distribution of gestational age between NEC and allergic enterocolitis(P<0.001).In NEC,the rates of neonates with systemic poisoning symptoms and intestinal peristalsis weakened or disappeared are 80.7% and 92.8%,respectively.However,the proportions in allergic enterocolitis are 0.7% and 2.8%,which is significantly lower than that of NEC.Allergic enterocolitis is more likely to have allergies history than NEC(P<0.05).There are no significant differencesfor neonates with these two diseases in sex,feeding patterns,delivery patterns and time of onset(P>0.05).4.NEC and allergic enterocolitis appear differently on the abdominal plain film.These two diseases in abdominal plain film gate of liver of pneumatosis pneumatosis,intestines and bowel rigidity on the difference was statistically significant(P<0.05).Allergic enterocolitis with NEC in abdominal plain film has significant difference for liver door pneumatosis,intestinal wall gas,and insufflate rigidity differences(P<0.05).There was no statistically significant difference on the bowel wall thickening and intestinal gas accumulation between NEC and allergic enterocolitis(P> 0.05).5.Allergic enterocolitis and NEC show different manifestations on abdominal ultrasound.There are 51 cases(61.4%)of intestinal peristalsis weakened or disappeared,41 cases(49.4%)of ascites,and 40 cases(48.2%)of thickening of the intestinal wall,36 cases(43.4%)of intestinal wall gas,29 cases(34.9%)of hepatic portal gas,13 cases(15.7%)of intestinal gas expansionand,7 cases(8.4%)insufflate rigidity in in NEC.Allergic enterocolitis shows 10 cases(6.9%)of intestinal peristalsis weakened or disappeared,12 cases(8.3%)of ascites,18 cases(12.4%)of intestinal wall thickening,6 cases(4.1%)of intestinal gas accumulation,6 cases(4.1%)of hepatic portal gas,22 cases(15.2%)of intestinal gas accumulation,0 cases insufflate rigidity.Allergic enterocolitis with NEC in abdominal ultrasound has significant difference for liver door pneumatosis,intestinal wall gas,insufflate rigidity and bowel wall thickening,intestinal peristalsis weaken or disappear,and peritoneal effusion obvious differences(P<0.05).There is no significant difference about bowel gas in abdominal ultrasound in neonates with allergic enterocolitis and NEC(P>0.05).Conclusion:1.Neonatal lower gastrointestinal bleeding is more common,accounting for the same period the total incidence of hospitalized neonates was 2.87‰.2.In 274 cases of neonatal lower gastrointestinal bleeding,the causes of LGIB in neonates include allergic enterocolitis,NEC,newborn asphyxia.3.There are some similarities and differences between allergic enterocolitis and NEC.Who have Allergic enterocolitis which are mostly occurred in full-term neonates generally own allergies history.The symptoms of systemic poisoning and abdominal symptoms in Allergic enterocolitis are relatively mild.NEC mostly occurs in preterm neonates,and the symptoms of systemic poisoning and abdominal symptoms are more serious.4.Abdominal ultrasonography is more sensitive to the differential diagnosis of allergic enterocolitis and NEC,especially better than abdominal X-ray examination in the observation of intestinal peristalsis and inflammatory exudation. |
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