Abstract Ref Number = APCP1030
SEPSIS-INDUCED EARLY GASTROINTESTINAL BLEEDING PRESENTED AS HEMATEMESIS MELENA IN NEWBORN
Pebriansyah Pebriansyah,Vini Jamarin,Risma Kerina Kaban
Bunda Women and Children Hospital Jakarta, Indonesia Bunda Women and Children Hospital Jakarta
Background : Early gastrointestinal bleeding in a newborn is a serious and life-threatening condition that has a broad differential diagnosis. It is relatively uncommon which more often occurs due to prolonged labor, cesarean delivery, asphyxia, respiratory distress, maternal blood ingestion, maternal drug use, cow’s milk protein allergy, platelet dysfunction, coagulation disorder, and sepsis. Early diagnosis and treatment are essential to prevent mortality.
Case Presentation Summary : A 1 day-old baby girl was admitted with a chief complaint of massive hematemesis and melena. The baby was born at term, clinically stable at birth, by vaginal delivery without any complication with 2350 gr birth weight. Vit K injection and Hepatitis B vaccination were administered intramuscularly after birth. She was breastfed after 6 hours. Mother had oral antibiotic during pregnancy due to urinary tract infection and upper respiratory tract infection. No family history of food allergy and intolerance. On physical examination, she was pale, tachycardic with poor peripheral perfusion. She was resuscitated with normal saline, leukodepleted packed red cells and fresh frozen plasma due to extremely decreased hemoglobin value from 19,1 to 7,8 g/dL and prolonged prothrombin time. Intravenous proton pump inhibitor (PPI) and 3rd line antibiotic were started as her procalcitonin was 29,40 ng/mL even though blood cultured showed no bacterial or yeast growth. APT Test was negative. The day after, she was clinically jaundiced with elevated total bilirubin. Abdominal ultrasound showed a sludge in gallbladder. No hemostatic intervention and endoscopic was required as she remained stable with no further bleeding. The patient was discharged 10 days after medication.
Learning Points/Discussion : Sepsis should always be suspected in a newborn with early massive gastrointestinal bleeding. Resuscitation with blood transfusion and PPI have high efficacy to control the bleeding. Identification and treatment of underlying cause are essential to prevent mortality.
Keywords: Gastrointestinal bleeding Hematemesis Melena Neonatal sepsis