Upper GI bleeding among neonates admitted to Mulago Hospital, Kampala, Uganda: A prospective cohort study

Abstract

Background: The World Health Organization (WHO) reports estimate that 85% of newborn deaths are due to infections, prematurity and fetal distress. These conditions are risk factors for upper GI bleeding (UGIB) in sick neonates. UGIB is associated with poor neonatal outcomes such as prolonged hospitalisation and poor weight gain. The magnitude of UGIB and its contribution to neonatal morbidity has not been described in most low income countries. Objective: To determine the occurrence and factors associated with UGIB among neonates admitted to the Special Care Unit (SCU) of Mulago Hospital. Methods: This was a prospective single cohort study where neonates admitted within 24 hours of birth were consecutively enrolled and followed up for seven days. Gastric aspirates from the neonates were examined daily over a period of 7 days using Guaiac and Apt tests for evidence of UGIB. Data on occurrence of UGIB has been presented as proportions and Odds Ratios for associated factors.

Gastrointestinal Emergencies in Neonates: A Review Article

“…Detailed history and a careful physical examination are crucial when evaluating a neonate with apparent GI bleeding. In cases of significant GI bleeding, diagnostic evaluation with the lab test, radiographs, and appropriate consultation are required to ensure timely diagnosis and treatment with an examination of the anal area for fissures [ 20 ]. Neonates born in the out-of-hospital setting may present with hematemesis as a presenting sign of hemorrhagic disease of the newborn secondary to vitamin K deficiency [ 20 , 21 ].…”

“…In cases of significant GI bleeding, diagnostic evaluation with the lab test, radiographs, and appropriate consultation are required to ensure timely diagnosis and treatment with an examination of the anal area for fissures [ 20 ]. Neonates born in the out-of-hospital setting may present with hematemesis as a presenting sign of hemorrhagic disease of the newborn secondary to vitamin K deficiency [ 20 , 21 ]. Unwell neonates may also present with disseminated intravascular coagulation (DIC) or liver failure.…”

“…The neonate may require endoscopy and both gastroenterology and pediatric surgeon consultation at the institution where the child is to be admitted. Maintaining homeostasis, identifying underlying causes, and treating the causes are the main aim of treatment in such a case [ 20 , 21 ].…”

Editorial: Non-communicable diseases are reaching epidemic proportions: evidence from low and middle income countries

“…Others are on environmental exposure to carcinogens in Cameroon, 29 and chronic inflammatory cells and damaged limbal basal epithelial cells in pterygium. 30 The section on surgery and the GIT includes several interesting papers on factors affecting mortality of critical care trauma patients 31 ; sarcoma of small bowel mesentery simulating hyper immune splenomegaly syndrome 32 ; and upper GI bleeding among neonates 33 . There are more papers on use of a drain after thyroid surgery 34 ; effect of bupivacaine on pulmonary function after elective lower abdominal operations 35 ; camel related panceatico-duodenal injuries 36 ; and postoperative pain in the first 48 hours.…”