Differential Diagnosis for Baby Spit Up with Frank Red Blood Clots
Single Most Likely Diagnosis
- Hemorrhagic disease of the newborn (HDN) due to vitamin K deficiency: This condition is a common cause of bleeding in newborns, especially in those who are exclusively breastfed and did not receive vitamin K prophylaxis at birth. The presentation of frank red blood in spit-up is consistent with this diagnosis.
Other Likely Diagnoses
- Swallowed maternal blood: If the mother has cracked nipples or is bleeding from the nipple, the baby may swallow blood, which can then be vomited. This is a common and usually benign condition.
- Gastroesophageal reflux with bleeding: Although less common, gastroesophageal reflux can cause irritation and bleeding in the esophagus, leading to blood in the spit-up.
Do Not Miss Diagnoses
- Esophageal tear or perforation: Although rare, an esophageal tear or perforation can be life-threatening and requires immediate medical attention. Symptoms can include severe pain, difficulty feeding, and bleeding.
- Gastrointestinal obstruction: Conditions like pyloric stenosis or intestinal obstruction can cause vomiting, which may occasionally be bloody. These conditions require prompt diagnosis and treatment to prevent serious complications.
- Infection or sepsis: In rare cases, an infection can cause bleeding in the gastrointestinal tract. This is more likely in premature or immunocompromised infants.
Rare Diagnoses
- Congenital gastrointestinal anomalies: Conditions like esophageal atresia, tracheoesophageal fistula, or other congenital anomalies can cause bleeding or vomiting. These are usually diagnosed prenatally or shortly after birth.
- Coagulopathy: Inherited or acquired coagulopathies can cause bleeding in newborns. These conditions are rare but important to consider, especially if there is a family history.
- Neonatal gastritis or ulcer disease: These conditions can cause gastrointestinal bleeding but are extremely rare in newborns.