Differential Diagnosis for 1 Day Old Newborn Spitting Up Blood

Single Most Likely Diagnosis

• Swallowed maternal blood: This is the most common cause of hematemesis in a newborn, occurring when the infant swallows blood during delivery, especially if there were vaginal tears or episiotomies. The blood is usually visible in the first few hours of life.

Other Likely Diagnoses

• Gastroesophageal reflux: Although more commonly associated with non-bloody spit-up, severe cases can lead to bleeding due to esophageal irritation.
• Trauma during delivery: Physical trauma during birth can cause internal injuries leading to bleeding, which might be visible as the newborn spits up blood.
• Infection: Early onset infections, particularly those involving the gastrointestinal tract, can cause inflammation and bleeding.

Do Not Miss Diagnoses

• Esophageal or gastric perforation: A life-threatening condition that requires immediate surgical intervention. It could be due to an congenital anomaly or iatrogenic causes.
• Coagulopathy: Disorders affecting blood clotting, such as hemophilia or vitamin K deficiency bleeding (VKDB), can lead to significant bleeding, including hematemesis.
• Vascular malformations: Abnormalities in blood vessel formation can lead to bleeding, including in the gastrointestinal tract.

Rare Diagnoses

• Congenital gastrointestinal anomalies: Conditions like esophageal atresia, tracheoesophageal fistula, or intestinal duplication can cause bleeding.
• Neonatal gastritis: Inflammation of the stomach lining can cause bleeding, though it's rare in newborns.
• Hirschsprung's disease: A congenital condition affecting the large intestine that can lead to enterocolitis and potentially bleeding, though it's more commonly associated with constipation or intestinal obstruction.