Clinical Analysis Of Neonatal Positive Fecal Occult Blood Test And Its Correlation With Food Allergy

Objective:The aim of this study is to analyze the etiology and other clinical features of neonates with fecal occult blood,to provide the basis for etiological diagnosis of neonatal hematochezia,and to explore the relationship between neonatal hematochezia and food allergy(FA)in infants.Methods:Clinical data of newborns hospitalized in the Department of Neonatology,the second hospital of Jilin University from December 2018 to March 2019 were collected,including abnormal pregnancy,the history of allergic diseases of parents,mode of conception,gender,mode of delivery,times of pregnancy,times of labor,gestational age,birth weight,age and weight when fecal occult blood test was positive,neonatal complications,transfusion of blood products and intravenous infusion of antibiotics before hematochezia,the using of auxiliary ventilation before hematochezia,causes of hematochezia,clinical manifestations,auxiliary examination(including blood routine,stool routine,C-reactive protein and procalcitonin)and occurrence of food allergy after discharge.The differences of clinical characteristics among different causes of hematochezia were compared.At the same time,the differences of clinical characteristics between infants with food allergy or not in nearly 2 years after discharge were compared.SPSS 26.0 was used for statistical analysis.Results:1.A total of 138 cases of neonates with fecal occult blood were eligible,including 51 cases(36.96%)considered to be caused by enema,16 cases(11.59%)of feeding intolerance(FI),14 cases(10.14%)of FA and 11 cases(7.97%)of suspected necrotizing enterocolitis(NEC stageⅠ).There were 4 cases(2.90%)of clinically confirmed necrotizing enterocolitis(NEC stageⅡ/Ⅲ),3 cases(2.17%)of intestinal infection,4 cases(2.90%)of gastric bleeding,2 cases(1.45%)of congenital intestinal malrotation with upper gastrointestinal obstruction,1 case(0.72%)of intestinal obstruction after necrotizing enterocolitis,3 cases(2.17%)of coagulation dysfunction and 2 cases(1.45%)of swallowed blood syndrome.2.Comparison of clinical characteristics of FA group,FI group and NEC stage I group:gestational age,birth weight and weight when fecal occult blood test was positive in FA group were higher than those in FI group(P<0.05);the incidence of neonatal respiratory distress syndrome in FI group was higher than that in FA group(P<0.05);the incidence of neonatal infection and anemia in the FA group was lower than that in the other two groups(P<0.05);the incidence of gastric residue in the FI group was higher than that in the FA group(P<0.05);the incidence of gross blood stool in the FA group was higher than that in the FI group(P<0.05);fever and abdominal distension in the NEC stage I group were more than those in the FA group(P<0.05);poor vitality and weakened bowel sounds in the NEC stage I group were higher than those in the other two groups(P<0.05);C-reactive protein in the NEC stage I group was higher than those in the FA group(P<0.05);eosinophil count of FA group was higher than that of the other two groups on day 0-10(P<0.05);the lymphocyte percentage and count of FA group were significantly higher than that of NEC stage I group on day 11(P <0.05).3.Comparison of clinical data of infants with or without FA in recent 2 years after discharge:compared with those without FA,the FA group had lower incidence of premature delivery and higher incidence of neonatal hyperbilirubinemia(P<0.05).There was no significant difference between the two groups in terms of the history of allergic diseases of parents,abnormal pregnancy of mothers,mode of pregnancy and causes of neonatal hematochezia.Conclusions:1.The etiology of neonatal hematochezia is very complex.2.The clinical characteristics of FA,FI and NEC stage I group are consistent with the pathogenesis.3.Some children with hematochezia without FA in the neonatal period will show allergy to certain kind of food after discharge.Meanwhile,FA may not occur after discharge in infants with FA in the neonatal period.4.The occurrence of FA in infants under 2 years old may be related to neonatal hyperbilirubinemia.Premature birth may be a protective factor.