Neonatal haematemesis

Clinical assessment and risk stratification

    • Hematemesis in a healthy new-born is most often caused by swallowed maternal blood during delivery31-32.
    • After the first 24 hours cracked nipples during breastfeeding is the most common cause31-32.
    • Obviously this should not occur in bottle-fed infants after the first 24 hours.
    • Differential diagnoses in “well” neonates include coagulopathy (especially if the infant did not receive a full dose of vitamin K) and congenital vascular lesions. In “sick” neonates consider DIC and liver failure.
      Digested blood

Image caption: Digested blood

  • What is a full dose of vitamin K?
    • A single intramuscular dose into the thigh given shortly after birth
    • OR three oral doses given within the first month of life
    • If any are omitted the infant is at risk of haemolytic disease of the newborn (HDN)


  • If an obvious source of maternal blood is found reassurance is all that is required.
  • Parents should be advised to return if the child is unwell or they are concerned.
  • If there are any doubt the patient should be referred for a paediatric opinion.