Rectal bleeding in early infancy: a warning sign of necrotizing enterocolitis that should not be overlooked in high-risk infants
In brief
Necrotizing enterocolitis causes about one-third of rectal bleeding episodes in infants under three months
In a review of 91 infants with early-onset rectal bleeding, 35% were ultimately diagnosed with necrotizing enterocolitis, making it the most common etiology. Surgery was needed in a quarter of those NEC cases, especially among infants with congenital heart disease or prematurity, underscoring the need for prompt evaluation in high-risk babies.
- Journal
- Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver (Q1)
- Published
- 5 September 2026
- Study design
- Cohort / observational study
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Domenico Umberto De Rose, Flaminia Pugnaloni, Sara Ronci, Ludovica Martini, Ivana Martinelli, Fabio Fusaro, et al.
- PMID
- 42701088
- DOI
- 10.1016/j.dld.2026.08.008
Why clinicians should know about it
- Picked for Pediatric Surgery (paper of the day, 8 September 2026): Rectal bleeding early sign of NEC in high‑risk infants
Abstract
BACKGROUND: Rectal bleeding in infants younger than 3 months may arise from benign conditions but can also represent an early sign of necrotizing enterocolitis (NEC). AIMS: We aimed to describe etiology, management, and outcomes of rectal bleeding in early infancy. METHODS: We retrospectively analysed data from patients presenting with rectal bleeding between 2015 and 2024, collecting demographics, comorbidities, diagnostic work-up, treatments, recurrence, and outcomes. RESULTS: Ninety-one infants were included, with a median age at onset of 20 days; 34 (37.4%) were preterm and 43 (47.3%) had congenital heart disease (CHD). NEC was the most frequent diagnosis (35.1%), followed by isolated rectal bleeding (IRB, 22.0%) and infectious gastroenteritis (16.5%). Among infants diagnosed with NEC, 25.0% required surgery; it occurred predominantly in those with CHD (25/32, 78.1%) and preterm infants (7/32, 21.9%). Stool pathogens were detected in 25.3% of cases. Bleeding recurrence occurred in 16.5% of infants. In-hospital mortality was 2.2%. CONCLUSIONS: NEC is the leading cause of rectal bleeding in early infancy, followed by IRB. Although IRB is often benign, rectal bleeding should always prompt careful evaluation, particularly in high-risk infants such as those with CHD and those born preterm, in whom rectal bleeding may represent an early manifestation of NEC. Early recognition and close monitoring are essential to optimize outcomes.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.