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stooling history, level of alertness, associated pain or tenderness, or any systemic
signs such as fever or apnea. Given the variable transit time of the intestine in
newborns, the distinction between hematochezia and melena is not as helpful in
distinguishing between upper and lower gastrointestinal bleeding and so both
should be evaluated similarly. Laboratory evaluation should include complete
blood count to assess for signs of anemia or chronic blood loss, elevated white
blood count, and/or eosinophilia. If infectious colitis is suspected, blood and stool
cultures should be sent prior to the initiation of intravenous antibiotics.
Abdominal radiograph may be warranted if there is suspicion of obstruction,
malrotation, or NEC.
Allergic Enteropathy
Allergic enteropathy can occur in newborns from an exposure to the offending
protein via formula or breast milk. Most common after 2 months of age, it can
present in the immediate neonatal period, most often with painless hematochezia
with or without associated diarrhea. The most common allergy is to cow-milk
protein, which can also affect breast-fed infants whose mothers ingest cow milk.
Up to 40% of infants with cow-milk protein will also have a soy protein allergy,
so that formula-fed infants should be given extensively hydrolyzed formulas.
Breast-fed infants should have mothers avoid both cow milk and soy products in
their diet. The prognosis for allergic enteropathy is overall good, with quick
resolution of symptoms once the offending protein has been removed from the
diet.
Acholic Stool
Acholic or gray-colored stool represents an obstruction to bilirubin excretion and
is always a pathologic finding. It is more often associated with an obstruction to
the biliary tract, as in biliary atresia, but can also be seen in hepatocellular
disease, such as hepatitis. It is accompanied by cholestasis and conjugated
hyperbilirubinemia. Congenital disorders of the hepatobiliary system may not
develop acholic stools until 2 weeks of life or later, so a history of normal
meconium or stool does not exclude hepatobiliary anomalies. Jaundice is covered
in detail in the previous Section: Color Changes.

Abdominal Masses
Goals of Treatment
Most abdominal mass lesions in the newborn are benign lesions or lesions that
can be monitored by the pediatrician in an outpatient setting. The goal of