Case 1: Oral Mucosal Bleeding in a 2-day-old Boy

Courtney Brennan; Brian Santacrose; Karine Barseghyan; Theodora Stavroudis

doi:10.1542/pir.2015-0120

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Courtney Brennan, MD*
Brian Santacrose, MD*
Karine Barseghyan, MD*
Theodora Stavroudis, MD*

^*Children’s Hospital Los Angeles, Los Angeles, CA.

AUTHOR DISCLOSURE
Drs Brennan, Santacrose, Barseghyan, and Stavroudis have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Presentation

A 2-day-old boy who was delivered at term via uncomplicated elective cesarean section presents with a 1-day history of oral mucosal bleeding. Upon completion of breastfeeding, the infant’s mother noticed that he had bleeding from the lower gingiva, which continued for 3 hours.

The infant has no fever, cough, rhinorrhea, vomiting, diarrhea, jaundice, petechiae, or ecchymoses. He had passed meconium 1 day after birth and is voiding normally. Prenatal screening laboratory results were negative, with the exception of a positive maternal hepatitis B surface antigen. The patient received hepatitis B immunoglobulin in addition to the hepatitis B vaccine. The maternal history was otherwise negative, and the mother did not take any medications during her pregnancy other than prenatal vitamins. There were no complications with the delivery, and Apgar scores were 9 and 9 at 1 and 5 minutes, respectively. Birthweight was 2,803 g. There is no family history of bleeding disorder.

Physical examination reveals a term infant in no acute distress. Vital signs are normal. His anterior fontanelle is open and flat. He is moving all extremities equally with normal tone, and he has normal newborn reflexes. His abdomen is soft and nontender, with no evidence of hepatosplenomegaly or ascites. Some minimal oral mucosal bleeding is evident, but there are no petechiae, ecchymoses, or other rashes. There is no evidence of jaundice, scleral icterus, hemangiomas, or bruits on auscultation. Findings on the remainder of his physical examination are within normal parameters.

Results …