Diarrhea and Dehydration

In this age group, diarrheal disease has some particular issues. The water content in the stools is higher than normal. Frequent evacuation of normal stools is not diarrhea, and the number of evacuations usually depends on diet and age. In a breastfed infant from 5 to 10 days of age loose stools are normal. If the neonate is in very good general status, with no signs of illness and feeds appropriately, the diagnosis will most probably be transition stools; these do not require treatment. After that period, breastfed infants’ stools continue to be loose, but usually without mucus or blood. The mother of an infant will normally recognize diarrhea because either the consistency of the stools or the frequency of evacuations will differ from normal.

Nevertheless, consider diarrhea in an infant younger than 2 months to be a severe infection and treat it accordingly.

Persistent diarrhea

Consider infants from 0 to 2 months of age with persistent (7 days or more) diarrhea severely ill and refer them to a hospital whenever possible. These patients require special care to prevent fluid loss. It might also be necessary to make dietary changes and to perform laboratory tests to identify the cause of diarrhea (Table 5).

Bloody Diarrhea

Most frequent causes of bloody diarrhea in the neonate include hemorrhagic disease (due to vitamin K deficiency), allergic colitis, necrotizing enterocolitis, or other coagulation disorders, such as disseminated intravascular coagulation due to sepsis. In infants older than 15 days of age, blood in the stools may result from anal fissures, cow’s milk allergy, or surgical disorders, such as intussusception. Bacterial dysentery is not common in this age group, but when it is suspected, consider Shigella and administer appropriate therapy. Amoebic dysentery is unusual in very young infants.

Consider bloody diarrhea in this age group as severe illness requiring urgent referral to a hospital (Table 6).