title: Does bloody aspirate reflect the state of upper gastrointestinal mucosa in a critically ill newborn?
abstract: OBJECTIVE
  Critically ill newborns have many risk factors to develop stress related mucosal lesions (SRML). We used upper endoscopy to evaluate the presence of SRML in these neonates, to know the specificity and sensitivity of the bloody gastric aspirate to detect SRML and to identify the risk factors associated with the presence of SRML and bloody gastric aspirate.
  
  
  METHODS
  This is a cross-sectional study done on 100 critically ill newborn after becoming clinically stable. SRML were diagnosed if there is hyperaemia, erosions or ulcers in the oesophagus, stomach, and/or the duodenum.
  
  
  RESULTS
  SRML were found in 77% of neonates in the NICU though frank bloody aspirate was detected in only 22% of neonates. The presence of bloody aspirate showed low sensitivity (24.68%) and high specificity (86.96%) for the presence of SRML. The presence of bloody gastric aspirate showed a double fold risk for the presence SRML (OR=2.184, CI=0.584-8.171). Factors associated with SRML included respiratory distress (p=0.000, risk=4.006), the use of nasogastric tube (p=0.017, OR=3.281) and the use of triple antibiotics (p=0.001, risk=1.432). Factors associated with the presence of bloody gastric aspirate included the use of nasogastric tube (OR=1.629, p=0.000) and the presence of haemostatic disorders (OR=3.143, p=0.039). It was also associated with lower haemoglobin levels (p=0.000).
  
  
  CONCLUSIONS
  SRML represents an under-diagnosed problem in NICUs. Absence of bloody gastric aspirate does not exclude the presence of SRML.
authors.affiliation: Cairo University Children's Hospital, The Neonatal Tertiary Care Unit, Egypt. raniatomerak@yahoo.com
authors.forename: Rania H
authors.initials: RH
authors.lastname: Tomerak
authors.forename: Ayman A
authors.initials: AA
authors.lastname: El Badawy
authors.forename: Ayman E
authors.initials: AE
authors.lastname: Eskander
authors.forename: Amira H
authors.initials: AH
authors.lastname: Mahmoud
mesh_terms: D001769:Blood; D016638:Critical Illness; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology*; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D006801:Humans; D007231:Infant, Newborn; D007413:Intestinal Mucosa / Q000473:pathology*; D007441:Intubation, Gastrointestinal; D008297:Male; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013312:Stress, Physiological; D013396:Suction