GI_Bleeding_Paediatrics_Prognosis_Prevention_Ref.pptx

doctor

1. Prognosis of GI Bleeding in Children Overall outcomes Mortality ~2 %; higher with shock, liver disease, multi‑organ failure. Re‑bleed during same admission: 8–20 %. Key prognostic factors: • Haemodynamic instability (tachycardia, hypotension). • Platelets <150 × 10⁹/L or INR > 1.5. • Critical‑illness markers (mechanical ventilation, sepsis, PRISM > 10). Risk‑stratification tools: paediatric Glasgow‑Blatchford (pGBS), Rockall, PEBSI. Early endoscopy (<24 h) lowers mortality and re‑bleeding.

2. Prevention Strategies Primary prevention (before first bleed) • Co‑prescribe PPI with chronic NSAIDs or steroids. • Stress‑ulcer prophylaxis (PPI/H₂RA) in ventilated/coagulopathic ICU patients. • Propranolol for portal‑hypertension varices; HBV vaccination. Secondary prevention (after first bleed) • Eradicate H. pylori with standard triple therapy. • Programmed variceal ligation ± β‑blocker until eradication. • Repeat endoscopy for high‑risk ulcers at 24–48 h; maintain PPI 4–8 weeks. • Correct anaemia (iron); optimise nutrition. • Educate caregivers on early signs and medication adherence.

3. References 1. Attard TM, et al. Mortality associated with GI bleeding in children: retrospective study. World J Gastroenterol . 2017;23(9):1608–1617. 2. Acute upper GI bleeding due to portal hypertension in children. J Pediatr Gastroenterol Hepatol . 2021. 3. Lazar C, et al. Practical aspects of upper GI bleeding in children. J Clin Med. 2023;12:2921. 4. Gilfoyle E, Parsons S. Stress‑Ulcer Prophylaxis Guideline (PICU). Alberta Children’s Hospital; 2024. 5. Garegnani L, et al. PPIs for prevention of NSAID ulcers (Cochrane). Cochrane Database Syst Rev. 2025;CD014585. 6. Murray K, Jonas M. Variceal bleeding & prophylaxis in paediatrics . NASPGHAN handout. 2014. 7. CHOP. Upper GI Bleed Clinical Pathway. Revised 2025.