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Neonate with red diaper
  1. Alfred Wang,
  2. Kristine Nanagas
  1. Emergency Medicine, Indiana University Health Methodist Hospital, Indianapolis, Indiana, USA
  1. Correspondence to Dr Alfred Wang, Emergency Medicine, Indiana University Health Methodist Hospital, Indianapolis, IN 46202, USA; azwang{at}iu.edu

https://doi.org/10.1136/emermed-2019-208625

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    Case presentation

    A 5-day-old  boy presented to the ED with 1 day of red tinted diapers (figure 1). The child was born at 39 weeks without major complications, received all medications/vaccinations after birth and had passed meconium normally. He was eating well and acting normally according to his mother. She expressed concern that he may have blood in his diaper, because she saw redness that she had not ever seen before. Physical exam was normal. He was breast fed twice in the ED and was ultimately discharged after a short course of observation.

    Figure 1
    Figure 1

    Diaper of neonate. A colour version of this figure can be found online.

    Question

    What is the cause of the discolouration?

    1. Urinary uric acid deposition.

    2. Haematochezia.

    3. Meconium.

    4. Haematuria.

    Answer: A

    Uric acid is a weak organic acid that is produced by the liver from diet and endogenous nucleic acid metabolism. The excretion of uric acid is high at birth and falls as the child ages. Because breast milk acidifies urine during the neonatal period, uric acid can precipitate and present as red/orange discolouration (compared with dark green meconium).1 As such, in the otherwise healthy infant, this discolouration is not usually concerning and investigations are generally not required.2 To help differentiate from haematuria or haematochezia, uric acid (unlike blood) usually turns into a fine powder when dry, which was evident on our patient’s diaper.

    While this problem is self-limited in well infants, it is important to consider other common causes of red/orange discoloured diaper. Medications such as rifampin, food such as beets and dehydration causing more concentrated urine can manifest the discolouration. In females, vaginal withdrawal bleeding can cause similar discolourations when the child is no longer exposed to maternal hormones. More serious causes include congenital syndromes that cause hyperuricosuria (such as Lesch-Nyhan syndrome), acute porphyrias and intestinal tract infections from Serratia marcescens. 2 3

    References

    1. ↵
      2. Stapleton FB ,
      3. Linshaw MA ,
      4. Hassanein K , et al
      . Uric acid excretion in normal children. J Pediatr 1978;92:911–4.doi:10.1016/S0022-3476(78)80359-X
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    2. ↵
      2. Amin R ,
      3. Eid L ,
      4. Edvardsson VO , et al
      . An Unusual Cause of Pink Diapers in an Infant: Questions and Answers. Ped Neph 2016;575:577–80.
      OpenUrl
    3. ↵
      2. Jeng JY ,
      3. Franz WB
      . Orange Stains in a Healthy Neonate’s Diaper. Clin Pediatr 2014;53:908–10.doi:10.1177/0009922814536777
      OpenUrlCrossRefPubMed

    Footnotes

    • Contributors AW and KN drafted the manuscript and contributed to its revision. AW takes responsibility for the paper as a whole.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Patient consent for publication Parental/guardian consent obtained.