Vaginal bleeding in newborns

There was recently a EMS request for vaginal bleeding in a newborn female patient.  A call of this nature was unusual and caused much anxiety on the part of the EMS crew that responded. The child was taken to the hospital and was informed that this can be a natural occurrence in some newborn girls due to hormonal effects from the mother's hormones that crossed the placental barrier when the baby was in utero. It typically occurs on the third day after birth and may continue for a few days. Large amounts of blood are not normal for withdrawal bleeding. If bleeding seems excessive, vitamin K deficient bleeding or other coagulopathy should be considered.   In addition to the vaginal bleeding there can be temporary breast enlargement in both male and female newborns.

Hormonal effects in newborns

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Hormonal effects in newborns occur because, while they are in the womb, babies are exposed to many chemicals (hormones) present in the mother's bloodstream. After birth, the infants are no longer exposed to these hormones. This exposure may cause temporary conditions in a newborn.

Information

Hormones from the mother (maternal hormones) are some of the chemicals that pass through the placenta into the baby's blood during pregnancy. These hormones can affect the baby.
For example, pregnant women produce high levels of the hormone estrogen. This causes breast enlargement in the mother. By the third day after birth, breast swelling may also be seen in newborn boys and girls. Such newborn breast swelling does not last, but it is a common concern among new parents.
The breast swelling should go away by the second week after birth as the hormones leave the newborn's body. Do not squeeze or massage the newborn's breasts because this can cause an infection under the skin (abscess).
Hormones from the mother may also cause some fluid to leak from the infant's nipples. This is called witch's milk. It is common and usually goes away within 2 weeks.
Newborn girls may also have temporary changes in the vaginal area.

• The skin tissue around the vaginal area, called the labia, may look puffy as a result of estrogen exposure.
• There may be a white fluid (discharge) from the vagina. This is called physiologic leukorrhea.
• There may also be a small amount of bleeding from the vagina.

These changes are common and should slowly go away over the first 2 months of life.

Alternative Names

Newborn breast swelling; Physiologic leukorrhea

References

In: Kliegman RM,Behrman RE, Jenson HB,Stanton BF, eds. Nelson Textbookof Pediatrics.19th ed. Philadelphia, Pa: Saunders Elsevier; 2011: chap XX.

Update Date: 2/21/2013

Updated by: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.