stooling history, level of alertness, associated pain or tenderness, or any systemic signs such as fever or apnea Given the variable transit time of the intestine in newborns, the distinction between hematochezia and melena is not as helpful in distinguishing between upper and lower gastrointestinal bleeding and so both should be evaluated similarly Laboratory evaluation should include complete blood count to assess for signs of anemia or chronic blood loss, elevated white blood count, and/or eosinophilia If infectious colitis is suspected, blood and stool cultures should be sent prior to the initiation of intravenous antibiotics Abdominal radiograph may be warranted if there is suspicion of obstruction, malrotation, or NEC Allergic Enteropathy Allergic enteropathy can occur in newborns from an exposure to the offending protein via formula or breast milk Most common after months of age, it can present in the immediate neonatal period, most often with painless hematochezia with or without associated diarrhea The most common allergy is to cow-milk protein, which can also affect breast-fed infants whose mothers ingest cow milk Up to 40% of infants with cow-milk protein will also have a soy protein allergy, so that formula-fed infants should be given extensively hydrolyzed formulas Breast-fed infants should have mothers avoid both cow milk and soy products in their diet The prognosis for allergic enteropathy is overall good, with quick resolution of symptoms once the offending protein has been removed from the diet Acholic Stool Acholic or gray-colored stool represents an obstruction to bilirubin excretion and is always a pathologic finding It is more often associated with an obstruction to the biliary tract, as in biliary atresia, but can also be seen in hepatocellular disease, such as hepatitis It is accompanied by cholestasis and conjugated hyperbilirubinemia Congenital disorders of the hepatobiliary system may not develop acholic stools until weeks of life or later, so a history of normal meconium or stool does not exclude hepatobiliary anomalies Jaundice is covered in detail in the previous Section: Color Changes Abdominal Masses Goals of Treatment Most abdominal mass lesions in the newborn are benign lesions or lesions that can be monitored by the pediatrician in an outpatient setting The goal of