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Hemorrhagic disease of the newborn

Definition

Hemorrhagic disease of the newborn is a bleeding disorder that usually develops shortly after a baby is born.

Alternative Names

Vitamin K deficiency bleeding; VKDB

Causes

A lack of vitamin K causes hemorrhagic disease of the newborn. Vitamin K plays an important role in blood clotting.

Babies usually have low levels of vitamin K for a variety of reasons. Vitamin K doesn't move easily across the placenta from the mother to the baby. As a result, a newborn doesn't have much vitamin K stored up at birth. Also, there isn't much vitamin K in breast milk.

Your baby may develop this condition if:

• A preventive vitamin K shot is not given at birth (if vitamin K is given by mouth instead of as a shot, it must be given more than once and it may not be as effective)
• You take certain anti-seizure drugs

The condition is grouped into three categories:

• Early onset hemorrhagic disease of the newborn is very rare. It occurs during the first hours of birth and certainly within 24 hours. Use of anti-seizure drugs or a blood thinner called coumadin during pregnancy is a common cause.
• Classic onset disease develops in breastfed infants who did not receive a vitamin K shot within the first week after birth. It is also rare.
• The late onset form is seen in infants older than 2 weeks up to 2 months old. It is more common in children who did not receive a vitamin K shot, and in those of Asian descent.

Newborns and infants with the following problems are more likely to develop this disorder:

• Alpha1-antitrypsin deficiency
• Biliary atresia
• Celiac disease
• Cystic fibrosis
• Diarrhea
• Hepatitis

Symptoms

The condition causes bleeding. The most common areas of bleeding include:

• A boy's penis if he has been circumcised
• Belly button area
• Gastrointestinal tract (may result in blood in the baby's bowel movements)
• Mucus membranes (such as the lining of the nose and mouth)
• Places where there has been a needle stick

There may also be:

• Blood in the urine
• Bruising
• Raised lump on the baby's head (suggesting bleeding underneath one of the skull bones)

Exams and Tests

Blood clotting tests will be done.

The diagnosis is confirmed if a vitamin K shot stops the bleeding and blood clotting time (prothrombin time) is within normal limits.

Treatment

Vitamin K is given if bleeding occurs. Patients with severe bleeding may need blood transfusions.

Outlook (Prognosis)

The outlook tends to be worse for babies with late onset hemorrhagic disease than other forms. There is a higher rate of bleeding inside the skull (intracranial hemorrhage) associated with the late onset condition.

Possible Complications

• Bleeding inside the skull (intracranial hemorrhage), with possible brain damage
• Death
• Severe bleeding

When to Contact a Medical Professional

Call your doctor if your baby has any unexplained bleeding.

Prevention

The American Academy of Pediatrics recommends giving every baby a shot of vitamin K immediately after birth. This practice has helped prevent the condition, which is now rare in the U.S.

The early onset form of the disease may be prevented by giving vitamin K shots to pregnant women who take anti-seizure medications.

References

Blood Disorders. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 103.

American Academy of Pediatrics Committee on Fetus and Newborn. Policy statement: controversies concerning vitamin K and the newborn. Pediatrics. 2003;112:191-192.

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