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Hemorrhagic Disease of the Newborn

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Hemorrhagic Disease of the Newborn, Neonatal Vitamin K Deficiency, Hemorrhagic Diathesis of the Newborn

  • Definitions
  1. Hemorrhagic Disease of the Newborn
    1. Newborn Vitamin K Deficiency resulting in disordered coagulation and Hemorrhage
  • Epidemiology
  1. Incidence: 1 in 200-400 newborns who are not administered Vitamin K at birth
  • Pathophysiology
  1. All children are born Vitamin K deficient
  2. Vitamin K is derived from gastrointestinal Bacteria and ingested food
  3. Vitamin K is not found in Breast Milk and does not cross placenta
  4. Clotting Factors 2, 7, 9, 10 and Proteins C and S are reliant on Vitamin K
  • Types
  1. Early Hemorrhage (first 24 hours of life)
    1. Increased risk with maternal use of Vitamin K Antagonists (e.g. antiepileptic medications)
    2. Examples: Phenytoin, Primidone, Methsuximide, Phenobarbital
  2. Classic Hemorrhage (days 2-14)
  3. Late or Delayed Hemorrhage (2 weeks to 12 weeks, and up to 6 months in some cases)
    1. Increased risk with malabsorption (e.g. Cystic Fibrosis, prolonged broad spectrum Antibiotics)
  • Findings
  1. Bruising
  2. Gastrointestinal Hemorrhage
  3. CNS Hemorrhage are most common
  • Labs
  1. INR/PT increased
  2. Partial Thromboplastin Time (PTT)
  3. Platelet Count
  1. Vitamin K 1-2 mg IV or IM AND
  2. Fresh Frozen Plasma (FFP) 10 ml/kg or Prothrombin Complex Concentrate (PCC4)
    1. Indicated for serious bleeding
  • Prevention
  1. All U.S. infants are given Vitamin K 1 mg IM within 6 hours of delivery (unless parents refuse)
  2. High risk mothers (e.g. anticonvulsant use)
    1. Administer Vitamin K 10 mg IM to mother at 24 hours prior to delivery
  • References
  1. Claudius and Anderson in Herbert (2021) EM:Rap 21(4): 10-1
  2. Goorin and Cloherty in Cloherty and Stark (1991) Manual of Neonatal Care, Little Brown, Toronto, p. 347