HEMORRHAGIC DISEASE

OF NEWBORNS
Prepared by:
Dr. MOHAMMED AQLAN MD
Consultant Pediatrics, Assistant professor of pediatrics
UNIVERSITY HOSPITAL , Sanaa

Prepared by Dr. Mohammed Aqlan MD © AUG. 2022

CONTENT

Definition & Overveiw

Clinical types &Presentations

Treatment & Prevention

Prepared by Dr. Mohammed Aqlan MD © AUG. 2022

 Hemorrhagic Disease of the Newborn
 Hemorrhagic disease is a bleeding problem that occurs in a baby during the
first few days of life (Transient deficiency in vitamin-K dependent factors )
 Babies are normally born with low levels of vitamin K, an essential factor in
blood clotting.
 A deficiency in vitamin K is the main cause of hemorrhagic disease in
newborn babies.
 Usually present 48–72 h after birth
 Late-onset (> 2 week) associated with vitamin K malabsorption,
e.g., neonatal hepatitis, biliary atresia
 Presents earlier if mother on phenobarbital, phenytoin, or coumadin

Prepared by Dr. Mohammed Aqlan MD © AUG. 2022

Early-onset vitamin K deficiency bleeding in the
newborn

 Early-onset vitamin K deficiency bleeding usually occurs during first 24 hours

after birth.
 It is seen in infants born to mothers taking anticonvulsant (eg, phenytoin,
barbiturates, carbamazepine) or antituberculosis medication (eg, rifampin,
isoniazid).
 Serious hemorrhagic complications can occur in this type of hemorrhage.
 Can be prevented by administration of vitamin K to the mother during the last 2-
4 weeks of pregnancy. When vitamin K supplementation is given after the birth
for early-onset vitamin K deficiency bleeding, it may be too late to prevent this
disease, especially if vitamin K supplementation was not provided during
pregnancy.

Prepared by Dr. Mohammed Aqlan MD © AUG. 2022

Classic vitamin K deficiency bleeding in the newborn

 Classic vitamin K deficiency bleeding usually occurs after 24 hours after

birth but may present as late as the first week of life.
 It usually occurs from the second day of life to the end of the first week;
however, it can occur during first month and sometimes overlaps with late-
onset vitamin K deficiency bleeding.
 Classic vitamin K deficiency bleeding is observed in infants who have not
received prophylactic vitamin K at birth (incidence ranging from 0.25 to 1.7
cases per 100 births).
 Infants who have this disease are often ill, have delayed feeding, or both.
 Bleeding commonly occurs in the umbilicus, gastrointestinal (GI) tract (ie,
melena), skin, nose, surgical sites (ie, circumcision) and, uncommonly, in the
brain. [3]

Prepared by Dr. Mohammed Aqlan MD © AUG. 2022

Late-onset vitamin K deficiency bleeding in the
newborn
 Late-onset vitamin K deficiency bleeding usually occurs between age
2-12 weeks; however, it can be seen as long as 6 months after birth.
 This disease is most common in breastfed infants who did not receive
vitamin K prophylaxis at birth. Vitamin K content is low in mature
human milk, with a range of 1-4 μg/L.
 More than half of these infants present with acute intracranial
hemorrhages. [3]

Prepared by Dr. Mohammed Aqlan MD © AUG. 2022

Clinical presentation

History

 The maternal history : especially the medications used during

pregnancy, the presence of medical conditions such as short gut
syndrome, and unusual dietary intakes.
 Surveillance during pregnancy and careful medical evaluation of
neonate after delivery .

Prepared by Dr. Mohammed Aqlan MD © AUG. 2022

Clinical presentation
Physical examination
 Most newborn infants are healthy upon examination; however, intracranial

hemorrhage can occur during the birthing process and can lead to severe
complications. Signs of intracranial hemorrhage include apnea with or without
seizures and a shocklike syndrome.
 Internal hemorrhage of organs other than the brain (eg, liver, adrenal glands) may

be difficult to detect; however, if they are suspected, careful physical monitoring

and serial imaging after birth are indicated.
 Soft-tissue hemorrhage is easier to recognize, but sequential measurements of the
bleeding into soft tissues or muscle are mandatory.

Prepared by Dr. Mohammed Aqlan MD © AUG. 2022

Differential Diagnosis

 Alloimmune Thrombocytopenia
 Consumption Coagulopathy
 Hepatobiliary Disease
 Maternal Isoimmune Thrombocytopenia
 Pediatric Von Willebrand Disease
 Uncommon Coagulopathies

Prepared by Dr. Mohammed Aqlan MD © AUG. 2022

Diagnosis

Initial workup for vitamin K deficiency bleeding (VKDB) in a newborn:

 A prothrombin time (PT)

 activated partial thromboplastin time (aPTT)

 fibrinogen levels

 platelet count

A prolonged PT is usually the first laboratory test result to be abnormal

in vitamin K deficiency bleeding .
The diagnosis of vitamin K deficiency bleeding is confirmed if
administration of vitamin K halts the bleeding and reduces the PT value.
Prepared by Dr. Mohammed Aqlan MD © AUG. 2022
Treatment

 Intravenous (IV) administration of vitamin K has been associated with

anaphylactoid like reactions.
 Fresh frozen plasma may be considered for moderate to severe
bleeding.
 Life-threatening bleeding may also be treated with prothrombin
complex concentrates (PCCs).

Prepared by Dr. Mohammed Aqlan MD © AUG. 2022

Forms of vitamin K

 The following three forms of vitamin K are known:

 K1: Phylloquinone is predominantly found in green leafy vegetables,
vegetable oils, and dairy products. The vitamin K given to neonates as
a prophylactic agent is an aqueous, colloidal solution of vitamin K1.
 K2: Menaquinone is synthesized by gut flora.
 K3: Menadione is a synthetic, water soluble form that is no longer used
medically because of its ability to produce hemolytic anemia.

Prepared by Dr. Mohammed Aqlan MD © AUG. 2022

Prevention

 Diet : The best sources of vitamin K are green

leafy vegetables, legumes, soybean, and olive oils.
 Breastfed infants should receive vitamin K
supplementation :
 Administration of intramuscular (IM) vitamin K is of
primary importance in the medical care of
neonates ( as a single IM dose of 0.5 to 1 mg).
 Newborns whose parents refuse IM vitamin K
should receive an oral dose of 2 mg at birth,
repeated at 2-4 and 6-8 weeks of age.

Prepared by Dr. Mohammed Aqlan MD © AUG. 2022

Thank You