Vitamin K deficiency bleeding of the newbornHemorrhagic disease of the newborn (HDN)
Vitamin K deficiency bleeding (VKDB) of the newborn is a bleeding disorder in babies. It most often develops in the first days and weeks of life.
A lack of vitamin K may cause severe bleeding in newborn babies. Vitamin K plays an important role in blood clotting.
Babies often have a low level of vitamin K for a variety of reasons. Vitamin K does not move easily across the placenta from the mother to the baby. As a result, a newborn does not have much vitamin K stored up at birth. Also, the bacteria that help make vitamin K are not yet present in a newborn's gastrointestinal tract. Finally, there is not much vitamin K in mother's 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 does not appear to be as effective as the shot).
- You take certain anti-seizure or blood-thinning drugs.
The condition is grouped into three categories:
- Early-onset VKDB is very rare. It occurs during the first hours after birth and within 48 hours. It is most usually caused by use of anti-seizure medicines or some other medicines, including a blood thinner called Coumadin, during pregnancy.
- Classic-onset disease occurs between 2 to 7 days after birth. It may be seen in breastfed infants who did not receive a vitamin K shot within the first week after birth, such as those for whom feedings were delayed initially. It is also rare.
- Late-onset VKDB is seen in infants between 2 weeks and 2 months old. It is also more common in children who did not receive a vitamin K shot.
Newborns and infants with the following problems involving the gastrointestinal system are also more likely to develop this disorder:
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 (resulting 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:
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) quickly becomes normal. (In vitamin K deficiency, the prothrombin time is abnormal.)
Vitamin K is given if bleeding occurs. Babies with severe bleeding may need plasma or blood transfusions.
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.
Complications may include:
- Bleeding inside the skull (intracranial hemorrhage), with possible brain damage
When to Contact a Medical Professional
Call your health care provider if your baby has:
- Any unexplained bleeding
- Abdominal behavior
Get emergency medical care right away if the symptoms are severe.
The early onset form of the disease may be prevented by giving vitamin K shots to pregnant women who take anti-seizure medicines. To prevent the classic and late-onset forms, the American Academy of Pediatrics recommends giving every baby a shot of vitamin K immediately after birth. Because of this practice, vitamin K deficiency is now rare in the United States except for those babies who do not receive the vitamin K shot.
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Centers for Disease Control and Prevention (CDC). Notes from the field: late vitamin K deficiency bleeding in infants whose parents declined vitamin K prophylaxis--Tennessee, 2013. MMWR Morb Mortal Wkly Rep. 2013;62(45):901-902. PMID: 24226627 www.ncbi.nlm.nih.gov/pubmed/24226627.
Greenbaum LA. Vitamin K deficiency. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 66.
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