II. Definitions

  1. Hemorrhagic Disease of the Newborn
    1. Newborn Vitamin K Deficiency resulting in disordered coagulation and Hemorrhage

III. Epidemiology

  1. Incidence: 1 in 200-400 newborns who are not administered Vitamin K at birth

IV. 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

V. 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)

VI. Findings

  1. Bruising
  2. Gastrointestinal Hemorrhage
  3. CNS Hemorrhage are most common

VII. Labs

VIII. Management: Hemorrhage

  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

IX. 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

X. 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

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Ontology: Hemorrhagic Disease of Newborn (C0019088)

Definition (MSH) Neonatal nasogastric or intracranial hemorrhage caused by vitamin K deficiency.
Definition (NCI) A condition characterized as a coagulation disturbance in newborns due to vitamin K deficiency resulting in impaired production of coagulation factors II, VII, IX, and X, and proteins C and S by the liver.(NICHD)
Definition (CSP) self-limited hemorrhagic disorder of the first days of life, caused by a deficiency of the vitamin K-dependent blood coagulation factors II, VII, IX, and X.
Concepts Disease or Syndrome (T047)
MSH D006475
ICD9 776.0
ICD10 P53
SnomedCT 12546009
English Hemorrhagic disease of newborn, HDN - Haemorrhagic dis newborn, HDN - Hemorrhagic dis newborn, Haemorrhag disease of newborn, Vitamin K defic.of newborn, hemorrhagic disease of newborn due to vitamin K deficiency (diagnosis), hemorrhagic disease of newborn due to vitamin K deficiency, hemorrhagic disease of newborn (diagnosis), hemorrhagic disease of newborn, Haemorrhagic disease of newborn, NB hemorrhagic disease, HEMORRHAGIC DIS NEWBORN, Newborn Hemorrhagic Disease, Newborn Hemorrhagic Diseases, Hemorrhagic Disease of Newborn, disease haemorrhagic newborn, hemorrhagic disease newborn, disease hemorrhagic newborn, newborn hemorrhagic disease, Vitamin K Deficiency Bleeding in Newborn, Hemorrhagic disease of the newborn, Hemorrhagic diathesis of newborn, Hemorrhagic disease of the newborn due to vitamin K deficiency, Neonatal vitamin K deficiency, Vitamin K deficiency of newborn, HDN - Haemorrhagic disease of newborn, HDN - Hemorrhagic disease of newborn, Haemorrhagic disease of the newborn, Vitamin K deficiency of the newborn, Haemorrhagic diathesis of newborn, Haemorrhagic disease of the newborn due to vitamin K deficiency, Hemorrhagic disease of the newborn due to vitamin K deficiency (disorder), deficiency; vitamin K, newborn, newborn; hemorrhagic disorder, vitamin K; deficiency, newborn
Dutch hemorragische aandoening van pasgeborene, deficiëntie; vitamine K, pasgeborene, pasgeborene; hemorragische aandoening, vitamine K; deficiëntie, pasgeborene, hemorragische ziekte pasgeborene
German haemorrhagische Diathese des Neugeborenen, Hämorrhagische Neugeborenenkrankheit, haemorrhagische Diathese Neugeborenes
Japanese 新生児出血性疾患, シンセイジシュッケツセイシッカン
Czech Krvácivý stav u novorozence, Krvácivé onemocnění novorozence, hemoragická nemoc novorozenců
French Syndrome hémorragique du nouveau-né, Maladie hémorragique du nouveau-né, Syndrome hémorragique néonatal, Maladie hémorragique des nouveau-nés, Maladie hémorragique néonatale
Italian Malattia emorragica del neonato
Portuguese Doença Hemorrágica do Recém-Nascido, Doença hemorrágica do recém-nascido
Spanish Enfermedad Hemorrágica del Recién Nacido, deficiencia de vitamina K del recién nacido, deficiencia neonatal de vitamina K, diátesis hemorrágica del recién nacido, enfermedad hemorrágica del recién nacido por deficiencia de vitamina K (trastorno), enfermedad hemorrágica del recién nacido por deficiencia de vitamina K, enfermedad hemorrágica del recién nacido, Enfermedad hemorrágica del recién nacido
Hungarian újszülöttkori haemorrhagiás betegség, Újszülött haemorrhagiás betegsége
Norwegian Blødningssykdom hos nyfødt, Hemoragisk sykdom hos nyfødt