Hemorrhagic Disease of the Newborn

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

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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

  1. INR/PT increased
  2. Partial Thromboplastin Time (PTT)
  3. Platelet Count

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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