3. HEMORRHAGIC DISEASE OF THE NEWBORN
Hemorrhagic disease of the newborn occurs
in I of every 200 - 400 neonates not given
vitamin K prophylaxis.
4. HEMORRHAGIC DISEASE OF THE NEWBORN
CLASSIFICATION
A moderate decrease in factors II, VII, IX and
X normally occurs in all newborn infants by
48-72 hour after birth, with a gradual return to
birth levels by 7-10 days of age.
5. HEMORRHAGIC DISEASE OF THE NEWBORN
CLASSIFICATION
This transient deficiency (classic form) of vitamin K-
dependent factors is due to lack of free vitamin K
from the mother and absence of the bacterial
intestinal flora normally responsible for the synthesis
of vitamin K.
Accentuation and prolongation of this deficiency
between the 2nd and 7th days of life result in
spontaneous and prolonged bleeding.
Hemorrhagic complications are more frequent in
breast-fed (poor source of vitamin K) than in formula-
fed infants.
6. HEMORRHAGIC DISEASE OF THE NEWBORN
CLASSIFICATION
Early-onset (0-24 hour) life-threatening
vitamin K deficiency induced bleeding occurs
if the mother has been treated with
phenytoin, primidone, methsuximide, or
phenobarbital.
7. HEMORRHAGIC DISEASE OF THE NEWBORN
CLASSIFICATION
Late onset (>2 week) is often associated
with vitamin K malabsorption (neonatal
hepatitis, biliary atresia, cystic fibrosis).
8. HEMORRHAGIC DISEASE OF THE NEWBORN
CLINICAL FEATURES
The most common form of bleeding is
melena (melena neonatorum); frank blood
may be passed per rectum in severe cases.
9. HEMORRHAGIC DISEASE OF THE NEWBORN
CLINICAL FEATURES
Hematemesis;
Hematuria;
Nasal, subgaleal, intracranial, post
circumcision, or vaginal bleeding; and
Hemorrhage from the umbilicus or into the
skin may also occur.
10. HEMORRHAGIC DISEASE OF THE NEWBORN
CLINICAL FEATURES
The prothrombin time (PT), clotting time, and
partial thromboplastin time are prolonged.
11. HEMORRHAGIC DISEASE OF THE NEWBORN
CLINICAL FEATURES
The levels of vitamin K dependent
coagulation factors II, VII, IX, and X
(Thrombotest) are significantly reduced.
12. HEMORRHAGIC DISEASE OF THE NEWBORN
Vitamin K facilitates post-transcriptional
carboxylation of factors II, VII, IX, and X. In
the absence of carboxylation, such factors
form PIVKA (protein induced in vitamin K
absence), which is a sensitive marker for
vitamin K status.
The platelet level is normal.
13. HEMORRHAGIC DISEASE OF THE NEWBORN
DIFFERENTIATE DIAGNOSIS
Factor VII and IX deficiency (only 5-35%
cases become clinically apparent in the
newborn period), DIC,
The swallowed blood syndrome (blood from
maternal source, contains adult hemoglobin,
promptly change to alkaline hematin with
alkali, Apt test-yellow-brown).
14. HEMORRHAGIC DISEASE OF THE NEWBORN
TREATMENT
1. Vitamin K, (phytomenadione) 1-5 mg, IM or
IV in a single dose.
2. If there is active bleeding or PT is greatly
prolonged, 10 ml/kg fresh frozen plasma with an
IV dose of 1 mg of vitamin K is given.
3. In cases where blood loss is severe and
sudden, transfusion of fresh blood (20 ml/kg) is
life-saving.
4. Vitamin K,, I mg/wk for the first 3 months of
life, may prevent late hemorrhagic disease of
newborn.
