Hemorrhagic Disease Of Newborn by Dr. Ravi Parthasarathy CRMI Department of Pediatrics Haemorrhagic disease of newborn • Hemorrhagic disease of the newborn is the commonest manifestation of vitaminK deficiency in infancy.It is also known as vitamin k deficiency bleeding. • Vitamin k plays a major key role in synthesis of Clotting factors 2,7,9,10 and anticoagulant protein c&s. Pathway Causes • Newborn have low vitamin K stores at birth • Vitamin K passes through placenta very poorly • Vitamin k levels are very low in breast feed • Gut flora not yet been developed • Liver disease Types • Early onset (<24 hrs) • Classical HDN (2-7 days) • Late HDN (1-6 month) Early Onset • Onset 0-24 hrs • Mainly due to maternal drugs that interfere with vitamin k (Phenobarbital,phenytoin,Warfarin,Rifampi cin ,Isoniazid) • Causes cephalhematoma,Subgaleal , Intracranial , Intraabdominal. CLASSICAL HDN • Onset 2-7 days • ~2% is mainly due to if infant is not given vitamin k • Mainly due to Vitamin K deficiency due to breastfeed LATE HDN • Onset - 1-6 month • Mainly due to cholestasis ( Biliary atresia, Cystic fibrosis , hepatitis) • Bleeding site: Intracranial,GIT,ENT, Cutaneous, Injection sites. Investigations • Coagulation Profile : PT/INR, apTT, Fibrinogen • Imaging studies: CT,MRI,USG • LFT, Stool for ocult blood Prevention and Management • Early HDN : Administration of Vitamin k to the infant at birth or 20 mg to the mother before birth • Classical HDN : Parenteral vitamin K at birth • Late HDN : Parenteral and high dose of vitamin K oral at the time of Cholestasis or malabsorption • At active phase 1-5 mg of vitamin K IV infusion can be given • Serious bleeding May require FFP or whole blood transfusion • ICT may require neurological intervention. Thanking you

1. Hemorrhagic Disease Of
Newborn
by
Dr. Ravi Parthasarathy
CRMI
Department of Pediatrics

2. Haemorrhagic disease of
newborn
• Hemorrhagic disease of the newborn is
the commonest manifestation of
vitaminK deficiency in infancy.It is also
known as vitamin k deficiency bleeding.
• Vitamin k plays a major key role in
synthesis of Clotting factors 2,7,9,10
and anticoagulant protein c&s.

3. Pathway

4. Causes
• Newborn have low vitamin K stores at
birth
• Vitamin K passes through placenta very
poorly
• Vitamin k levels are very low in breast
feed
• Gut flora not yet been developed
• Liver disease

5. Types
• Early onset (<24 hrs)
• Classical HDN (2-7 days)
• Late HDN (1-6 month)

6. Early Onset
• Onset 0-24 hrs
• Mainly due to maternal drugs that interfere
with vitamin k
(Phenobarbital,phenytoin,Warfarin,Rifampi
cin ,Isoniazid)
• Causes cephalhematoma,Subgaleal ,
Intracranial , Intraabdominal.

8. CLASSICAL HDN
• Onset 2-7 days
• ~2% is mainly due to if infant is not
given vitamin k
• Mainly due to Vitamin K deficiency due
to breastfeed

9. LATE HDN
• Onset - 1-6 month
• Mainly due to cholestasis ( Biliary
atresia, Cystic fibrosis , hepatitis)
• Bleeding site: Intracranial,GIT,ENT,
Cutaneous, Injection sites.

10. Investigations
• Coagulation Profile : PT/INR, apTT,
Fibrinogen
• Imaging studies: CT,MRI,USG
• LFT, Stool for ocult blood

11. Prevention and Management
• Early HDN : Administration of Vitamin k to
the infant at birth or 20 mg to the mother
before birth
• Classical HDN : Parenteral vitamin K at
birth
• Late HDN : Parenteral and high dose of
vitamin K oral at the time of Cholestasis or
malabsorption

12. • At active phase 1-5 mg of vitamin K IV
infusion can be given
• Serious bleeding May require FFP or
whole blood transfusion
• ICT may require neurological intervention.

13. Thanking you