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Vitamin K deficiency bleeding of the newborn

  • Definition
    • Vitamin K deficiency bleeding of the newborn (VKDB) is a bleeding disorder in babies. It most often develops shortly after a baby is born.

  • Alternative Names
    • Hemorrhagic disease of the newborn (HDN)

  • Causes
    • 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 24 hours. Use of anti-seizure medicines or some other medicines, including a blood thinner called Coumadin, during pregnancy is a common cause.
      • Classic onset disease occurs between 24 hours and 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, especially 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 more common in children who did not receive a vitamin K shot.

      Newborns and infants with the following problems involving the gastrointestinal tract are more likely to develop this disorder:

  • Symptoms
    • 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 (may result 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) is within normal limits.

  • Treatment
    • Vitamin K is given if bleeding occurs. Babies with severe bleeding may need plasma or blood transfusions.

  • Outlook (Prognosis)
    • 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.

  • Possible Complications
    • Complications may include:

      • Bleeding inside the skull (intracranial hemorrhage), with possible brain damage
      • Death
  • When to Contact a Medical Professional
    • Call your health care provider if your baby has any unexplained bleeding.

  • Prevention
    • The early onset form of the disease may be prevented by giving vitamin K shots to pregnant women who take anti-seizure medications.

      The American Academy of Pediatrics recommends giving every baby a shot of vitamin K immediately after birth. This practice has helped prevent the classic and late-onset forms of the condition, which is now rare in the U.S.

  • References
    • Centers for Disease Control and Prevention. 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, Stanton BF, St Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 53.

      Weddle M, Empy A, Crossen E, et al. Are pediatricians complicit in vitamin K deficiency bleeding? Pediatrics. 2015;136(4):753-757. PMID: 26371205 www.ncbi.nlm.nih.gov/pubmed/26371205.