3. INTRODUCTION
Any hemorrhagic manifestation due to
deficiency of vitamin K dependent clotting
factors is known as HAEMORRHAGIC
DISEASE OF NEWBORNS (HDN).
Coagulation factors II, VII, IX, X and others
Gla-proteins ( proteins C, protein S, protein
Z) also depend on the presence of vitamin K
for their activity.
4. VITAMIN K
Predominantly found in
green leafy vegetables,
vegetable oils, and dairy
products, vitamin K given to
neonates as a prophylactic
agent is an aqueous,
colloidal solution of vitamin
K .
MENADIO
NE
K1
Synthesized by
gut flora.
MENAQUIN
ONE
K3
Menadione is a
synthetic, water
soluble form .
PHYLLOQUINO
NE
K2
6. VITAMIN K IMPORTANCE
Vitamin K is an essential cofactor for γ- glutamyl carboxylase
enzymatic activity that catalyses the γ-carboxylation of
specific glutamic acid residues in a subclass of proteins.
VITAMIN K IN NEWBORN BABIES
Newborn babies are predisposed to develop vitamin K
deficiency, because of the following :-
Minimal transplacental passage of vitamin K.
Limited hepatic storage of vitamin K in newborn.
Low concentration of vitamin K in breast milk.
Absence of bacterial intestinal flora normally responsible
for the synthesis of vitamin K.
7. CLASSIFICATION OF HDN
EARLY HDN
ONSET :- 0-24 HRS
INCIDENCE :- Rare
SITE :-
Cephalohematoma,subgaleal,
intracranial, gastrointestinal,
umbilicus, intra-abdominal.
ETIOLOGY :- Maternal drugs
(phenobarbital, phenytoin,
warfarin, rifampin, isoniazid) that
interfere with vitamin K.
RISK FACTORS :- Inherited
coagulopathy.
CLASSICAL HDN
ONSET :- 2-7 DAYS
INCIDENCE :- 2% if infant not
given vitamin K.
SITE :- Gastrointestinal, ear-
nose-throat-mucosal,
intracranial, circumcision,
cutaneous, injection sites.
ETIOLOGY :- Vitamin K
deficiency , breast feeding.
LATE HDN
ONSET :- 1-6 MONTHS
INCIDENCE :- Dependent on primary
disease
SITE :- Intracranial, gastrointestinal,
cutaneous, ear-nose-throat-mucosal,
injection sites, thoracic.
ETIOLOGY :- Cholestasis– malabsorption
of vitamin K ( biliary atresia, cystic
fibrosis , haepatis).
RISK FACTORS :- Abetalipoprotin
deficiency , idiopathic, idiopathic in Asian
breast- fed infants, warfarin ingestion.
12. INVESTIGATIONS
COAGULATION PROFILE :- Prothrombin time ( PT ), activated partial thromboplastin time ( aPTT ),
fibrinogen levels, and platelet count should be included in the initial workup for vitamin K deficiency
bleeding in a newborn.
• A prolonged PT is usually the first laboratory test result to be abnormal in vitamin K deficiency
bleeding.
• Normal aPTT , Fibrinogen levels and a platelet count.
• Factor assay.
IMAGING STUDY :- CT Scan , MRI, USG.
CBC
LFT
Stool for occult blood.
ERCP
Liver biopsy
13. MANAGEMENT
Intramuscular administration of 1mg of vitamin K at the time of birth
prevents the decrease in vitamin K- dependent factors in full-term infants,
but it’s not uniformly effective in the prophylaxis of hemorrhagic disease of
the newborn, particularly in breast-fed and in premature infants.
The disease maybe effectively treated with a slow intravenous infusion of 1-
5mg of vitamin K1.
Serious bleeding, particularly in premature infants or those with liver
disease , may require a transfusion of fresh frozen plasma or whole blood.
Hematomas, melena and post- circumcision and umbilical cord bleeding
maybe present, only 5-35% of cases of factor VII and IX deficiency become
clinically apparent in the newborn period. Treatment of the rare congenital
deficiencies of coagulation factors requires fresh frozen plasma or specific
factor replacement.
14. TREATMENT
Shock
•Stabilization with blood transfusion @ of 15 to 20
Ml/kg or 10-20 ml/kg NS bolus.
•Repeat bolus if there is no improvement Target MBP
>40 mm/hg.
•Furthur BT if necessary with Crossmatched PRBC of
maternal blood group.
15.
16. VKBD NOT IN SHOCK
• Injection of vitamin K (therapeutic)
• Injection/oral vitamin k (prophylactic)
VKBD NOT IN SHOCK
Early HDN classical HDN Late HDN
Injection vit. K Injection vit. K Injection vit.K
@ Of 2mg I/V @ of 1-2mg I/V @ 1mg I/V
• Every week till 3 months or bleeding corrected
• Transfusion SOS
• If, 1) Hb @ 10-12 gm.
2) Birth wt. <1.5kg (preterm)
3) Critically ill
Give : FFP @10 ml/kg
17.
18.
19. SURGICAL CARE
Normally, vitamin K deficiency bleeding
infants do not require surgical care but
in rare cases , an infant may need
neurosurgical evaluation and
treatment.
Other conditions, such as those
associated with short bowel syndrome
and hepatobiliary disease may require
23. COMPLICATIONS
• INTRACRANIAL HEMORRHAGE :- primary serious
complication.
• Anaphylactoid like reactions during intravenous
administration .
• Hyperbilirubinemia or hemolytic anemia after high doses of
doses of vitamin K1
• Hematomas at site of injection, if administered IM.
26. PREVENTION
EARLY HDN
Administration of vitamin K to infant
at birth or to mother ( 20mg )
before birth.
CLASSICAL HDN
Parenteral vitamin K at birth.
LATE HDN
Parenteral and high–dose oral
vitamin K during periods of
malabsorption or cholestasis.
27. PROGNOSIS
In the absence if intracranial hemorrhage ,
the prognosis for vitamin K deficiency
bleeding in an otherwise healthy infant is
excellent.
Prognosis after intracranial hemorrhage
depends on the extent and location of the
hemorrhage.
Long-term sequelae of intracranial
hemorrhage may include motor and
intellectual deficits.
