Vitamin K Deficiency Bleeding (VKDB) is also known as hemorrhagic disease of the newborn. It is a condition that can present with life threatening hemorrhage due to low levels of vitamin K at birth. It is preventable with the routine administration of vitamin K at birth. Presentation falls into one of three categories.
|Type||Time Of Presentation||Characteristics|
|Early||0-24 hours after birth||Severe|
Mainly found in infants whose mothers used certain medications (like medicines to treat seizures or isoniazid) that interfere with how the body uses vitamin K
|Classical||1-7 days after birth||Bruising|
Bleeding from the umbilical cord
|Late||2-12 weeks after birth is typical, but can occur up to 6 months of age in previously healthy infants||30-60% of infants have bleeding within the brain|
Tends to occur in breastfed only babies who have not received the vitamin K shot
Warning bleeds are rare
According to the CDC:
- Early and classical VKDB are more common, occurring in 1 in 60 to 1 in 250 newborns, although the risk is much higher for early VKDB among those infants whose mothers used certain medications during the pregnancy.
- Late VKDB is rarer, occurring in 1 in 14,000 to 1 in 25,000 infants.
- Infants who do not receive a vitamin K shot at birth are 81 times more likely to develop late VKDB than infants who do receive a vitamin K shot at birth.
Risk factors for VKD include:
- Certain drugs taken during pregnancy which may interfere with vitamin K metabolism.
- Anti-tubercular drugs (isoniazid)
- Early gestation – Preterm babies are at a higher risk of having VKDB.
- Place of delivery- Home births do not have access to vitamin K injection until follow up visit.
- Breast feeding
Physical examination findings may include:
- Head and facial bruising, cephalohematoma
- Irritability, seizures, excessive sleepiness, or a lot of vomiting – signs of intracranial bleeding
- Hemoptysis, respiratory distress – signs of intrathoracic bleeding
- Melena or hematemesis – gastrointestinal bleeding
- Petechiae, pale skin
- Scleral icterus – typically seen after 3 weeks of life
- Bleeding from mucous membranes, including the gums, nose. For darker skinned babies, the gums may appear pale
- Bleeding after circumcision
- Bleeding from the umbilical stump
- Bleeding from vaccination sites
- Prothrombin time (PT) should be more than 4 times normal
- Normal platelet count
- Normal fibrinogen level
- Partial thromboplastin time (PTT) may also be increased due to decreased activity of factors 2,9 and 10
- Clotting time will be increased due to clotting factor deficiency
- 1mg vitamin K intra-muscularly (IM)
- Treat hemorrhage with blood transfusion and address life threatening bleeds (Intracranial hemorrhage)
- Exclude other causes of newborn coagulopathy: Hemophilia, DIC, ITP – all should have other lab abnormalities.