Vitamin K Deficiency Bleeding (VKDB) in Infancy

1999 ◽  
Vol 81 (03) ◽  
pp. 456-461 ◽  
Author(s):  
Rüdiger von Kries ◽  
Marlies Cornelissen ◽  
Andrew McNinch ◽  
Maureen Andrew ◽  
Anton Sutor
Keyword(s):  
Breast Feeding ◽  
Vitamin K ◽  
Age Of Onset ◽  
Early Recognition ◽  
Warning Signs ◽  
Hemorrhagic Disease ◽  
Vitamin K Deficiency ◽  
Vitamin K Deficiency Bleeding ◽  
K Deficiency ◽  
Oral Doses

Summary Terminology. Replace the term “Hemorrhagic Disease of the Newborn” (HDN) by “Vitamin K Deficiency Bleeding” (VKDB), as neonatal bleeding is often not due to VK-deficiency and VKDB may occur after the 4-week neonatal period. Definition. VKDB is bleeding due to inadequate activity of VK-dependent coagulation factors (II, VII, IX, X), correctable by VK replacement. Diagnosis. In a bleeding infant a prolonged PT together with a normal fibrinogen level and platelet count is almost diagnostic of VKDB; rapid correction of the PT and/or cessation of bleeding after VK administration are confirmative. Warning signs. The incidence of intracranial VKDB can be reduced by early recognition of the signs of predisposing conditions (prolonged jaundice, failure to thrive) and by prompt investigation of “warning bleeds”. Classification. VKDB can be classified by age of onset into early (<24 h), classical (days 1-7) and late (>1 week <6 months), and by etiology into idiopathic and secondary. In secondary VKDB, in addition to breast feeding, other predisposing factors are apparent, such as poor in-take or absorption of VK. VK-Prophylaxis: Benefits. Oral and intramuscular VK (one dose of 1 mg) protect equally well against classical VKDB but intramuscular VK is more effective in preventing late VKDB. The efficacy of oral prophylaxis is increased with a triple rather than single dose and by using doses of 2 mg vitamin K rather than 1 mg. Protection from oral doses repeated daily or weekly may be as high as from i.m. VK. VK-Prophylaxis: Risks. VK is involved in carboxylation of both the coagulation proteins and a variety of other proteins. Because of potential risks associated with extremely high levels of VK and the possibility of injection injury, intramuscular VK has been questioned as the routine prophylaxis of choice. Protection against bleeding should be achievable with lower peak VK levels by using repeated (daily or weekly) small oral doses rather than by using one i.m. dose. Breast feeding mothers taking coumarins. Breast feeding should not be denied. Supervision by pediatrician is prudent. Weekly oral supplement of 1 mg VK to the infant and occasional monitoring of PT are advisable. Conclusion. VKDB as defined is a rare but serious bleeding disorder (high incidence of intracranial bleeding) which can be prevented by either one i.m. or multiple oral VK doses.

scholarly journals INTRACEREBRAL BLEEDING IN LATE HEMORRHAGIC DISEASE OF THE NEWBORN

2019 ◽  
pp. 1-2
Author(s):  
Jayashree Nadkarni
Keyword(s):  
Vitamin K ◽  
Task Force ◽  
Current Status ◽  
Hemorrhagic Disease ◽  
Current Guideline ◽  
Vitamin K Deficiency ◽  
Vitamin K Deficiency Bleeding ◽  
Vitamin K Prophylaxis ◽  
New Born ◽  
K Deficiency

1 Vitamin K Ad Hoc Task Force. Controversies concerning vitamin K and the newborn. Pediatrics 1993; 91: 1001-1003. 2. Isarangkura PB, Pintadit P, Tejavej A, Siripoonya P. Chulajata C, Green GM. Vitamin K prophylaxis in the neonate by oral route and its significance in reducing infant mortality and morbidity. J Med Assoc Thai 1986; 69: 56-61. 3. Ijland MM, Pereira RR, Cornelissen EA. Incidence of late vitamin K deficiency bleeding in new-borns in the Netherlands in 2005: Evaluation of the current guideline. Eur J Paediatr 2008; 167: 165-169. 4. Waseem M. Vitamin K and hemorrhagic disease of new-borns. South Med J 2006; 99: 1199. 5. Lane PA, Hathaway WE. Vitamin K in infancy. J Pediatr 1985; 106: 351-359. 6. Singh M. Vitamin K during infancy: Current status and recommendations.Indian Pediatr 1997; 34: 708-712. 7. Bor O, Akgun N, Yakut A, et al. Late hemorrhagic disease of the new-born.Paediatr Int 2000; 42: 64-66. 8. D?Souza IE, Rao SD. Late hemorrhagic disease of new-born. Indian Paediatr 2003; 40: 226-229. 9. Flood VH, Galderisi FC, Lowas SR, et al. Hemorrhagic disease of the new-born despite vitamin K prophylaxis at birth. Paediatr Blood Cancer 2008; 50: 1075-1077. 10. Zengin E, Sarper N, Türker G, et al. Late haemorrhagic disease of the new- born. Ann Trop Paediatr 2006; 26: 225-231. 11. Sutor AH, Dagres N, Niederhoff H. Late form of vitamin K deficiency bleeding in Germany. KlinPediatr 1995; 207: 89-97

Fatal Intracranial Hemorrhage in a Normal Infant Secondary to Vitamin K Deficiency

PEDIATRICS ◽  
1983 ◽  
Vol 72 (4) ◽  
pp. 562-564
Author(s):  
PETER A. LANE ◽  
WILLIAM E. HATHAWAY ◽  
JOHN H. GITHENS ◽  
RICHARD D. KRUGMAN ◽  
DONNA A. ROSENBERG
Keyword(s):  
Vitamin K ◽  
Correct Diagnosis ◽  
Fatal Case ◽  
Male Infant ◽  
Hemorrhagic Disease ◽  
Normal Infant ◽  
Vitamin K Deficiency ◽  
Hospital Emergency Room ◽  
History Of ◽  
K Deficiency

Since the initiation of routine vitamin K prophylaxis in newborns, the incidence of hemorrhagic disease of the newborn has been dramatically decreased. Recently there have been suggestions in the literature that prophylaxis may be unnecessary.1-4 We report here a fatal case of vitamin K deficiency in an otherwise healthy 1-month-old who did not receive prophylaxis. This case is illustrative because the child was initially thought to have suffered nonaccidental trauma. In addition, the correct diagnosis was confirmed, retrospectively, after vitamin K administration, with new assays for vitamin K-deficient prothrombin. CASE REPORT This 4-week-old male infant was seen at a community hospital emergency room with a one-day history of irritability, poor feeding, and decreased responsiveness without fever.

scholarly journals Intracranial Hemorrhage Caused by Vitamin K Deficiency Beyond Neonatal Period

2017 ◽  
Vol 37 (1) ◽  
pp. 104-107 ◽  
Author(s):  
Sudhir Adhikari ◽  
Eva Gauchan ◽  
Tejesh Malla ◽  
Brijesh Sathian ◽  
Kalipatanam Seshagiri Rao
Keyword(s):  
Intracranial Hemorrhage ◽  
Vitamin K ◽  
Neonatal Period ◽  
National Policy ◽  
Vitamin K Deficiency ◽  
Vitamin K Deficiency Bleeding ◽  
Vitamin K Prophylaxis ◽  
Clinical Presentations ◽  
Intracranial Bleed ◽  
K Deficiency

Vitamin K deficiency bleeding (VKDB) can manifest as intracranial hemorrhage (ICH) and is still prevalent in poor resource countries. Infants aged one to twelve months with the diagnosis of ICH from 1st July 2011 to 30th June 2016 were included. There were 16 cases of ICH attributed to vitamin K deficiency. Clinical presentations were anemia16 (100%), bulged fontanel 13(81.3%), seizures 10(62.5%), vomiting 8(50%) and fever 9(56.3%). Mean INR at admission was 8.575±7.267 and 1.868±0.838 after three doses of vitamin K administration. Sites of intracranial bleed were parenchymal 5(31.3%), subdural 4(25%), extradural 2(12.5%), ventricular 2(12.5%). In 3(18.8%) of cases bleeding was more extensive involving more than one site. Mortality was 4(25%) and 3(18.8%) had abnormal neurological findings at discharge. There is an urgent need for national policy for vitamin K prophylaxis at birth.

scholarly journals Vitamin K prophylaxis for prevention of vitamin K deficiency bleeding: a systematic review

2016 ◽  
Vol 36 (S1) ◽  
pp. S29-S35 ◽  
Author(s):  
M J Sankar ◽  
A Chandrasekaran ◽  
P Kumar ◽  
A Thukral ◽  
R Agarwal ◽  
...  
Keyword(s):  
Systematic Review ◽  
Vitamin K ◽  
Vitamin K Deficiency ◽  
Vitamin K Deficiency Bleeding ◽  
Vitamin K Prophylaxis ◽  
K Deficiency

THE VITAMIN K DEFICIENCY IN INFANCY IN JAPAN -- THE SECOND NATIONWIDE SURVEY

1987 ◽  
Author(s):  
T Nagao ◽  
Y Hanawa ◽  
K Sawada ◽  
I Tsukimoto ◽  
I Ikeda ◽  
...  
Keyword(s):  
Vitamin K ◽  
Nationwide Survey ◽  
Near Miss ◽  
Screening Tests ◽  
Hemorrhagic Disease ◽  
Vitamin K Deficiency ◽  
K Deficiency ◽  
Hemorrhagic Tendency ◽  
Bile Duct Atresia ◽  
Nation Wide Survey

Questionnaires were sent to 1,218 hospitals with more than 200 beds, in order to know the incidence of hemorrhagic disease due to vitamin K deficiency in infancy beyond 2 weeks after birth, during 4 and a half years, i.e. from January 1981 to June 1985. Out of the 534 cases reported, 407 had no obvious reasons for vitamin K deficiency: "idiopathic vitamin K deficiency in infancy". Other 68 cases had bleedingepisodes due to vitamin K deficiency associated with hepatobiliary lesions (e.g.congenital bile duct atresia), chronic diarrhea, long term antibiotic therapy and so on: "secondary vitamin K deficiencyin infancy". The third group consisting of 59 cases was so called "near miss" type, in which hemorrhagic tendency was discovered at the time of mass screening tests for vitamin K deficiency or by chance withoutany clinical hemorrhage. In the idiopatic group, 345 cases (84.8%) developed their bleeding episodes between 21 and 59 days of age, and 368 cases (90.4%) were wholly breast-fed. Intracranial hemorrhage was seen in 338 cases (83.0%) of this group. In most cases of this series (97.3%),no vitamin K was supplemented after birth. Administration of vitamin K is an urgent routine procedure during the first one or two months of life for all newbornbabies, although the incidence of the idiopathic vitamin K deficiency in infancyhas not decreased significantly comparedto the results of the first nation-wide survey (Jan. 1978 - Dec. 1980). This study was sponsored by the Ministry of Health and Welfare of Japan.

scholarly journals Vitamin K Deficiency Bleeding in Infancy

Nutrients ◽  
2020 ◽  
Vol 12 (3) ◽  
pp. 780
Author(s):  
Shunsuke Araki ◽  
Akira Shirahata
Keyword(s):  
Oral Administration ◽  
Vitamin K ◽  
Placental Transfer ◽  
Late Onset ◽  
Newborn Infants ◽  
Coagulation Factors ◽  
Epidemiological Studies ◽  
Vitamin K Deficiency ◽  
Vitamin K Deficiency Bleeding ◽  
K Deficiency

Vitamin K is essential for the synthesis of few coagulation factors. Infants can easily develop vitamin K deficiency owing to poor placental transfer, low vitamin K content in breast milk, and poor intestinal absorption due to immature gut flora and malabsorption. Vitamin K deficiency bleeding (VKDB) in infancy is classified according to the time of presentation: early (within 24 h), classic (within 1 week after birth), and late (between 2 week and 6 months of age). VKDB in infancy, particularly late-onset VKDB, can be life-threatening. Therefore, all infants, including newborn infants, should receive vitamin K prophylaxis. Exclusive breastfeeding and cholestasis are closely associated with this deficiency and result in late-onset VKDB. Intramuscular prophylactic injections reduce the incidence of early-onset, classic, and late-onset VKDB. However, the prophylaxis strategy has recently been inclined toward oral administration because it is easier, safer, and cheaper to administer than intramuscular injection. Several epidemiological studies have shown that vitamin K oral administration is effective in the prevention of VKDB in infancy; however, the success of oral prophylaxis depends on the protocol regimen and parent compliance. Further national surveillance and studies are warranted to reveal the optimal prophylaxis regimen in term and preterm infants.

Sign in / Sign up

Export Citation Format

Share Document