Haemorrhagic disease of the newborn

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Haemorrhagic disease of the newborn
Other namesVitamin K deficiency bleeding
Phylloquinone structure.svg
Vitamin K1
SpecialtyPediatrics Edit this on Wikidata

Haemorrhagic disease of the newborn, also known as vitamin K deficiency bleeding (VKDB), is a coagulation disturbance in newborn infants due to vitamin K deficiency. As a consequence of vitamin K deficiency there is an impaired production of coagulation factors II, VII, IX, X, protein C and protein S by the liver, resulting in excessive bleeding (hemorrhage).

Signs and symptoms[edit]

The disease causes an increased risk of bleeding. The most common sites of bleeding are the umbilicus, mucous membranes, gastrointestinal tract, circumcision and venepunctures.

Causes[edit]

Newborns are relatively vitamin K deficient for a variety of reasons. They have low vitamin K stores at birth, vitamin K passes the placenta poorly, the levels of vitamin K in breast milk are low and the gut flora has not yet been developed (vitamin K is normally produced by intestinal bacteria).

Diagnosis[edit]

Precise diagnosis by measuring proteins induced by vitamin k absence (PIVKA). But this is usually not required.

Treatment[edit]

Treatment consists of vitamin K supplementation.[1] This is often given prophylactically to newborns shortly after birth.

United States[edit]

As a result of the occurrences of vitamin K deficiency bleeding, the Committee on Nutrition of the American Academy of Pediatrics has recommended 0.5–1 mg of vitamin K1 be administered to all newborns shortly after birth.[2]

United Kingdom[edit]

In the UK, vitamin K supplementation is recommended for all newborns within the first 24 hours.[3] This is usually given as a single intramuscular injection of 1 mg shortly after birth but as a second-line option can be given by three oral doses over the first month.[4]

Controversy[edit]

Controversy arose in the early 1990s regarding this practice, when two studies suggested a relationship between parenteral administration of vitamin K and childhood cancer.[5] However, poor methods and small sample sizes led to the discrediting of these studies, and a review of the evidence published in 2000 by Ross and Davies found no link between the two.[6] Doctors reported emerging concerns in 2013,[7] after treating children for serious bleeding problems. They cited lack of newborn vitamin K administration as the reason that the problems occurred, and recommended that breastfed babies could have an increased risk unless they receive a preventative dose.

References[edit]

  1. ^ Hubbard D, Tobias JD (November 2006). "Intracerebral hemorrhage due to hemorrhagic disease of the newborn and failure to administer vitamin K at birth". South. Med. J. 99 (11): 1216–20. doi:10.1097/01.smj.0000233215.43967.69. PMID 17195415.
  2. ^ American Academy of Pediatrics Committee on Fetus Newborn (July 2003). "Controversies concerning vitamin K and the newborn. American Academy of Pediatrics Committee on Fetus and Newborn" (PDF). Pediatrics. 112 (1 Pt 1): 191–2. doi:10.1542/peds.112.1.191. PMID 12837888.
  3. ^ Logan S, Gilbert R (1998). "Vitamin K For Newborn Babies" (PDF). Department of Health. Archived from the original (PDF) on 7 January 2013. Retrieved 12 Oct 2014.
  4. ^ "Postnatal care: Routine postnatal care of women and their babies [CG37]". www.nice.org.uk. NICE. Jul 2006. Retrieved 12 Oct 2014.
  5. ^ Parker L, Cole M, Craft AW, Hey EN (January 1998). "Neonatal vitamin K administration and childhood cancer in the north of England: retrospective case-control study". BMJ. 316 (7126): 189–93. doi:10.1136/bmj.316.7126.189. PMC 2665412. PMID 9468683.
  6. ^ McMillan DD, et al. (Canadian Paediatric Society, Fetus and Newborn Committee) (1997). "Routine administration of vitamin K to newborns". Paediatrics & Child Health. 2 (6): 429–431. doi:10.1093/pch/2.6.429.
  7. ^ "Newborns get rare disorder after parents refused shots". Having four cases since February just at Vanderbilt was a little bit concerning to me

External links[edit]

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