Hemorrhagic disease of the newborn

Question 1

Definition

Answer 1

Hemorrhagic disorder in early neonatal period due to deficiency of vitamin K dependant clotting factors (II, VII, IX, X).

Incidence

• Affect about 2% of neonates not given vitamin K at birth
• Preterm and Breast milk feeders are more at risk than formula feeder full term.

Question 2

Etiology

Answer 2

1-Maternal medication during pregnancy may deplete neonatal vitamin K store e.g. phenytoin, phenobarbitone
2-Depletion of transplacental vitamin K by the 2 nd day of life
3-Delay of endogenous vitamin K synthesis to the 7th day; (due to lack of intestinal bacteria flora especially in cases receiving TPN or prolonged broad spectrum antibiotics).
4-Liver immaturity in preterm

Question 3

Clinical picture

Answer 3

1. Bleeding tendency:
   * Timing?
   - Usually between the 2 nd - 7 th day of life (may be early or late).
   * Sites ?
   - Commonly gastrointestinal, umbilical, or circumcision site
   - Rarely internal hemorrhage
   * Look ?
   - The baby looks well except if there is severe hemorrhage or intra

cranial hemorrhage.

2. May be hemorrhagic anemia (pallor, tachycardia up to shock).

Question 4

Investigations

Answer 4

o Prolonged prothrombin time (P.T.) and partial thromboplastin time (P.T.T)
o Deficiency of vitamin K dependant factors
o Normal bleeding time and platelet count

Question 5

Prevention

Answer 5

Vitamin K1(1 mg ), intra muscular at birth

Question 6

Treatment

Answer 6

o Vitamin K 1 1-5 mg intravenous daily for 3 days
o Fresh plasma transfusion for preterm , liver diseases and active bleeding
o Fresh blood transfusion in severe bleeding.