Pathology
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Atlas of Neonatal Pathology
Marta Ježová, Josef Feit
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+ Neonatal pathology
Hemorrhagic disease of the newborn
Introduction

Vitamin K deficiency bleeding.

Etiology
  • Vitamin K is required for production of coagulation factors II., VII., IX. and X. in the liver
  • Newborns are relatively vitamin K deficient because of
    • low vitamin K stores at birth
    • low levels of vitamin K in the breast milk
    • sterility of the intestine
Clinical signs

Bleeding from umbilicus, mucous membmranes, gastrointestinal tract, venipunctures, large cephalhematoma or skin bruising. Intracranial bleeding is rare.

Bleeding is a problem exlusively in breastfed infants. Formulas contain supplemental vitamin K.

The occurence is rare due to routine prophylaxis (intramuscular administration of vitamin K immeditely after birth, regular administration of vitamin K per os to all breastfed infants in the neontal period).

  • Early onset disease  —  less than 24 hours after birth, occurs rarely with maternal medication that interferes with vitamin K
  • Classic onset  —  2 – 7 days after birth in breastfed neonates
  • Late onset  —  after 2 weeks of life, risk factors besides breastfeeding include diarrhea, hepatitis, cystic fibrosis, absence of prophylaxis. Late onset disease tends to be more serious with higher occurence of intracranial bleeding.