Hemorrhagic disease of the newborn
Vitamin K deficiency bleeding.
- 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
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