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Clinical Problems
Published in Christopher Flannigan, A Practical Guide to Managing Paediatric Problems on the Postnatal Wards, 2017
Prevention of vitamin K deficiency bleeding (VKDB) of the newborn (previously known as haemorrhagic disease of the newborn) is now routine policy throughout the UK. While both oral and parenteral vitamin K offer adequate protection against early VKDB, there is increasing evidence that parenteral vitamin K is more effective than oral vitamin K in preventing late VKDB,44 and as a result many units are now offering intramuscular vitamin K as standard. As breast milk has less vitamin K than formula milk, breastfed infants are at higher risk of VKDB (particularly late onset).
Hematological problems in the neonate
Published in Prem Puri, Newborn Surgery, 2017
Andrea M. Malone, Owen P. Smith
Vitamin K deficiency bleeding (VKDB) is classified as early, classical, or late. Classical VKDB usually occurs on the second to seventh day of life as a result of decreased synthesis of vitamin K-dependent factors. The etiology of vitamin K deficiency in newborns is multifactorial and includes reduction of storage, functional immaturity of the liver, lack of bacterial synthesis of vitamin K in the gut, and low amounts of vitamin K in breast milk.32 Early VKDB is due to the placental passage of compounds that interfere with vitamin K metabolism, such as maternal anticonvulsant medications, vitamin K antagonists (warfarin), and drugs used to treat tuberculosis. This usually presents within 24 hours of life and may cause a cephalohematoma, intracranial hemorrhage, or bleeding from the umbilical stump. Late VKDB is again due to inadequate vitamin K content in breast milk and occurs almost exclusively in breastfed infants. The diagnostic evaluation of VKDB is straightforward as the prothrombin time (PT) is always prolonged, and the activated partial thromboplastin time (aPTT) is nearly always prolonged. Typically, the PT is prolonged out of proportion to the aPTT. The most effective management of VKDB is prevention, and all newborns should receive vitamin K at birth. Exceptions to the rule are those children with known G6PD deficiency in the family, as a significant number of these patients will develop frank hemolysis. In those children who present with frank bleeding due to VKDB, parenteral vitamin K and plasma or prothrombin complex concentrates can be given to arrest the blood loss.25
Life-threatening massive upper gastrointestinal bleeding in a term and healthy baby
Published in Baylor University Medical Center Proceedings, 2023
Serdar Alan, Sevde Nur Vural, Hacer Fulya Gulerman, Meryem Albayrak, Didem Aliefendioglu
Upper gastrointestinal (UGI) bleeding involves a hemorrhage originating from the proximal part of the ligament of Treitz in the distal duodenum and presenting with hematemesis or melena.1 The most common cause of hematemesis or the presence of blood in the stomach contents in newborns in the first days of life is usually maternal blood swallowed during delivery or sucking from a cracked nipple.2 Vitamin K deficiency bleeding (VKDB) of the newborn, previously known as hemorrhagic disease of the newborn, has decreased considerably in the era of vitamin K prophylaxis.3 The common reported causes of UGI bleeding in newborns are stress gastritis, gastric/duodenal ulcers, esophagitis, nasogastric tube trauma, vascular malformations, gastrointestinal duplications, coagulopathy, congenital coagulation defects, and milk protein allergy.4 Massive UGI hemorrhage is very rare in healthy term infants and is commonly seen in sick or premature infants and infants with asphyxia.5 Here we report a previously healthy newborn admitted to the neonatal intensive care unit (NICU) due to life-threatening severe UGI hemorrhage.
Vitamin K Deficiency in the Setting of Blenderized Tube Feeding Regimen in a Teenager: A Case Report
Published in Journal of Dietary Supplements, 2023
N. Khan, M. Taimur, A. Malkani, R. Lamsal
There can be clinically significant bleeding in neonates who do not have a mature gut flora and have not received vitamin K immediately after birth (3, 4). The American Academy of Pediatrics (AAP) currently recommends a single intramuscular (IM) dose of 0.5 to 1 mg of vitamin K within 6 h after birth to prevent vitamin K deficiency bleeding (VKDB) in newborns (5). The World Health Organization (WHO) also recommends all newborns receive 1 mg of vitamin K intramuscularly after birth (6). However, beyond neonatal period, there are no recommendations to evaluate for vitamin K deficiency (VKD) as this is rarely encountered.