Haemorrhage of the newborn and Vitamin K

Vitamin K is poorly transported across the placenta and breast milk is a poor dietary source.  On top of this, the body is unable to store large amounts of vitamin K.  Vitamin K is important in the production of clotting factors II, VII, IX and X.

As such, newborn infants are at risk of severe bleeding due to lack of vitamin K-

Vitamin K Deficiency Bleeding

‘Types of VKDB’

  • Early- within 24 hours
  • Classic- 1-7 days
  • Late- 7 days- week 12

Risk Factors and Prevention

  • Risk
    • Early VKDB
      • Maternal drugs (particularly anti-TB e.g. rifampicin, isoniazid; anti-epileptics/convulsants; and anti-coagulants) – combined with trauma at delivery can cause severe early VKDB
    • Classic VKBD
      • Drugs (as above)
      • Exclusive breastfeeding in babies who have not had prophylaxis
    • Late
      • Usually caused by malabsorption of vitamin K
        • diarrhoeal disease
        • can be due to undiagnosed cholestasis
  • Prevention
    • Vitamin K injection soon after birth (1mg IM) should be given to prevent VKDB

Presentation and Management

  • Common bleeding sites include
    • the GI tract (malaena, haematemesis)
    • skin/mucous membranes (nose, gums)
    • sites of trauma (at delivery- particularly the scalp)
  • More rarely, intracranial bleeding can occur

Management of haemorrhagic disease

  • Subcut Vit K and/or oral vit K
  • If severe (or intracranial) bleeding, fresh frozen plasma can be given with vit K to replace clotting factors
    • Rarely, transfusion may be required.
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