• Clinical science

Vitamin K deficiency bleeding of the newborn (Hemorrhagic disease of the newborn)

Abstract

Vitamin K deficiency bleeding of the newborn (VKDB) refers to spontaneous bleeding in a newborn caused by a deficiency of vitamin K dependent coagulation factors. As vitamin K does not cross the placental barrier, is not present in breast milk, and is not synthesized in the sterile gut of a newborn, vitamin K levels are low in all neonates. VKDB is rare in industrialized countries as most children receive a vitamin K injection at birth. VKDB is categorized as early-onset (within 24 hours after birth), classic (within 4 weeks), or late-onset (between 2–8 months). Common sites of bleeding include intracranial, subgaleal, gastrointestinal, and nasal. Treatment is focused on managing the bleeding with, e.g., transfusions and restoring bleeding homeostasis by administering vitamin K.

Epidemiology

  • Without prophylaxis: affects 0.25–2% of newborns

References:[1]

Epidemiological data refers to the US, unless otherwise specified.

Etiology

The underlying cause is always a deficiency of vitamin K, which can be due to various factors:

References:[2][3][1]

Clinical features

  • Early-onset: within 24 hours after birth; intracranial bleeding common
  • Classic: within 4 weeks after birth; intracranial bleeding rare
  • Late-onset: between 2–8 months after birth; intracranial bleeding common

References:[2][1]

Diagnostics

Coagulation studies:

References:[1]

Treatment

References:[1]

Prevention

In the US, all newborns receive intramuscular vitamin K (0.5–1 mg) at birth.

References:[2]