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Vitamin K deficiency bleeding of the newborn
Definition
Vitamin K deficiency bleeding (VKDB) of the newborn is a bleeding disorder in babies. It most often develops in the first days and weeks of life.
Alternative Names
Hemorrhagic disease of the newborn (HDN)
Causes
A lack of vitamin K may cause severe bleeding in newborn babies. Vitamin K plays an important role in blood clotting.
Babies often have a low level of vitamin K for a variety of reasons. Vitamin K does not move easily across the placenta from the mother to the baby. As a result, a newborn does not have much vitamin K stored up at birth. Also, the bacteria that help make vitamin K are not yet present in a newborn's gastrointestinal tract. Finally, there is not much vitamin K in mother's milk.
Your baby may develop this condition if:
- A preventive vitamin K shot is not given at birth (if vitamin K is given by mouth instead of as a shot, it must be given more than once, and it does not appear to be as effective as the shot).
- The mother takes certain anti-seizure or blood-thinning drugs.
The condition is grouped into three categories:
- Immediate-onset VKDB is very rare. It occurs within the first 48 hours after birth and is usually a result of anti-seizure medicines or some other medicines, including a blood thinner called warfarin (Coumadin), taken by mothers during pregnancy.
- Early-onset (formerly called “classic-onset”) disease is also rare. It occurs between 1 to 14 days after birth. It is usually seen in breastfed infants who did not receive a vitamin K shot.
- Late-onset VKDB is seen in infants between 2 weeks and 6 months old. It is also more likely to happen in those who did not receive a vitamin K shot.
Anyone of any age with the following problems involving the gastrointestinal system is also at risk to develop this disorder:
- Alpha1-antitrypsin deficiency
- Biliary atresia or other cholestatic liver disease
- Celiac disease
- Cystic fibrosis or other causes of pancreatic insufficiency
- Diarrhea (prolonged)
- Hepatitis
- Inflammatory bowel disease
Symptoms
Vitamin K deficiency causes bleeding. The most common areas of bleeding include:
- At the site of circumcision
- Belly button area
- Gastrointestinal tract (resulting in blood in the baby's bowel movements)
- Mucous membranes (such as the lining of the nose and mouth)
- Places where there has been a needle stick
- The brain
There may also be:
- Blood in the urine
- Bruising
- Seizures (convulsions) or abnormal behavior due to bleeding inside the skull
Exams and Tests
Blood clotting tests will be done.
The diagnosis can be confirmed if a vitamin K shot stops the bleeding and blood clotting time (PT or prothrombin time) quickly becomes normal (within 6 to 24 hours). (If the deficiency is not severe, the PT may not be abnormal.)
Treatment
Vitamin K is given if bleeding occurs. Babies with severe bleeding may need plasma or blood transfusions.
Outlook (Prognosis)
The outlook tends to be worse for babies with late-onset hemorrhagic disease than other forms. There is a higher rate of bleeding inside the skull (intracranial hemorrhage) associated with the late-onset condition.
Possible Complications
Complications may include:
- Bleeding inside the skull (intracranial hemorrhage), with possible brain damage
- Death
When to Contact a Medical Professional
Contact your health care provider if your baby has:
- Any unexplained bleeding
- Seizures
- Abdominal behavior
Get emergency medical care right away if the symptoms are severe.
Prevention
The early onset form of the disease may be prevented by giving vitamin K shots to pregnant women who take anti-seizure medicines. To prevent the classic and late-onset forms, the American Academy of Pediatrics recommends giving every baby a shot of vitamin K immediately after birth. Because of this practice, vitamin K deficiency is now rare in the United States except for those babies who do not receive the vitamin K shot.
References
Greenbaum LA. Vitamin K deficiency. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 66.
Hand I, Noble L, Abrams SA. Vitamin K and the newborn infant. Pediatrics. 2022;149(3):e2021056036. PMID: 35190810 pubmed.ncbi.nlm.nih.gov/35190810/.
Samji N, Chan A, Bhatt MD. Bleeding and clotting disorders in pediatrics. In: Hoffman R, Benz EJ, Silberstein LE, et al, eds. Hematology: Basic Principles and Practice. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 148.