Hemorrhagic disease of the newborn
Hemorrhagic disease of the newborn (HDN) is a bleeding disorder in babies. It most often develops shortly after a baby is born.
Vitamin K deficiency bleeding; VKDB
A lack of vitamin K causes hemorrhagic disease of the newborn. Vitamin K plays an important role in blood clotting.
Babies often have low levels 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, there is not much vitamin K in breast 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 may not be as effective)
- You take certain anti-seizure or blood thinning drugs
The condition is grouped into three categories:
- Early onset hemorrhagic disease of the newborn is very rare. It occurs during the first hours after birth and within 24 hours. Use of anti-seizure drugs or a blood thinner called coumadin during pregnancy is a common cause.
- Classic onset disease occurs between 24 hours and 7 days after birth. It may be seen in breast-fed infants who did not receive a vitamin K shot within the first week after birth. It is also rare.
- Late onset HDN is seen in infants between 2 weeks and 2 months old. It is more common in children who did not receive a vitamin K shot.
Newborns and infants with the following problems involving the gastrointestinal tract are more likely to develop this disorder:
- Alpha1-antitrypsin deficiency
- Biliary atresia
- Celiac disease
- Cystic fibrosis
The condition causes bleeding. The most common areas of bleeding include:
- A boy's penis, if he has been circumcised
- Belly button area
- Gastrointestinal tract (may result in blood in the baby's bowel movements)
- Mucus membranes (such as the lining of the nose and mouth)
- Places where there has been a needle stick
There may also be:
- Blood in the urine
- Raised lump on the baby's head (suggesting bleeding underneath one of the skull bones)
Exams and Tests
Blood clotting tests will be done.
The diagnosis is confirmed if a vitamin K shot stops the bleeding and blood clotting time (prothrombin time) is within normal limits.
Vitamin K is given if bleeding occurs. Patients with severe bleeding may need blood transfusions.
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.
- Bleeding inside the skull (intracranial hemorrhage), with possible brain damage
- Severe bleeding
When to Contact a Medical Professional
Call your doctor if your baby has any unexplained bleeding.
The early onset form of the disease may be prevented by giving vitamin K shots to pregnant women who take anti-seizure medications.
The American Academy of Pediatrics recommends giving every baby a shot of vitamin K immediately after birth. This practice has helped prevent the classic and late-onset forms of the condition, which is now rare in the U.S.
Blood Disorders. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011.
American Academy of Pediatrics Committee on Fetus and Newborn. Policy statement: controversies concerning vitamin K and the newborn. Pediatrics. 2003;112:191-192.
Warren M et al. Notes from the field: late vitamin K deficiency bleeding in infants whose parents declined vitamin K prophylaxis--Tennessee, 2013. MMWR Morb Mortal Wkly Rep. 2013 Nov 15;62(45):901-2.