What is hemorrhagic disease
of the newborn?
Hemorrhagic disease of the newborn is a rare
bleeding problem that can occur after birth. Hemorrhaging is excessive bleeding.
It’s a potentially life-threatening condition.
The condition is caused by vitamin K
deficiency. As a result, it’s often called vitamin K deficiency bleeding, or
VKDB. Vitamin K plays a key role in blood clotting. Because vitamin K is not
efficiently passed on from mother to baby in utero, most babies are born with
low stores of this vitamin in their system.
VKDB is categorized according to the timing
of first symptoms:
onset occurs within 24 hours of birth
onset occurs within two to seven days
onset occurs within two weeks to six months
It’s now common practice for neonatal
physicians to give babies a shot of vitamin K-1, also called phytonadione, shortly
after birth. This helps protect the newborn from VKDB.
of hemorrhagic disease of the newborn
If your baby has VKDB, they may show subtle
signs of “failure to thrive” before a serious bleeding event occurs. These
bleeds, which may seem insignificant
weight for your baby’s age
increase in weight
Bleeding can occur in one or multiple areas,
umbilical stump, the naval area where their umbilical cord was removed
mucous membranes of their nose and mouth
penis, if it’s circumcised
where they’ve been stuck by a needle, for example, for vaccinations
You may notice blood in their stool or urine,
bruising, or a raised lump on their head. If the raised lump appears early on, it’s
probably a cephalohematoma. This is a type of hematoma that occurs when blood
vessels underneath the scalp rupture during delivery. It usually resolves on
its own. However, if the head lump appears later on, it can be an intracranial hemorrhage. This is bleeding inside
the skull. It’s a life-threatening condition.
Causes of hemorrhagic
disease of the newborn
VKDB is caused by vitamin K deficiency. For
most people, the primary dietary source of vitamin K is green leafy vegetables.
Vitamin K is also a byproduct of certain types of bacteria that live in your
intestines and colon (gut flora).
There are a number of reasons why newborns
are prone to vitamin K deficiency. For one thing, only small amounts of vitamin
K are transferred across the placenta during pregnancy. Human breast milk
contains only small amounts of vitamin K too. The primary gut flora (Lactobacillus)
found in breast-fed babies doesn’t synthesize vitamin K.
Risk factors for hemorrhagic
disease of the newborn
The risk factors for VKDB vary, depending on
Early onset VKDB occurs within the first 24
hours after birth. Your baby’s risk of developing it is higher if their birth
mother takes certain medications while pregnant, including:
drugs that interfere with vitamin K metabolism, such as phenytoin, phenobarbital,
caramezepine, or primidone
thinning medications, such as warfarin (Coumadin) or aspirin
such as cephalosporins
medications, such as rifampin and isoniazid
Classic onset VKDB occurs within the first
week after birth, typically in babies who have not received prophylactic
vitamin K at birth. Your baby’s risk of developing it is higher if they are
Late onset VKDB is seen in babies up to 6
months old. This form is also more common in babies who did not receive a
vitamin K shot. Risk factors include:
levels of vitamin K in breast milk
atresia, which causes slow bile flow
deficiency, which may cause lung and liver disease
and treatment for hemorrhagic disease of the newborn
If your baby’s doctor suspects they have
VKDB, they will perform blood clotting tests. They will give your baby a shot
of vitamin K-1. If this stops your baby’s bleeding, the doctor can confirm that
the cause is VKDB.
If your baby is diagnosed with VKDB, the doctor
will determine a specific treatment plan. It may include blood transfusions if your
baby’s bleeding is severe.
The outlook is good for infants with early onset
or classic onset disease symptoms. However, late onset VKDB can be more
serious. It poses a higher risk of life-threatening intracranial bleeding. This
involves bleeding in the skull, which can cause brain damage or death.
To learn more about your baby’s specific diagnosis,
treatment options, and outlook, talk to your doctor.
hemorrhagic disease of the newborn
If you breast-feed your baby, talk to your
doctor about steps you can take to help them get enough vitamin K. According to
the American Academy of Pediatrics,
every newborn baby should receive an injection of vitamin K after delivery.
This is a preventive measure to help protect your baby from VKDB.