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Hemorrhagic disease of the newborn is a life-threatening condition that is due to insufficient vitamin K levels in newborns as a result of various causes. Proper management of the disease can help reduce disease incidence. This activity outlines the evaluation and treatment of hemorrhagic disease of the newborn and explains the role of the interprofessional team in managing patients with this condition.
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- Neonatal hemorrhagic disease is often due to vitamin K deficiency. Other causes include defective coagulation, hepatic issues, and hereditary bleeding disorders. Assessment includes gestational age, family history, maternal history (SLE, ITP, infections, medications), and bleeding site (mucocutaneous vs. deep).
- Vital signs assessment (heart rate, respiration, color) helps determine if the baby is well or sick. In well babies with hemorrhage, consider birth trauma, swallowed maternal blood, vitamin K deficiency, maternal drug intake, autoimmune issues, and localized vascular disorders. In sick babies, consider infection, asphyxia, DIC, and thrombosis.
- Initial screening tests include a complete blood count (CBC) with differential, platelet count, peripheral smear examination, prothrombin time (PT), and partial thromboplastin time (PTT). In well babies with hemorrhage, if platelet count is normal but PT and PTT are increased, vitamin K deficiency is likely.
- Vitamin K is essential for synthesizing coagulation factors II, VII, IX, and X. The term "vitamin K deficiency bleeding" (VKDB) is sometimes preferred over "hemorrhagic disease of the newborn" (HDN) as HDN encompasses more causes.
- Classical HDN occurs on days 2-7, typically in breastfed infants due to low vitamin K in breast milk and inadequate synthesis. Early HDN presents within 24 hours of birth due to maternal medication interfering with vitamin K metabolism (anticoagulants, anticonvulsants). Late HDN occurs beyond the first week (3-8 weeks) due to inadequate synthesis, liver disease, malabsorption, or antibiotic therapy.
- Diagnosis of classical HDN is primarily clinical, based on bleeding in an otherwise healthy newborn and abnormal coagulation profiles. Elevated PIVKA-II (protein induced by vitamin K absence) levels may confirm early and late HDN, but vitamin K levels are less reliable.
- Management involves a single dose of IV or subcutaneous vitamin K (1-2 mg). IM injection is avoided due to hematoma risk. Severe bleeding may require repeated doses, fresh frozen plasma, or prothrombin complex concentrate. Late HDN may necessitate regular vitamin K supplements.
- Preventive measures include prophylactic administration of intramuscular vitamin K (1-2 mg) at birth. Oral vitamin K prophylaxis is less effective against late HDN. Pregnant mothers on oral anticonvulsants should receive vitamin K supplements (10-20 mg) for 15-30 days before delivery. Weekly vitamin K is advised for babies on broad-spectrum antibiotics, total parenteral nutrition, or those with cholestasis, chronic diarrhea, or malabsorption.
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