Hemorrhagic Disease of Newborn Clinical Presentation
- Author: Dharmendra J Nimavat, MD, FAAP; Chief Editor: Ted Rosenkrantz, MD more...
The maternal history is very important when assessing vitamin K deficiency bleeding (VKDB), especially the medications used during pregnancy, the presence of medical conditions such as short gut syndrome, and unusual dietary intakes.
Better surveillance during pregnancy and careful medical evaluation of neonate after delivery are essential.
Most newborn infants are healthy upon examination, even if early onset bleeding is present; however, intracranial hemorrhage can occur during the birthing process and can lead to severe complications.
Signs of intracranial hemorrhage include apnea with or without seizures and a shocklike syndrome.
Internal hemorrhage of organs other than the brain may be difficult to detect; however, if they are suspected, careful physical monitoring and serial imaging after birth are indicated.
Soft tissue hemorrhage is easier to recognize, but sequential measurements of the bleeding into soft tissues or muscle are mandatory.
Vitamin K deficiency in the newborn can be present for various reasons (see Pathophysiology).
Maternal medications that interfere with vitamin K stores or function (eg, carbamazepine, phenytoin, barbiturates, some cephalosporins, rifampin, isoniazid, warfarin or warfarinlike drugs) can result in vitamin K deficiency bleeding in the infant.
In addition to breastfeeding, clinical states that are risk factors for late-onset vitamin K deficiency bleeding include the following:
- Alpha1-antitrypin deficiency
- Intestinal bacterial overgrowth
- Chronic exposure to broad spectrum antimicrobials
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