eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Neonatology

Hemorrhagic Disease of Newborn: Follow-up

Author: Dharmendra J Nimavat, MD, FAAP, Assistant Professor of Clinical Pediatrics, Department of Pediatrics, Division of Neonatology, Southern Illinois University School of Medicine
Coauthor(s): Michael P Sherman, MD, Professor, Department of Child Health, University of Missouri-Columbia School of Medicine; Director, Fellowship Training Program in Neonatal-Perinatal Medicine, NICU, Columbia Regional Hospital; Professor Emeritus, Department of Pediatrics, University of California, Davis, School of Medicine
Contributor Information and Disclosures

Updated: Sep 14, 2009

Follow-up

Further Inpatient Care

  • In patients with vitamin K deficiency bleeding (VKDB), follow-up for continued bleeding after vitamin K administration is indicated because other causes may be present.
  • Hematocrit levels should be obtained serially and before discharge
  • Ensure neurologic complications are stable or resolved before discharge.
  • Mild vitamin K deficiency bleeding that has been treated successfully can be monitored on an outpatient basis.

Further Outpatient Care

  • Follow-up interval after discharge depends on the nature and severity of bleeding, the hematocrit at discharge, and any neurologic abnormalities that could recur.

Transfer

  • Infants with evidence of intracranial bleeding may require transfer to a level III nursery after stabilization with subcutaneous vitamin K and other aspects of supportive care.

Deterrence/Prevention

  • Intramuscular (IM) vitamin K prophylaxis at birth is the standard of care in the United States.
  • Commercial infant formulas in the United States contain supplemental vitamin K.
  • These measures have served to make vitamin K deficiency bleeding a rarity in the United States. However, parental refusal of prophylaxis and an increasing frequency of breastfeeding may cause a resurgence of vitamin K deficiency bleeding in developed countries.24

Complications

  • Intracranial hemorrhage is the primary serious complication of vitamin K deficiency bleeding.
  • Complications of treatment include anaphylactoidlike reactions during intravenous (IV) vitamin K administration, hyperbilirubinemia or hemolytic anemia after high doses of vitamin K, and hematomas at the site of injection, if administered IM.

Prognosis

  • In the absence of intracranial hemorrhage, the prognosis for vitamin K deficiency bleeding in an otherwise healthy infant is excellent.
  • Prognosis after intracranial hemorrhage depends on the extent and location of the hemorrhage.
  • Long-term sequelae of intracranial hemorrhage may include motor and intellectual deficits.

Patient Education

The following are useful links to various governments and educational organizations:

Miscellaneous

Medicolegal Pitfalls

  • Most hospital nurseries include vitamin K administration in standing admission orders.
  • A newborn's hospital chart should have a specific place for documentation of dose and administration.
  • Failure to provide vitamin K at birth and subsequent bleeding presents a legal liability for physicians and hospitals.
  • If parents refuse prophylaxis, document the discussion of the risks and benefits along with the parents' refusal in the medical record of the infant.

Special Concerns

  • Many Web sites have information that oppose vitamin K prophylaxis for newborn infants. Misinformation is related to an increased risk of cancer, toxicity from additives, and even an increased risk of autism. Many parents do not have balanced information regarding the benefits of vitamin K versus the limited risk of side effects. Prenatal and intrapartum education should cover the subject. The education should address the negative claims about vitamin K on the Internet and discuss scientific studies that show the claims cannot be substantiated. The benefits of vitamin K should be emphasized.
  • Please see the Web sites provided in Patient Education for more information regarding vitamin K.
 
Acknowledgments

The authors appreciate the review of this article and helpful suggestions for improvement from Professor Daniel Batton, the Director of the Neonatology Division at Southern Illinois University School of Medicine.



More on Hemorrhagic Disease of Newborn

Overview: Hemorrhagic Disease of Newborn
Differential Diagnoses & Workup: Hemorrhagic Disease of Newborn
Treatment & Medication: Hemorrhagic Disease of Newborn
Follow-up: Hemorrhagic Disease of Newborn
Multimedia: Hemorrhagic Disease of Newborn
References
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References

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Further Reading

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Keywords

hemorrhagic disease of newborn, HDN, vitamin K deficiency bleeding, VKDB, early-onset VKDB, classic VKDB coagulopathy, late-onset VKDB, GI neonatal bleeding, intracranial hemorrhage, ICH, umbilical cord bleeding, leukemia, cholestasis, intracranial hemorrhage, apnea, seizures, diarrhea, hepatitis, cystic fibrosis, celiac disease, short bowel syndrome, intestinal bacterial overgrowth, treatment, diagnosis

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Contributor Information and Disclosures

Author

Dharmendra J Nimavat, MD, FAAP, Assistant Professor of Clinical Pediatrics, Department of Pediatrics, Division of Neonatology, Southern Illinois University School of Medicine
Dharmendra J Nimavat, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics and American Association of Physicians of Indian Origin
Disclosure: Nothing to disclose.

Coauthor(s)

Michael P Sherman, MD, Professor, Department of Child Health, University of Missouri-Columbia School of Medicine; Director, Fellowship Training Program in Neonatal-Perinatal Medicine, NICU, Columbia Regional Hospital; Professor Emeritus, Department of Pediatrics, University of California, Davis, School of Medicine
Michael P Sherman, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, European Society for Paediatric Research, Perinatal Research Society, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Medical Editor

Oussama Itani, MD, FAAP, FACN, Clinical Associate Professor of Pediatrics and Human Development, Michigan State University; Medical Director, Department of Neonatology, Borgess Medical Center
Oussama Itani, MD, FAAP, FACN is a member of the following medical societies: American Academy of Pediatrics, American College of Nutrition, American College of Physician Executives, and American Heart Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

David A Clark, MD, Chairman, Professor, Department of Pediatrics, Albany Medical College
David A Clark, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Pediatric Society, Christian Medical & Dental Society, Medical Society of the State of New York, New York Academy of Sciences, and Society for Pediatric Research
Disclosure: Nothing to disclose.

CME Editor

Carol L Wagner, MD, Professor of Pediatrics, Medical University of South Carolina
Carol L Wagner, MD is a member of the following medical societies: American Academy of Pediatrics, American Chemical Society, American Medical Women's Association, American Public Health Association, American Society for Bone and Mineral Research, American Society for Clinical Nutrition, Massachusetts Medical Society, National Perinatal Association, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Chief Editor

Ted Rosenkrantz, MD, Professor, Departments of Pediatrics and Obstetrics/Gynecology, Division of Neonatal-Perinatal Medicine, University of Connecticut School of Medicine
Ted Rosenkrantz, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Pediatric Society, Connecticut State Medical Society, Eastern Society for Pediatric Research, and Society for Pediatric Research
Disclosure: Nothing to disclose.

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