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Hemorrhagic Disease of Newborn Follow-up

  • Author: Dharmendra J Nimavat, MD, FAAP; Chief Editor: Ted Rosenkrantz, MD  more...
Updated: Jan 02, 2016

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.


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.



Intramuscular (IM) vitamin K prophylaxis at birth is the standard of care in the United States.[21]

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.[21, 33]



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.



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.

Contributor Information and Disclosures

Dharmendra J Nimavat, MD, FAAP Associate 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, American Association of Physicians of Indian Origin

Disclosure: Nothing to disclose.


Michael P Sherman, MD, FAAP Professor, Department of Child Health, University of Missouri-Columbia School of Medicine; Neonatologist, Women’s and Children’s Hospital; Professor Emeritus, Department of Pediatrics, University of California, Davis, School of Medicine

Michael P Sherman, MD, FAAP is a member of the following medical societies: American Pediatric Society, American Society for Microbiology, American Thoracic Society, Pediatric Infectious Diseases Society, American Association for the Advancement of Science, European Society for Paediatric Research, Western Society for Pediatric Research, Perinatal Research Society, American Academy of Pediatrics, American Association of Immunologists, Society for Pediatric Research

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

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 and Dental Associations, Medical Society of the State of New York, New York Academy of Sciences, 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 Pediatric Society, Eastern Society for Pediatric Research, American Medical Association, Connecticut State Medical Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

Additional Contributors

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 Association for Physician Leadership, American Heart Association, American College of Nutrition

Disclosure: Nothing to disclose.


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.

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Vitamin K cycle.
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