PE19.7 | Hemorrhagic Disease of Newborn — Summary & Reflection

KEY TAKEAWAYS

Vitamin K Deficiency Bleeding (VKDB) — formerly 'haemorrhagic disease of the newborn' — results from deficiency of Vitamin K-dependent clotting factors (II, VII, IX, X). Neonates are physiologically deficient because of poor placental transfer, very low breast milk content (1–4 mcg/L), sterile gut (no bacterial K2 synthesis), and immature hepatic synthesis. Three forms: early VKDB (0–24h, maternal drugs — warfarin/anticonvulsants/anti-TB), classic VKDB (days 2–7, breastfed, no prophylaxis — umbilical/GI bleeding, infant well), late VKDB (2 weeks–6 months, breastfed + malabsorption/cholestatic liver disease — 30–60% present with intracranial haemorrhage). Laboratory pattern: prolonged PT + aPTT with normal platelet count and fibrinogen. Acute treatment: Vitamin K1 1 mg IV/IM + FFP for life-threatening bleeding. Prevention: Vitamin K1 1 mg IM at birth for all neonates (universal NIS; 0.5 mg if <1.5 kg). Exclusive breastfeeding is a risk factor; formula-fed infants are protected by fortified formula.

REFLECT

Reflect on the striking reality that a single preventable injection at birth can eliminate a condition that, without prophylaxis, causes intracranial haemorrhage in 30–60% of late VKDB cases. Think about the clinical situations in which Vitamin K prophylaxis might be missed in your context: home deliveries, early hospital discharge, low-resource settings, or parental refusal based on misinformation. How would you counsel a parent who has heard that 'Vitamin K injection causes cancer' and is refusing it? Reflect also on the diagnostic challenge: a well 7-week-old infant with seizures and no obvious trauma — would VKDB be in your differential, and what historical question (Was Vitamin K given?) would immediately re-stratify the risk? These reflections will sharpen your clinical instincts for a common, preventable condition.