First described by Charles Townsend in 1894, (1) hemorrhagic disease of newborns (HDN HDN Hemolytic disease of the newborn, see there ) is undoubtedly linked to vitamin K deficiencyVitamin K Deficiency Definition
Vitamin K deficiency exists when chronic failure to eat sufficient amounts of vitamin K results in a tendency for spontaneous bleeding or in prolonged and excessive bleeding with trauma or injury. ..... and can cause bleeding in infants in the first few weeks of life. It is one of the causes of acquired hemostatic hemostatic /he·mo·stat·ic/ (he?mo-stat´ik)1. causing hemostasis, or an agent that so acts.
2. due to or characterized by stasis of the blood.
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he·mo·stat·icadj. disorder in early infancy. Vitamin K is a cofactor cofactor
An atom, organic molecule, or molecular group that is necessary for the catalytic activity (see catalysis) of many enzymes. A cofactor may be tightly bound to the protein portion of an enzyme and thus be an integral part of its functional structure, or it may for the hepatic carboxylationcarboxylation /car·box·y·la·tion/ (kahr-bok?si-la´shun) the addition of carbon dioxide or bicarbonate to form a carboxyl group, as to pyruvate to form oxaloacetate. --------------------------------------------------------------------------------
car·box·yl·a·tionn. ..... . of glutamic acid residues in a number of proteins, including the procoagulantprocoagulant /pro·co·ag·u·lant/ (-ko-ag´ul-int)1. tending to promote coagulation.
2. a precursor of a natural substance necessary to coagulation of the blood. factors II, VII, IX and X.
Vitamin K is transmitted poorly across the placental barrier, and at birth, vitamin K levels are often below the detection limit of 0.02 ng/mL. The clotting system of the newborn is essentially intact except for a deficiency in vitamin K dependent clotting factors. Failure to provide vitamin K at birth poses a risk for the development of hemorrhagic HemorrhagicA condition resulting in massive, difficult-to-control bleeding.
Mentioned in: Hantavirus Infections
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hemorrhagic
pertaining to or characterized by hemorrhage. disease in the neonatal period. HDN is exceedingly rare in the United States because of the routine administration of prophylactic vitamin K shortly after birth.
HDN is classically defined as early or late, depending on the time of onset related to birth. The classic form of HDN usually presents on days 2 to 7 of life in healthy, breastfed, full-term infants. The common bleeding sites are gastrointestinal, cutaneous cutaneous /cu·ta·ne·ous/ (ku-ta´ne-us) pertaining to the skin. --------------------------------------------------------------------------------
cu·ta·ne·ousadj.Of, relating to, or affecting the skin.
--------------------------------------------------------------------------------CutaneousPertaining to the skin. , nasal and from the site of circumcision. Late HDN presents between weeks 2 and 12 of life, and is related to conditions that interfere with the vitamin K supply. It may present with intracranial hemorrhage. This form of vitamin K deficiency is mainly due to inadequate vitamin K intake in exclusively breastfed infants. Late hemorrhagic disease of the newbornhemorrhagic disease of the newborn A neonatal condition caused by vitamin K deficiency, the combined result of a lack of unbound maternal vitamin K, immaturity of the fetal liver and lack of vitamin K-producing bacteria in the infant colon Clinical Abrupt early . rarely occurs in formula-fed infants because of formula supplementation with vitamin K (approximately 4-100 [micro]g/L).
HDN is still an important cause of mortality and morbidity in developing countries where vitamin K prophylaxis is not routinely practiced. Studies from these countries showed a higher incidence of late onset vitamin K deficiency bleeding.
(2) Since hemorrhagic disease of the newborn can lead to significant morbidity and mortalityMorbidity and Mortality can refer to: Morbidity & Mortality, a term used in medicine Morbidity and Mortality Weekly Report, a medical publication See also
Morbidity, a medical term Mortality, a medical term
., it should be prevented by providing vitamin K prophylaxis to all newborns.
Does vitamin K prophylaxis prevent HDN? The answer is yes, and the data in this country support the efficacy of neonatal vitamin K prophylaxis for the prevention of HDN. The American Academy of PediatricsThe American Academy of Pediatrics ("AAP") is an organization of pediatricians, physicians trained to deal with the medical care of infants, children, and adolescents. Its motto is: "Dedicated to the Health of All Children.recommends vitamin [K.sub.1] prophylaxis to all newborns as a single, IM dose of 0.5 to 1 mg.
(3) A single IM injection of vitamin K, designed to prevent early vitamin K deficiency bleeding, may protect against late deficiency bleeding,
(4) but this has not been tested in randomizedran·dom·ize tr.v. ran·dom·ized, ran·dom·iz·ing, ran·dom·iz·esTo make random in arrangement, especially in order to control the variables in an experiment.trials with respect to its effect on late HDN.
(5) However, one study showed a significant decline in the incidence of the late form of vitamin K deficiency bleeding.
(6) In this issue of the Southern Medical Journal, a review of two infants with intracranial hemorrhage due to hemorrhagic disease of the newborn is presented. Both were secondary to failure of vitamin K administration at birth. The infants in this report were born at home, did not receive vitamin K prophylaxis and developed intracranial hemorrhage at five weeks of age. The author concluded that late onset hemorrhagic disease of the newborn might occur when prophylactic vitamin K is not administered at birth and can have serious and even devastating consequences. This article emphasizes the association between failure of administration of vitamin K and risk of development of hemorrhagic disease of the newborn. In conclusion, HDN, although uncommon, does still occur and has the potential for severe consequences. Therefore, vitamin K prophylaxis at birth is a priority and should be provided to all newborns to prevent HDN and its associated complications, including intracranial hemorrhage.
