Overview

Newborn Hemorrhagic Disease, currently referred to as Vitamin K Deficiency Bleeding (VKDB), is a bleeding disorder that occurs in neonates due to insufficient levels of vitamin K. Vitamin K is essential for the synthesis of clotting factors II, VII, IX, and X, as well as proteins C and S. A deficiency results in impaired blood coagulation and an increased risk of spontaneous bleeding.

Etiology

Newborns are predisposed to vitamin K deficiency because:

• Vitamin K poorly crosses the placenta.
• The neonatal liver is immature and synthesizes clotting factors inefficiently.
• The newborn gut lacks bacterial flora responsible for vitamin K production.
• Breast milk contains low levels of vitamin K compared to formula milk.

Classification

VKDB is classified into three types:

1. Early VKDB (within 24 hours of birth)
   • Often associated with maternal use of medications such as anticonvulsants, antitubercular drugs, or anticoagulants.
2. Classical VKDB (2–7 days of life)
   • Commonly presents with bleeding from the umbilical stump, gastrointestinal tract, skin, or circumcision site.
3. Late VKDB (2 weeks to 6 months)
   • Frequently occurs in exclusively breastfed infants who did not receive vitamin K prophylaxis.
   • Intracranial hemorrhage is a serious and potentially life-threatening complication.

Clinical Manifestations

• Bruising and petechiae
• Bleeding from injection or puncture sites
• Gastrointestinal bleeding (melena or hematemesis)
• Intracranial hemorrhage
• Prolonged bleeding time

Diagnosis

Diagnosis is based on clinical presentation and laboratory findings, including:

• Prolonged Prothrombin Time (PT)
• Normal platelet count
• Rapid correction of PT after vitamin K administration

Management

Immediate administration of vitamin K (usually 1 mg intramuscularly or intravenously) is the primary treatment. Severe cases may require fresh frozen plasma or blood transfusion.

Prevention

Routine prophylactic administration of intramuscular vitamin K at birth is the most effective preventive measure and is recommended worldwide.

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